Successful Management of Coronary Guidewire Fracture Using Intravascular Ultrasound—Guided Stent Jailing Technique During Retrograde Chronic Total Occlusion Recanalization

Figures

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  FIGURE 1. Coronary computed tomography angiography revealed calcification at the entry of occlusion and the length of the occlusion > 20 mm (a). Coronary angiography showed complete occlusion of the right coronary artery with a blunt entry, bending > 45° (b). The left anterior descending artery and left circumflex artery supplied tortuous and poorly developed collateral branches to the right coronary artery (c).

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  FIGURE 2. The Sion guidewire could not be advanced through the collateral branch to the distal RCA (a). The selective injection revealed extreme tortuosity of the septal collateral (b). The Suoh 03 guidewire passed through the tortuous channel with an acute angle (c). The Fielder XT‐A guidewire could not be advanced through the occlusion under the support of the microcatheter (d). The UB3 guidewire successfully reached the proximal RCA through the collateral branch (e). During the intervention, the UB3 guidewire might have fractured in the microcatheter because we found no feedback from the tip when we tried to rotate to adjust its direction (f). The tip of the retrieved retrograde guidewire was clean without the sign of unraveling (g).

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  FIGURE 3. The antegrade Gaia 2 guidewire passed through the occlusion, but it failed to rendezvous with the retrograde guidewire (a). The Fielder XT‐A guidewire was again attempted to pass through the occlusion and rendezvoused well with the retrograde guidewire (b). A 2.0 mm balloon was progressively delivered and dilated from the distal to the proximal of the occlusion (c).

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  FIGURE 4. IVUS was performed to locate the exact position and assess the tip of the fractured remnant (a). Another Fielder XT‐R guidewire was advanced within the retrograde microcatheter to push the fractured remnant into the true lumen for aortic sinus snaring (b). The microcatheter was retracted with negative pressure (c). The fractured guidewire can only be partially retracted during microcatheter withdrawal (d: before retraction, e: after retraction). The guidewire remnant was left in situ (f).

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  FIGURE 5. Post procedure angiographic images of the RCA (a). No damage to collateral branch was observed (b).