Successful Combination of the Slipstream and the Tip Detection-Antegrade Dissection and Re-Entry Techniques for Chronic Total Occlusion.

ABSTRACT:

Objective

We describe combining the slipstream technique with the tip detection-antegrade dissection and re-entry (TD-ADR) technique using AnteOwl intravascular ultrasound (IVUS) for challenging calcified chronic total occlusion lesions when conventional IVUS-guided approaches fail.

Key steps

The procedure included the following steps. 1) Confirm on IVUS that the first guidewire is in the subintimal space. 2) Re-insert the AnteOwl IVUS using the first wire lumen only. 3) Advance a Sasuke double-lumen catheter over the same wire to the IVUS tip. 4) Introduce a second guidewire (Conquest Pro 12 Sharpened Tip with 15° bend) through the second wire port. 5) Perform TD-ADR under IVUS guidance to achieve true lumen re-entry.

Potential pitfalls

IVUS cannot directly visualize

SUBMITTER: Yoshinaga M 

PROVIDER: S-EPMC12790251 | biostudies-literature | 2025 Nov

REPOSITORIES: biostudies-literature