Case and Plan:
59-year-old male presented with CCS Class IV angina and coronary CTA revealing total mid LAD occlusion. A Cardiac Cath on February 25, 2022 revealed 1 V CAD: total occlusion of mid LAD with distal vessel filling antegradely and retrogradely with EF = 65% and SYNTAX Score of 12. Patient underwent unsuccessful intervention of mid LAD CTO via antegrade approach. Now planned for stage PCI of mid LAD CTO via RCA collaterals using retrograde approach.
Q&A
Q
Which three collateral surfing wires do you prefer?
A.
Fielder family (FC preferred by us, XT-R, XT-A), Sion Black and SUOH-3 are the 3 best collateral surfing wires available in the market.
Q
Viper or RG 3? Please suggest differentiating characteristics.
A.
RG3 is 0.010" softer & distal hydrophilic while Viper is 0.014" stiffer but non hydrophilic, both can be used for externalization for retrograde CTO recanalization cases. We now have starting using RG3 more due to its softer and hydrophilic properties.
Q
Please provide features of use of SUOH 3?
A.
SUOH 3 has hydrophilic coating with 0.3gm tip load. Hence it has 1:1 torque and goes thru the septal collaterals easily.
Q
Is this wire turning out to be a good option? Who makes it?
A.
We have limited recent experience with SUOH 3, but is rapidly becoming our favorite wire for septal surfing due to easy torqueability. It is made by Asahi Intec.
Q
How does SUOH 3 compare with SION Black?
A.
SION Black has a hydrophilic coating with polymer jacketed, hence stiffer with 0.8gm tip load. SUOH-3 is hydrophilic with softer tip load of 0.3gm; hence is becoming our favorite wire for septal surfing.
Q
You use these two wires exclusively for retrograde CTO?
A.
We start with Fielder FC and then rapidly change to SUOH-3 guidewire.
Q
Any situations to prefer Turnpike over Corsair?
A.
Yes Turnpike works better in heavily calcified lesions and we have few rare cases of Corsair tip breaking off when used in heavily calcified lesions.
Q
Any new support catheters that you are using and that are promising?
A.
Finecross remains our workhorse support catheter (about 80% cases) with Corsair in about 15-18% and Turnpike being used rarely.
Q
Can you describe your technique of advancing and withdrawing Corsair?
A.
For all these support catheters including Corsair, we suggest to put the torque device near the back-end of the support catheter, then holding in the palm and then clockwise rotate by right hand fingers upto 20 turns (while holding torque device steady in the palm). Most of the time this strategy works to cross the complex long calcified lesions. Once crossed, withdraw the catheter by turning counter clockwise.
Q
Is Corsair the best available catheter with 1:1 torquing?
A.
Yes Corsair is the best 1:1 torquing support catheter but avoid making >20 turns at one time; if did not cross then make 15-20 counter clockwise turns to undo the torque and then readvance.
