Case 209: Manual of CTO PCI - Side BASE

A patient was referred for PCI of an LAD CTO with an ambiguous proximal cap at the takeof of a septal. IVUS-guided antegrade puncture failed causing a small wire perforation. A balloon was inflated sealing the perforation. Retrograde via septal collaterals from the PDA and via an epicardial collateral from a diagonal failed. The side-BASE technique was used: a balloon was inflated partially inside the LAD and partially inside the diagonal and a knuckled Gladius Mongo wire was advanced extraplaque through the proximal cap. Reentry into the distal true lumen was achieved using the stick and drive technique with a Gaia 3rd wire with an excellent final result after stenting.

[@shangz0216]

Thanks for the excellent case presentation.

[@cardiologiadeimpacto]

Beautiful case. Thanks. We are very grateful for your teaching

[@magisrb]

Looks like Gladius crossed in lumen, could you confirmed it with angio/IVUS ? It would save you re entry device

[@manosbrilakis]

Agree - IVUS is critical here

[@amrhanafymahmoud9829]

Why not using sasuke microcatheter

[@amrhanafymahmoud9829]

During antegrade

[@manosbrilakis]

Great point - we did use a dual lumen microcatheter because we had live IVUS guidance of the proximal cap puncture. Using a dual lumen microcatheter would help with support but not sure it would necessarily change the course of the wire, especially after the wire followed the initial suboptimal course.