Efficiency of the Guide Extension Catheter-Facilitated Tip-in Technique in the Recanalization of Coronary Chronic Total Occlusion

Abstract

Background

The tip-in technique, which involves advancing an antegrade microcatheter cross the lesion over a retrograde guidewire, is an elaborated maneuver in the recanalization of coronary chronic total occlusion (CTO). We seek to assess the efficiency of a guide extension catheter-facilitated tip-in technique in comparison to the traditional retrograde approach, which is accomplished by an externalization wire.

Methods

Thirty-three CTO patients successfully revascularized using guide extension catheter-facilitated “tip-in” were included and matched with another 33 patients by J-CTO score and operators, whose CTO was recanalized using an externalized wire. The manipulation time from the first retrograde wire entering the antegrade guide to the first antegrade balloon inflation in the occlusion was calculated.

Results

Compared with the wire-externalization group, the manipulation time in the tip-in group was significantly shortened [389s; interquartile range (IQR), 272–478 vs 706s; IQR, 560–914; p < 0.001]. There was a trend in decreasing total operation time and radiation dose, but it did not reach statistical significance.

Conclusion

Guide extension catheter-facilitated tip-in is an efficient method to achieve the recanalization of CTO in a retrograde way, which would be pivotal when the retrograde microcatheter could not be advanced into the antegrade guide catheter.

Keywords:

• chronic total occlusion
• extension guide catheter
• tip-in
• retrograde

Data Sharing Statement

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Ethics Approvement

This study was approved by the Ethics Committee of Zhongshan Hospital, Fudan University (No.: B2021-726R) and conducted in accordance with the guidelines of the Declaration of Helsinki. All participants provided written informed consent at the time of index hospitalization.

Author Contributions

Hao Lu and Juying Qian are corresponding authors. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

There are no conflicts of interest pertaining to this submission.

Additional information

Funding

There is no funding to report.