First Validation of the “Bite-In” Technique for Retrograde Chronic Total Occlusion Revascularization

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2026-07-03 Epub Date: 2026-04-15 DOI:10.1002/ccd.70594

Yahang Tan, Wanjing Zhang, Jing Cheng, Yixing Yang, Tao Zhang, Lin Zhao

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引用次数: 0

Abstract

Background

Failure in manipulating the retrograde guidewire (RGW) or advancing the retrograde microcatheter (MC) is a common challenge in the retrograde approach to chronic total occlusion (CTO). Effective strategies to overcome the limited control of the RGW deformation have not yet been developed.

Aims

This study aimed to evaluate the predictive performance of five CTO scoring systems for time-efficient guidewire (GW) crossing.

Methods

From May 2024 to June 2025, the “bite-in” technique was employed in 40 out of 60 consecutive patients due to failure of the “tip-in.” In this approach, the RGW is first advanced into the Guidezilla catheter, followed by controlled antegrade rotation of the MC to facilitate spontaneous capture of the RGW at the coaxial interface. This technique eliminates the need for active RGW manipulation during this critical step.

Results

The right coronary artery was the most common CTO site (24/40, 60%). The mean J-CTO, PROGRESS, and JR-CTO scores were 2.5 ± 1.0, 0.7 ± 0.7, and 1.5 ± 0.9, respectively. A primary retrograde strategy was employed in 30% of all procedures. The mean duration of the retrograde approach was 111.1 ± 45.6 min. Limited RGW control and failed retrograde MC advancement occurred in 88% and 75% of cases, respectively. Bite-in technical success was achieved in all patients. No procedural complications were adjudicated to bite-in.

Conclusions

The bite-in technique is a feasible and safe method in the retrograde approach to CTO by facilitating connection between the retrograde and antegrade lumens. Larger multicenter studies are warranted to validate its long-term efficacy compared with the tip-in approach, despite its acceptable short-term performance.

查看原文本刊更多论文

首次验证“咬合”技术用于逆行慢性全闭塞血运重建术。

背景：操作逆行导丝（RGW）或推进逆行微导管（MC）失败是逆行入路治疗慢性全闭塞（CTO）的常见挑战。目前还没有有效的策略来克服对RGW变形的有限控制。目的：本研究旨在评估五种CTO评分系统对时间效率导丝（GW）穿越的预测性能。方法：从2024年5月至2025年6月，对60例因“尖牙入牙”失败的患者中40例采用“咬合”技术。在这种方法中，首先将RGW推进到Guidezilla导管中，然后控制MC的顺行旋转，以促进在同轴界面处自发捕获RGW。这种技术消除了在这个关键步骤中对主动RGW操作的需要。结果：右冠状动脉为最常见的CTO部位（24/40,60%）。J-CTO、PROGRESS和JR-CTO的平均评分分别为2.5±1.0、0.7±0.7和1.5±0.9。30%的手术采用初级逆行策略。逆行入路的平均时间为111.1±45.6 min。RGW控制受限和逆行MC进展失败分别发生在88%和75%的病例中。所有患者的咬合技术均取得成功。没有程序性并发症被裁定为咬入。结论：咬入技术可促进逆行和顺行腔间的连接，是一种可行、安全的逆行入路CTO治疗方法。尽管其短期表现可接受，但仍有必要进行更大规模的多中心研究，以验证其与提示疗法相比的长期疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.