Video 8.2.7: Manual of CTO PCI - When and how to do “BASE” and “scratch and go”

The "move the cap" techniques include the "scratch and go" and the BASE (Balloon-Assisted Subintimal Entry).
The goal of these techniques is to create an entry into the extraplaque (formerly called subintimal) space proximal to the proximal cap.
Indications for the "move the cap" techniques:
1. Ambiguous proximal cap
2. Wire impenetrable proximal cap
3. Balloon uncrossable lesions
4. Balloon undilatable lesions
Steps of the "scratch and go" technque:
Step 1: Wire the vessel proximal to the CTO
Step 2: Advance a microcatheter proximal to the proximal cap
Step 3: Insert stiff tip guidewire into the microcatheter and advance it towards the vessel wall
Step 4: Advance the microcatheter over the stiff tip guidewire inside the vessel wall
Step 5: Insert a polymer-jacketed guidewire through the microcatheter
Step 6: Create a of knuckle into the dissection plane
Step 7: CTO crossing
Step 8: Reentry
Steps of the "scratch and go" technque:
Step 1: Wire the vessel proximal to the CTO
Step 2: Advance a balloon proximal to proximal cap
Step 3: Balloon inflation
Step 4: Contrast injection
Step 5: Delivery of microcatheter proximal to proximal cap
Step 6: Insert a polymer-jacketed guidewire and create a knuckle
into the dissection plane
Step 7: CTO crossing
Step 8: Reentry

[@zadigbalaban8359]

The best man in the World in Changing and Remove the Cap. Sir Brilakis thanks

[@drmz2007]

Thank you sir for sharing this educational video.

[@shangz0216]

Thanks for sharing.

[@mehmetdemir2369]

Very good explanation

[@maisamtaherian986]

Thank you very much. Is it necessary to make a bend on the polymer jacket wire before delivering in the microcatheter?

[@manosbrilakis]

You can create a small bend or an "umbrella handle" bend on the wire, either can work.

[@ahmedzahran7016]

Very nice , may I ask if the right guiding was changed during the scratch and go first case?

[@manosbrilakis]

Good point - yes, it was changed from Amplatz to JR4.

[@francessantos3472]

😕 "promosm"