Tip detection-antegrade dissection and re-entry method as a bail-out technique for coronary perforation in chronic total occlusion intervention: a case report

Abstract Background Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) increases the risk of complications. Case summary In CTO PCI of the right coronary artery, AnteOwl WR intravascular ultrasonography (AO-IVUS; Terumo Corp., Tokyo, Japan) revealed that the antegrade guidewire had entered the subintimal space just beyond the CTO entrance and created a perforation outside the vessel approximately 1 cm distal to it. As the distal part of the AO-IVUS was outside the vessel, its removal worsened the bleeding hence, was left it in place. Tip detection-antegrade dissection and reentry techniques were performed using a Conquest Pro 12 Sharpened Tip guidewire (Asahi Intecc Co., Ltd., Aichi, Japan). The Conquest Pro 12 Sharpened Tip guidewire successfully reentered from the subintimal space into the true lumen immediately before the perforation site. Because the perforation and reentry sites were adjacent to each other, a covered stent was placed, , which enabled simultaneous haemostasis at the perforation site and recanalisation of the CTO lesion. Discussion Although AO-IVUS-based tip detection-antegrade dissection and re-entry is an advanced technique, we believe that it is valuable for various PCI cases.