The Combination of the Slipstream and the TD‐ADR Techniques: An Effective and Safe Strategy for Precision Recanalization of Complex Chronic Total Occlusions

BACKGROUND: We aimed to evaluate the efficacy and safety of the combination of the Slipstream technique and the tip detection-antegrade dissection and re-entry (TD-ADR) technique in the treatment of complex CTO lesions. METHODS: Forty-seven consecutive patients with long CTO lesion (>20 mm) between June 2024 and March 2025 were enrolled. The main steps of the procedure included: (1) for a CTO characterized by an ambiguous proximal cap and the presence of an applicable side branch originating proximal to the occlusion, the Slipstream technique was used to identify the precise entry point of the CTO lesion and guide the puncture into the CTO proximal cap. (2) Once the stiff guidewire went into the subintimal space during the advancement, IVUS was advanced along the guidewire to confirm the entry point of the subintimal space. (3) Advanced a dual-lumen microcatheter over the same guidewire and introduced another stiffer wire via the second wire port to puncture the entry point, and tried to re-enter the true lumen. RESULTS: In this study, 17 (36.2%) cases were stumpless, and the left anterior descending artery (LAD) was the most frequent CTO target vessel (55.3%). The entry point into the subintimal space was identified by IVUS in all 47 cases, the combination of the Slipstream and TD-ADR techniques was succeeded in 42 cases. Fourty five CTO cases were finally successfully recanalized (95.7%) with no serious procedure-related complication. CONCLUSION: The combination of the Slipstream and the TD-ADR techniques is feasible and safe for the recanalization of complex CTO lesions.