Case 288: Manual of CTO PCI - The bridge

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A patient with an OM1 CTO with a tortuous bridging collateral was referred for CTO PCI after 2 prior failed attempts. Antegrade crossing was unsuccessful despite using multiple polymer-jacketed guidewires and a Gaia Next 2. We attempted to do the BASE technique (balloon-assisted subintimal entry) but were not successful. After multiple attempts we crossed retrogradely to the OM1 from an epicardial collateral originating from the first diagonal with a Suoh 03 wire through a Caravel microcatheter but the Caravel could not cross the collateral. Contrast injection showed extravasation at the proximal cap likely due to disruption of the bridging collateral. A 2nd 6 Fr EBU 3.75 guide catheter was used to advance an antegrade balloon and stop flow to the circumflex. A FineCross M3 was delivered retrogradely to the distal cap, followed by successful guide extension reverse CART. A R350 could not be externalized, hence the tip in technique was done, followed by antegrade wiring and stenting with an excellent final result.


Excellent article on “tip in” and other portal techniques by Claudiu Ungureanu: https://pmc.ncbi.nlm.nih.gov/articles/PMC11694543/
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Cardiology
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