Case 228: Manual of CTO PCI - "Rendez-vous"

A patient with ischemic cardiomyopathy was referred for PCI of a RCA CTO. The RCA CTO had a blunt proximal cap, length of approximately 30 mm, diffusely diseased distal vessel and septal+epicardial collaterals. Antegrade wiring with a Fielder XT-A and Gladius Mongo failed. A Suoh 03 crossed through a septal collateral but a Caravel microcatheter could not cross. Using a Trapliner a Corsair XS microcatheter was delivered to the distal cap. A retrograde Gladius Mongo was advanced to the proximal cap and formed the target for an antegrade Gaia Next 2 wire that crossed to the mid RCA. The Gladius Mongo was withdrawn and the Gaia Next 2 wire was advanced inside the Corsair XS microcatheter (rendez-vous technique). Using a Sasuke microcatheter a wire was advanced to the PDA followed by successful balloon angioplasty and stenting.

[@user-el3rb1ny1n]

Thanks a lot for your experienced case and lifehacks of complex retrograde

[@shangz0216]

Thanks for the educative case presentation.

[@drmz2007]

Thank you
Excellent case

[@mahmoud_elrayes]

Excellent case with so many tips and tricks. One question; the radiopaque length of the antegrade wire along the Turnpike Spiral seems to be less than 15 cm(of the Gaia Next 2 wire) ..I may be wrong....Could you please figure out? Great thanks

[@manosbrilakis]

Great point, you are right - we switched the Gaia Next 2 to a Mongo that make it into the retrograde microcatheter.

[@amrhanafymahmoud9829]

Sir why not use this technique rendezvous vous more in retrograde you had mentioned its use 5 to 10%only inspire I carries several advantages

[@manosbrilakis]

It is quite hard to advance the antegrade wire in the retrograde microcather - in this case it worked because the antegrade wire was in the distal true lumen and the the distal vessel size was quite small.