Case 152: PCI Manual - Reversed guidewire

A patient was referred for PCI of an LAD/diagonal bifurcation lesion. Wiring of the LAD was challenging, as the guidewires preferentially entered in to the diagonal. Wiring attempts resulted in acute vessel closure, likely due to dissection. Wiring of the LAD failed despite using various guidewires through a Corsair and a Sasuke microcatheter. We used the reversed guidewire technique with a Sion black bent 3 cm from the tip and delivered to the diagonal with the help of the Sasuke microcatheter. Upon withdrawal the Sion black wire successfully entered the LAD. Provisional stenting of the LAD/diagonal bifurcation was performed, but a severe lesion remained in the diagonal. The diagonal was stented using the culotte technique with an excellent final result.
Link to the original reversed guidewire publication by Kawasaki: pubmed.ncbi.nlm.nih.gov/17932...
How to do culotte bifurcation stenting: • How to do culotte bifu...
How to do provisional bifurcation stenting: • 16.2 Provisional bifur...

[@matheuscsmed]

Thank you, Matheus Silva

[@drmz2007]

Excellent demonstration of reverse guide wire. I have used this technique in a case of LCX/Om bifurcation with single lumen micro catheter. We can also tried angled micro catheter like super cross or venture . 👏

[@shangz0216]

Thanks for the excellent illustration.

[@muhammadhamidsaeed7585]

Excellent demonstration by an excellent teacher 👏 👍

[@apurvavasavada383]

Great demo of the reversed wire. Could you please demonstrate how prep and introduce the reverse wire into the Touhey in a furure video?

[@dmxspark]

I went to ijcto Hyderabad, really hoping to meet you there. 😢

[@llacielona]

The wiring of LAD was spectacular! The lesion seemed Medina 1,0,0 before the LAD wiring, so why not dilate LAD first ( over the LAD/Diagonal wire)then try wiring. I think that would have changed the angulation of lesion.

[@apurvavasavada383]

Yes. That should not be left as last resort. Better to try before too much manipulation dissects the tricky entry. Chance of losing the branch is quite low.

[@amrhanafymahmoud9829]

Thanks slot for this illustration. Important information. But I would like to show us in live illustration double kissing which endfletor should Inflat and to how many pressure and second balloon.

[@dr.goibov9508]

Well done! 👏 👏 👏 inflating a balloon in the diagonal could solve the problem 🤔 Is it a muscle bridge in the middle of the LAD? If it is a bridge and hemodynamically significant bridge in the middle of the LAD and lesion more proximally what should we do? treat the lesion? even if we treat the lesion we will still have a muscle bridge 🤔

[@wbcjunior]

how did you put the hairpin string in the mc? thread the bent rope without the prod? could you explain how to insert the string?