|
Anchor-Tornus technique |
Combined use of the Tornus microcatheter and side-branch anchoring to cross a balloon-uncrossable CTO. |
277 |
|
|
Antegrade balloon puncture |
Variation of the reverse CART technique: the antegrade balloon remains inflated during retrograde crossing attempts and is punctured by the retrograde wire, which is then advanced while the antegrade balloon is retracted under fluoroscopy (the latter technique is also called the transit balloon technique). |
229 |
|
|
Antegrade microcatheter probing |
After retrograde guidewire crossing the retrograde microcatheter is advanced into the antegrade guide catheter, followed by the removal of the retrograde guidewire and intubation of the microcatheter with an antegrade wire. |
240 |
|
|
Back bleeding sign |
Blood coming out of the microcatheter after aspirating for at least 30 s (after guidewire withdrawal): it suggests (but does not prove) distal true lumen position. |
384 |
416 |
BAM |
Balloon-assisted microdissection (also called grenadoplasty) |
Technique for crossing balloon-uncrossable lesions: a small (1.20–1.50 mm in diameter) balloon is advanced into the lesion as far as possible and inflated to high pressure until it ruptures. Balloon rupture can modify the proximal cap and facilitate crossing with another balloon. |
269 |
|
BASE |
Balloon-Assisted Subintimal Entry |
One of the “move-the-cap” techniques used in cases of proximal cap ambiguity: a slightly oversized balloon is inflated proximal to the CTO, to create a dissection, through which a knuckled guidewire is advanced subintimally around the proximal cap. |
295 |
|
BAT |
Balloon-Assisted Tracking technique |
Technique for advancing catheters through tortuous radial arteries: a balloon is advanced halfway in and halfway out the tip of the guide catheter and inflated. The guide/inflated balloon assembly is then advanced through the area of tortuosity. The BAT technique can also be used for sheathless insertion of guide catheters. |
24 |
|
|
Block and deliver |
Technique for managing coronary perforations. A balloon is advanced proximal to or at the site of perforation and inflated to prevent continued bleeding into the pericardium. A covered stent or a microcatheter (for coil delivery) is advanced proximal to this blocking balloon. The blocking balloon is transiently deflated, followed by advancement of the covered stent or microcatheter for sealing the perforation. Coil delivery is done while the blocking balloon is inflated, minimizing bleeding into the pericardium. A large (8 Fr) guide catheter is needed for delivering covered stents, whereas smaller guide catheters suffice for delivering coils. |
396, 403 |
|
|
Bobsled |
Bobsled refers to changing the location of reentry attempts during antegrade dissection and reentry, using the Stingray balloon. Reentry is usually attempted at a healthier, straighter, and larger vessel segment. |
189 |
191, 332 |
|
Bridge or rendezvous |
Technique for inserting an antegrade wire through a CTO after successful retrograde crossing. After retrograde guidewire crossing the retrograde microcatheter is inserted into the antegrade guide catheter and aligned with an antegrade microcatheter, followed by insertion of an antegrade guidewire into the retrograde microcatheter. |
240 |
|
|
Buddy wire stent anchor |
Technique for increasing guide catheter support that can be used if the proximal vessel needs stenting: a buddy wire can be inserted and a stent deployed over the original guidewire, effectively trapping the buddy wire, which then provides strong guide catheter support. |
133 |
131, 273 |
|
Confluent balloon |
Variation of the CART technique in which both antegrade and retrograde balloons are inflated simultaneously in a kissing fashion to cause the subintimal space to become confluent, allowing wire passage through the CTO. |
228 |
230 |
CART |
Controlled Antegrade and Retrograde Tracking and dissection |
Technique for reentry into the true lumen after subintimal CTO crossing during the retrograde approach: a balloon is inflated over the retrograde guidewire creating a space into which an antegrade guidewire is advanced. |
221–222 |
|
Contemporary reverse CART |
Contemporary reverse Controlled Antegrade and Retrograde Tracking and dissection |
Variation of reverse CART technique: a small (2.0–2.5 mm) antegrade balloon is used to facilitate crossing of the retrograde guidewire into the antegrade true lumen. Using a small balloon (instead of a larger one as is done in the standard reverse CART technique) minimizes the size of dissection and vessel injury. |
229 |
220 |
Contrast-guided STAR |
Contrast-guided Subintimal Tracking And Reentry; also called Carlino technique |
Variation of the STAR technique in which contrast is injected through a microcatheter inserted into the proximal cap or within the subintimal space to create/visualize a dissection plane, thus facilitating guidewire advancement. |
162 |
161, 193 |
|
Deflecting balloon or blocking-balloon technique |
Technique for facilitating crossing when there is a side branch near the proximal or distal cap. A balloon is inflated at the ostium of the side branch, blocking entry of the guidewire into it and facilitating advancement of the guidewire through the target lesion. |
316 |
|
|
Double-blind stick-and-swap |
Technique for reentering into the distal true lumen using the Stingray balloon after subintimal guidewire crossing. It is similar to the stick-and-swap technique, in which a stiff guidewire (such as the Stingray guidewire) is used to create an exit channel toward the distal true lumen, followed by exchange for a polymer-jacketed guidewire for completing the reentry. In stick-and-swap, contralateral contrast injection is used to determine the location of the distal true lumen relative to the Stingray balloon. In the double-blind stick-and-swap technique there is no contrast injection; instead a puncture is performed using a stiff wire on both sides of the Stingray balloon, followed by advancement of a polymer-jacketed guidewire on both sides of the Stingray balloon until reentry is achieved. |
186 |
75, 183 |
DRAFT |
Deflate, Retract, and Advance into the Fenestration technique |
Variation of the reverse CART technique that requires two operators: the antegrade balloon is deflated and withdrawn by one operator while the other operator advances the retrograde guidewire through the space created by the balloon being retracted until the retrograde guidewire enters the antegrade guide catheter. |
227 |
|
e-CART |
ElectroCautery-Assisted Re-enTry |
Variation of the reverse CART technique used when the retrograde guidewire cannot penetrate the proximal cap and an antegrade wire cannot be advanced (usually in flush aortoostial lesions). A retrograde stiff guidewire (usually a Confianza Pro 12) is advanced as far as possible into the occlusion over a microcatheter, followed by cautery activation (for 1 sec) to burn through the impenetrable tissue into the aorta. |
309 |
312, 313 |
|
Fast-spin CrossBoss technique |
Technique used for advancing a CrossBoss microcatheter: the catheter is rotated rapidly using the proximal torque device until it advances through the occlusion. |
166 |
73, 257, 327 |
|
Finish with the boss |
Technique for minimizing the extent of subintimal dissection performed using a knuckled guidewire. Subintimal advancement of the knuckled guidewire is stopped proximal to the distal cap; followed by exchange of the knuckled wire for a CrossBoss catheter to complete the last part of subintimal crossing. The CrossBoss catheter has smaller profile than a knuckled guidewire, decreasing the likelihood of subintimal hematoma formation that can hinder reentry into the distal true lumen. |
189 |
75, 178 |
Guideliner-assisted reverse CART |
Guideliner-assisted reverse Controlled Antegrade and Retrograde Tracking and dissection |
Variation of the reverse CART technique: a guide catheter extension is advanced over the proximal guidewire to form a proximal target for the retrograde guidewire to enter. |
226 |
220 |
|
Hairpin technique; also called “reversed guidewire” technique |
Technique for wiring highly angulated vessels. A polymer-jacketed guidewire is bent approximately 3 cm from the wire tip and the knuckle is advanced through the introducer into the coronary artery. Upon withdrawal the guidewire tip enters into the angulated side branch. |
324 |
52, 214, 332 |
IVUS-guided CART |
Intravascular ultrasound-guided Controlled Antegrade and Retrograde Tracking and dissection |
Variation of the reverse CART technique: intravascular ultrasound is used to determine the location of the antegrade and retrograde guidewire and to allow precise sizing of the antegrade balloon. Intravascular ultrasound allows safe use of larger balloons, which in turn increase the likelihood of successful retrograde wire crossing. IVUS can also help determine whether significant recoil occurs after antegrade balloon inflation. |
226 |
220 |
J-CTO score |
Japan Chronic Total Occlusion Score |
Five-point score for prediction of the likelihood of successful guidewire crossing within the first 30 min of crossing attempts. It was developed from the Multicenter Chronic Total Occlusion Registry in Japan. The five variables are: blunt stump, CTO calcification, within CTO tortuosity, occlusion length ≥20 mm, and prior failed attempt. |
12 |
10, 126, 332 |
|
Jet exchange, also called hydraulic exchange, or Nanto technique |
Technique for removing a microcatheter while maintaining guidewire position. It is performed by connecting an inflating device over the back end of the microcatheter, inflating it at high pressure, and removing the microcatheter, while the antegrade flow keeps the guidewire in position. However, the trapping technique is more reliable and is preferred for over-the-wire system exchanges. |
136 |
|
|
Just-marker technique |
Variation of the retrograde technique. The retrograde wire is advanced to the distal cap and acts as a marker of the distal true lumen position, facilitating antegrade crossing attempts. |
231 |
202, 218, 219, 258 |
|
Kissing-wire technique |
Variation of the retrograde technique that involves manipulation of both antegrade and retrograde wires within the occluded segment until crossing is achieved. |
231 |
203, 219 |
|
Knuckle-boss technique |
Technique for preventing entry of the CrossBoss catheter into side branches. The CrossBoss catheter is withdrawn proximal to the origin of the side branch, and a knuckled wire is advanced past the side branch (the larger size of the knuckle often prevents it from entering the side branch). |
173 |
|
LAST |
Limited Antegrade Subintimal Tracking |
Wire-based technique for reentering into the distal true lumen after subintimal guidewire crossing. Usually a stiff guidewire with a 90 degrees angle is manipulated until it enters the distal true lumen. Because it is unpredictable, the LAST technique is currently used infrequently. The Stingray system is preferred for achieving distal true lumen reentry. |
193 |
159, 162, 194, 384 |
Mini-STAR |
Mini Subintimal Tracking And Reentry |
Variation of the STAR technique in which a polymer-jacketed guidewire (such as the Fielder FC or XT) is used to reenter into the distal true lumen immediately after the occlusion rather than further down the distal vessel. |
|
|
|
|
Similar with the LAST technique, mini-STAR is currently used infrequently; the Stingray system is the preferred strategy for distal true lumen reentry. |
193 |
162, 384 |
|
Modified Carlino technique |
Modification of the Carlino technique (subintimal contrast injection) in which a small amount of contrast (0.5–1.0 mL) is injected into the subintimal space during cineangiography. The modified Carlino technique is often used to resolve proximal cap ambiguity and also for treating balloon uncrossable lesions. |
195 |
|
|
Mother – daughter – granddaughter technique |
Simultaneous use of two guide catheter extensions (i.e., a 6 Fr extension through an 8 Fr extension) when multiple extreme vessel bends need to be navigated. |
36 |
|
|
Move-the-cap techniques |
These techniques use antegrade dissection and reentry to clarify the course of the occluded vessel in case of proximal cap ambiguity and facilitate crossing. The following techniques are included in this category: balloon-assisted subintimal entry (BASE), scratch-and-go, and the Carlino technique. |
295 |
164, 308, 318 |
|
Open-sesame technique |
Technique for facilitating crossing when there is a side branch at the proximal cap. Balloon inflation is performed in the side branch inducing a geometrical shift of the proximal cap plaque, which in turn enables guidewire entry into the CTO. |
314 |
|
|
Parallel-wire technique |
During antegrade wire escalation if the initial guidewire enters the subintimal space, it is left in place and a new guidewire is inserted next to the original guidewire to facilitate crossing into the distal true lumen. |
154 |
156, 173, 179, 242 |
|
Ping-pong guide |
Two guide catheters are used to simultaneously engage the same target vessel. One guide is pulled back to enable engagement with the other guide catheter and vice versa. |
395–398 |
86, 205, 207, 294, 307, 387, 395 |
PROGRESS-CTO score |
PROspective Global REgiStry for the Study of Chronic Total Occlusion Intervention score |
Scoring system that uses four variables (proximal cap ambiguity, moderate/severe tortuosity, circumflex artery CTO, and absence of interventional collaterals) to create a four-point score that helps predict technical success. |
13 |
10 |
|
Proxis-Tornus technique |
Insertion of a Tornus microcatheter through a Proxis device (increased support) to cross balloon-uncrossable CTOs. Since the Proxis device is no longer commercially available, a guide catheter extension can be used instead of the Proxis catheter. |
277 |
|
RASER technique |
Rotablation and laser technique |
Technique for treating balloon-uncrossable and balloon-undilatable lesions in which laser is used first to facilitate advancement of a rotational atherectomy wire (either directly or using a microcatheter for exchange), followed by rotational atherectomy. |
282 |
|
Reverse CART |
Reverse Controlled Antegrade and Retrograde Tracking and dissection |
Reverse CART is the opposite of the CART technique: a balloon is inflated over the antegrade guidewire creating a space into which the retrograde guidewire is advanced. At present, reverse CART is the most commonly used technique for retrograde reentry. |
222–223 |
204, 219, 220, 227, 228, 309, 314 |
|
Reverse wire trapping technique |
Technique for delivering an antegrade guidewire through a CTO after successful retrograde guidewire crossing. The retrograde guidewire is snared with a small snare, followed by withdrawal of the retrograde guidewire by pulling the antegrade snare through the CTO into the distal true lumen. This technique is used very rarely. |
240 |
|
|
Scratch-and-go technique |
This is one of the move-the-cap techniques. A stiff guidewire is advanced toward the vessel wall into the subintimal space proximal to the CTO (scratching the wall). A microcatheter follows the wire into the subintimal space. The stiff guidewire is exchanged for a polymer-jacketed guidewire that is advanced to form a knuckle that then crosses the occlusion. |
299 |
164, 222, 295 |
|
See-saw wire-cutting technique |
Modified version of the wire-cutting technique for treating balloon-uncrossable lesions. Two balloons are advanced over two guidewires to the proximal cap of the CTO. The first balloon is inserted as far as possible into the lesion and inflated, effectively cutting the proximal cap with the second guidewire. The process is repeated with the second balloon, modifying the cap on the other side until the lesion is successfully crossed with a balloon. |
271–272 |
|
|
See-saw technique |
This is a variation of the parallel wire technique: during antegrade wire escalation if the guidewire enters into the subintimal space it is left in place and a second guidewire is advanced over a second microcatheter next to the first guidewire to cross the occlusion. Two microcatheters are used in the see-saw technique versus only one in the parallel-wire technique. |
154–155 |
156 |
|
Septal surfing |
Technique for retrograde guidewire crossing through septal collaterals. In contrast to the contrast-guided technique, in which contrast injection is used to determine the course of the septal collaterals and help guide the guidewire, in the surfing technique the guidewire is advanced blindly back and forth through the collateral until it crosses into the distal true lumen. |
210 |
|
|
Side-branch anchor technique |
Technique for increasing guide catheter support. A workhorse guidewire is advanced into a side branch proximal to the target lesion, followed by inflation of a small balloon into the side branch. The size of the balloon is selected to match the size of the collateral vessel. The side branch balloon is inflated to 6–8 atm, anchoring the guide into the vessel. |
130–131 |
166, 273, 448 |
STAR |
Subintimal Tracking And Reentry |
STAR is the original antegrade dissection/reentry technique that was described by Antonio Colombo. A knuckled polymer-jacketed guidewire is advanced through the subintimal space until it spontaneously reenters into the distal true lumen, usually at a bifurcation. |
193 |
159, 359 |
Stent Reverse CART |
Stent Reverse Controlled Antegrade and Retrograde Tracking and dissection |
This is a variation of the reverse CART technique: a stent is deployed from the proximal true lumen into the subintimal space to facilitate retrograde wiring into the stent. It is used infrequently as a last resort because it is irreversible and may sometimes hinder reentry, for example when the retrograde guidewire crosses through the stent struts. |
227 |
220, 229 |
|
Stick-and-drive technique |
This is the classic technique for reentering into the distal true lumen using the Stingray balloon. The Stingray guidewire is advanced without rotation through the side port of the Stingray balloon so as to puncture back into the true lumen. After confirmation of distal true lumen position with contralateral injection the Stingray guidewire is rotated 180 degrees and advanced further down into the vessel. The stick-and-swap technique is preferred in most cases, especially when the distal vessel is of small caliber, tortuous, of diffusely diseased, as the stiff Stingray guidewire may cause injury of the distal vessel. |
183 |
|
|
Stick-and-swap technique |
Technique for reentry into the true lumen using the Stingray balloon: an initial puncture is performed using the Stingray wire to create a connection with the distal true lumen. The Stingray wire is removed and a Pilot 200 (or similar polymer-jacketed) guidewire is advanced through the same side port into the tunnel created by the Stingray wire to enter the distal true lumen. |
186, 188 |
75, 183, 189 |
STRAW |
Subintimal TRAnscatheter Withdrawal technique |
Aspiration of hematoma that develops during antegrade dissection/reentry crossing to facilitate reentry. STRAW can be performed either through the Stingray balloon itself, or ideally through another microcatheter or over-the-wire balloon advanced proximal to the Stingray balloon. |
189–190 |
191, 194, 389 |
|
Subintimal distal anchoring technique |
Technique for treating balloon-uncrossable lesions after successful guidewire crossing. A second guidewire is advanced subintimally through the occlusion and a balloon is advanced over the subintimal guidewire to anchor the true lumen guidewire, over which a balloon can then be advanced through the occlusion. |
276–277 |
267, 272 |
|
Tip-in technique |
After retrograde guidewire crossing an antegrade microcatheter is advanced over the retrograde guidewire through the occlusion, followed by insertion of an antegrade guidewire and antegrade delivery of balloons and stents. This technique results in less strain on the collaterals; however, unlike guidewire externalization, loss of guidewire position may occur. |
240–241 |
242, 372, 417 |
|
Wire-cutting technique |
Technique for treating balloon-uncrossable or balloon-undilatable lesions. A second guidewire is advanced through the occlusion and a balloon is inflated over the original guidewire while pulling the second guidewire, scoring and modifying the lesion. |
271 |
|
