Power Flush, a Novel Bailout Technique for Stumpless Aorto-Ostial CTOs: A Case-Based Approach.

ABSTRACT

BACKGROUND: Aorto-ostial coronary artery flush chronic total occlusions are a challenging subset of lesion with peculiar characteristic the near complete lack of guiding catheter support, the presence of a thicker layer of muscular fibers and a greater collagen and calcium content, responsible for balloon dilatation's resistance and greater recoil tendency. We introduce a novel bailout technique to overcome retrograde wire failure in accessing aorta, a variation of the Carlino technique which we named Power Flush. MATERIALS AND METHODS: Power Flush consists in a forceful injection of contrast dye directly through the guiding catheter positioned against the aortic wall in correspondence to the coronary ostium location, to gain access to the extra-plaque space and proceed with the vessel's recanalization. In one case we used a further iteration named Nick And Flush, in which a preliminary nicking of the aortic wall with a penetrative wire was done before the Power Flush. RESULTS: We hereby present three cases of aorto-ostial right coronary artery flush chronic total occlusions. In two of them we utilized the Power Flush technique, in one case we employed its variant Nick And Flush. We were successful in all cases and no complication occurred. CONCLUSIONS: In this kind of lesions Power Flush and Nick And Flush are effective bailout techniques to overcome retrograde wire failure to reach aorta.