Telescoping catheter technique in percutaneous coronary intervention. How would I approach it?

Abstract

HOW WOULD I APPROACH IT? The authors present an interesting and challenging case regarding percutaneous treatment, and with a very complex resolution. This is the case of a patient already surgically revascularized with significant ischemia whose revascularization option is through the bypass on which the entire territory of the left circumflex artery depends on. At this point right now of the angioplasty where the stent cannot be crossed despite the use of the buddy-wire technique, and even though the stent was very short and had good navigability, I would try the following staged maneuvers: 1) Try to advance a high-support guidewire a little more distal inside the native vessel taking advantage of the native artery good distal bed so that the guidewire section with the highest support of all is placed on the curve zone. If possible, I would even bend the tip to avoid damaging the artery aware that the push forward maneuvers we’ll be performing can uncontrollably displace the guidewire at any time. 2) Benefit from the balloon already crossed and the lesion already dilated to redilate the lesion with the balloon using the anchorage technique with the balloon to move the guide extension catheter forward, cross the curve, and eventually reach...