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Tips of the dual-lumen microcatheter-facilitated reverse wire technique in percutaneous coronary interventions for markedly angulated bifurcated lesions Metabolic Interactions and Differences between Coronary Heart Disease and Diabetes Mellitus: A Pilot Study on Biomarker Determination and Pathogenesis A Randomized Trial Evaluating Online 3-Dimensional Optical Frequency Domain Imaging-Guided Percutaneous Coronary Intervention in Bifurcation Lesions Clinical Outcomes Following Coronary Bifurcation PCI Techniques: A Systematic Review and Network Meta-Analysis Comprising 5,711 Patients Long-term outcomes of routine versus provisional T-stenting for de novo coronary bifurcation lesions: five-year results of the Bifurcations Bad Krozingen I study Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British Bifurcation Coronary Study: old, new, and evolving strategies Bench testing and coronary artery bifurcations: a consensus document from the European Bifurcation Club Clinical Outcome of Double Kissing Crush Versus Provisional Stenting of Coronary Artery Bifurcation Lesions: The 5-Year Follow-Up Results From a Randomized and Multicenter DKCRUSH-II Study (Randomized Study on Double Kissing Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions) Incidence of Adverse Events at 3 Months Versus at 12 Months After Dual Antiplatelet Therapy Cessation in Patients Treated With Thin Stents With Unprotected Left Main or Coronary Bifurcations Comparison of intravascular ultrasound-guided with angiography-guided double kissing crush stenting for patients with complex coronary bifurcation lesions: rationale and design of a prospective, randomized and multicenter DKCRUSH VIII trial

Clinical Case Study2019 Dec 20[Online ahead of print]

JOURNAL:Catheter Cardiovasc Interv. Article Link

Streamlined reverse wire technique for the treatment of complex bifurcated lesions

K Hasegawa, Wataru Yamamoto, S Nakabayashi et al. Keywords: POT; bifurcation; left main; myocardial infarction; wall shear stress

ABSTRACT


Inserting a guidewire into an extremely angulated side branch (SB) is difficult. Reverse wire technique (RWT) method was developed to specifically overcome this challenging situation, and it has become common among operators performing percutaneous coronary intervention. The first step of RWT involves the delivery of a reverse wire (RW) beyond the bifurcation, together with dual lumen catheter (DLC). This step is sometimes difficult, due to the stenosis proximal to bifurcation. Balloon dilatation of the stenosis is sometimes required to make space for the RW passage, but this lesion modification involves a potential risk of vessel damage, plaque shift, or carina shift, which results in the occlusion of the target SB. Streamlined RWT is a novel method we developed to facilitate RW delivery. It consists of the following three steps: (a) Advancing a DLC alone beyond the occlusion and inserting a preshaped RW into a non-target SB distal to the bifurcation. (b) Adjusting the position of the bending part of RW and the exit port of DLC together at the ostium of the non-target SB. (c) Advancing the RW and DLC simultaneously, while holding them both together. All procedures subsequent to the delivery of RW are the same as those required in conventional RWT. This technique enables us to deliver a RW through severe stenosis without the risk of either vessel injury or the occlusion of target SB. It also helps us to save time and effort in accomplishing SB access, even during the treatment of complex bifurcated lesions.