Intentional Intimal Tracking Via a 6-F Guiding Catheter Using a Novel Puncture Wire: The Solo Technique.

objectiveWe describe a minimalistic tip detection-intentional intimal tracking technique (the solo technique) using a solo Bingo Reach (BR) wire with real-time intravascular ultrasound (IVUS) guidance through a 6-F guiding catheter. KEY STEPS: The solo technique consists of the following steps: 1) confirmation by IVUS that the initial guidewire is located within the subintimal space; 2) identification and marking of the entry point where the wire penetrates into the false lumen; 3) advancement of the BR wire toward the proximal cap of the chronic total occlusion lesion; 4) controlled rotation of the BR wire with continuous verification of tip orientation under real-time IVUS guidance; and 5) advancement of the wire to achieve successful re-entry into the true lumen. POTENTIAL PITFALLS: In the absence of a microcatheter, wire displacement may occur during IVUS catheter withdrawal; therefore, meticulous fluoroscopic monitoring is essential. TAKE-HOME MESSAGE: This combined approach provides an effective bailout strategy using a 6-F guiding catheter, thereby expanding procedural options in challenging percutaneous coronary intervention scenarios.