OTW Balloon-Facilitated Antegrade True Lumen Puncture (OFATP): A Novel Simplified Technique for Chronic Total Occlusion Recanalization-: A Case Report

Background Achieving precise guidewire puncture into the intraplaque entry point remains a key challenge in antegrade chronic total occlusion (CTO) intervention, as not all lesions have a side branch adjacent to the entry point for real-time intravascular ultrasound guidance. This difficulty is a major contributor to subsequent hematoma expansion, intervention failure, and even complications. Case summary A 48-year-old man was admitted for heart failure with mildly reduced ejection fraction. Coronary angiography revealed two-vessel disease: two-segment severe stenosis of right coronary artery (RCA) stenosis and a CTO of the proximal left anterior descending (LAD) artery. The patient declined coronary artery bypass grafting and consented to percutaneous coronary intervention. A staged approach was adopted, with RCA intervention performed first, followed by readmission for elective LAD intervention. During LAD intervention, over-the-wire balloon–assisted guidewire puncture enabled efficient antegrade guidewire crossing of the occluded segment into the distal true lumen. The patient was asymptomatic and discharged on postoperative 2 days later. Discussion This case highlights the potential utility of OTW balloon-facilitated antegrade true lumen puncture (OFATP) as an interventional technique in the antegrade approach.