C-53 | Innovative Traction Balloon Technique with a Non-Compliant Balloon for Guide Extension Negotiation in Complex Coronary Interventions

Tortuosity and calcifications lead to difficult device delivery during coronary angioplasty . Guide extensions (GE) enhance the guide support. Its deep insertion may be difficult with recent methods. Here, we present the efficacy and success of a Traction Balloon Technique (TBT) for it. Patients, in whom methods as supportive guide, stiff wire, buddy wire, anchor wire/ balloon etc. and current methods of GE insertion have partially/ fully failed; were subjected to GE assisted angioplasy with TBT and studied prospectively. In contrast to conventional anchor balloon technique, in which, balloon is static and GE is pushed; we allowed GE to track passively with an active traction on a large non-compliant (NC) anchor balloon inflated distally. Traction was exerted at hub with a forceps in right hand of an operator. Y adapter was kept open. An outward traction on a guide was maintained at the hub of a balloon with left hand of the operator. History; indication; lesion and procedural details were noted. Total 32 vessels of 31 patients of 62.5 ± 12.0 years, underwent GE assisted PCI for acute coronary syndrome (n=27) and effort angina (n=5) from radial (n=29) or femoral (n=3) route. There were in-stent restenosis in one, coronary anomalies in two and prior bypass surgety in two. GE was inserted for 2 (1-4) times/ vessel up to maximum depth of 53.7 ± 19.1 mm with use of NC balloons of 2.7 ± 0.3 mm diameter and 11.6 ± 2.6 mm length as anchors with a balloon: artery diameter ratio of 0.96 ± 0.08 for balloon delivery for pre-dilatation (n=8), stent delivery (n=32) including delivery beyond proximal stent (n=6), delivery of NC balloon for postdilatation (n=19), alignment of guiding (n=7) or selective contrast injection (n=3). Total 50 stents of 3.04 ± 0.5 mm diameter and 33.3 ± 12.5 mm length were deployed in lesions with 90.8 ± 7.3% stenosis; 51.06 ± 20.9 mm length; AHA type C (n=32); SCAI type 2 (n=22) or 4 (n=10); tortuosity score 2 (1-3); calcification grade 3 (1-4) within 36.1 ± 15.9 minutes. Procedural success was 100% with no complications. All are doing well at 7 (1-38) months. TBT for GE insertion is a reasonable alternative to other methods for device delivery in coronary complexities with no major complications.