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

You Zhou,&ast; Lixiang Deng,&ast; Zhe Wang,&ast; Yiqing Hu, Zhangwei Chen, Hao Lu, Juying Qian, Junbo Ge Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University; National Clinical Research Center for Interventional Medicine; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, 200032, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hao Lu, Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University; National Clinical Research Center for Interventional Medicine; Shanghai Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China, Tel +86-21-64041990, Email lu.hao@zs-hospital.sh.cn Juying Qian, Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University; National Clinical Research Center for Interventional Medicine; Shanghai Clinical Research Center for Interventional Medicine, 1609 Xietu Road, Shanghai, 200032, People’s Republic of China, Tel +86-21-64041990 ext 2728, Email qian.juying@zs-hospital.sh.cnBackground: 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