A different kind of anchor: An alternative to the distal anchoring technique




We read with interest the case report by Fiocca, et al., on how to perform distal anchoring technique by 6 French radial approach in complex coronary procedures . Complex anatomy continues to challenge the interventionist performing percutaneous coronary intervention (PCI). If one cannot deliver stents to the target lesion, procedural success is impossible and failure can result in increased morbidity . Techniques to improve stent delivery have included the mother–daughter technique as well as the anchoring balloon technique . We described a variant of the anchoring balloon technique with utilization of the prodigy balloon . Unlike with classic anchoring balloon techniques where a small balloon may be inflated in a side branch, we developed a very compliant elastomeric balloon that can be inflated usually at the origin of the vessel to allow firm guiding catheter placement without guiding catheter trauma. We have been successful in utilizing this technique in coronary and other complex interventions (11). Fiocca, et al., reported utilizing an anchoring balloon technique passing the anchoring balloon in the distal portion of the vessel utilizing a 6 French radial approach. (See Figs. 1–18 .)




Fig. 1


A 55 year old veteran was found to have a total occlusion of his right coronary artery and an EF of about 35%. He is at least 100 lb overweight and imaging is compromised and there are no significant decent LAD collaterals for the distal right coronary artery. This angiogram shows the RCA occlusion with an 8F JR4 guide.



Fig. 2


As we approached this CTO, we feel having an over the wire catheter or balloon in place aids with the use of the CrossLock™. This allows us to move wires in and out and exchange as necessary without removing the CrossLock™. It also allows us to maintain inflation of the CrossLock™ balloon. We first utilized a Miracle 3 wire. The support of the CrossLock™ allowed us to cross the proximal portion of the CTO. With the FineCross and CrossLock™ in place, we exchanged for a Gaia 1 wire.



Fig. 3


The Gaia 1 wire subtended the CTO.



Fig. 4


The guiding catheter CrossLock™ combination allows us to easily manipulate the wire into the distal right coronary artery. Notice the support and ability to inject even with the CrossLock™ balloon inflated because of the monorail aspect of the device.



Fig. 5


Deployment of a 38 mm 3.5 stent with the CrossLock™ inflated.



Fig. 6


The distal vessel still has a large area of plaque. With the CrossLock™ inflated, it was easy to cross the previously placed stent.



Fig. 7


With the CrossLock™ in place, the distal stent was easily placed with good support.



Fig. 8


Final results.

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Nov 13, 2017 | Posted by in CARDIOLOGY | Comments Off on A different kind of anchor: An alternative to the distal anchoring technique

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