ArticleJACC. Case reports2025
Successful Combination of the Slipstream and the Tip Detection-Antegrade Dissection and Re-Entry Techniques for Chronic Total Occlusion.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
objectiveWe describe combining the slipstream technique with the tip detection-antegrade dissection and re-entry (TD-ADR) technique using AnteOwl intravascular ultrasound (IVUS) for challenging calcified chronic total occlusion lesions when conventional IVUS-guided approaches fail. KEY STEPS: The procedure included the following steps. 1) Confirm on IVUS that the first guidewire is in the subintimal space. 2) Re-insert the AnteOwl IVUS using the first wire lumen only. 3) Advance a Sasuke double-lumen catheter over the same wire to the IVUS tip. 4) Introduce a second guidewire (Conquest Pro 12 Sharpened Tip with 15° bend) through the second wire port. 5) Perform TD-ADR under IVUS guidance to achieve true lumen re-entry. POTENTIAL PITFALLS: IVUS cannot directly visualize the advancement of the microcatheter over the true lumen second guidewire, thus careful fluoroscopic guidance is crucial. TAKE-HOME MESSAGES: This combined approach provides an effective bailout strategy when microcatheter advancement fails owing to severe calcification. The dual-lumen design, real-time pullback system, and short tip-to-transducer distance of the AnteOwl IVUS optimizes both the slipstream and TD-ADR techniques simultaneously.
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