Imaging behind occluded areas with an iatrogenic perforated balloon: A safe, practical, and simple new method of visualizing the distal lumen in total occlusion.

Abstract

In the present study, we investigated the effectiveness and reliability of a new method that reveals whether guidewire advanced distal to the lesion is in the lumen in patients with acute (ATO) or chronic coronary total occlusion (CTO). Forty-one patients with symptomatic ATO and 22 patients with CTO who were admitted into our catheterization laboratory between January 2016 and March 2017 were included. In patients in whom antegrade filling could not be demonstrated after passing 0.014″ guidewire beyond the total lesion, a 1.25 × 15 mm balloon was punctured with a needle outside the operative field to visualize the total lesion. This perforated balloon was then used to deliver an opaque substance through this hole to visualize the distal part. The mean age of our 63 patients was 66 ± 12 years. They had diabetes (57%), hypertension (100%), and a history of PCI (85%). The mean procedural time was 27 ± 6.8 min, and the mean volume of contrast material used was 93.9 ± 24 mL. This technique was 100% successful in accurately demonstrating the distal lumen and preventing complications. This new method we developed is much simpler and more useful than other methods for visualization of the true lumen because we can re-orient the balloon at the time of opaque injection and use 190 cm guidewire without additional costs. Additionally, one balloon is sufficient for the operation.