A Novel Approach to Treat Coronary Chronic Total Occlusion: Balloon-Assisted Revascularization-A Retrospective Study.

Background: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains a significant challenge and new techniques are needed for rapid and safe CTO recanalization.

Aims: To explore a novel balloon-assisted revascularization technique (BART) for successful management of CTO.

Methods: Patients who underwent CTO recanalization using BART between January 2020 and June 2022 were included in this study. The baseline clinical data, CTO vessel characteristics, and technical details were retrospectively analyzed. The procedure began with antegrade guidewire crossing of the CTO lesion. If contralateral angiography demonstrated the guidewire entering the subintimal space, a balloon was advanced along the guidewire and inflated. The inflated balloon served as a mechanical barrier to block antegrade blood flow to prevent hematoma formation, meanwhile providing back-up support facilitating the manipulation of a second guidewire for CTO penetration and final recanalization.

Results: A total of 32 consecutive patients who underwent the procedure were included in this study. The median J-CTO score was 2.5 with 26 patients (81.3%) having a J-CTO score ≥ 2. The right coronary artery was the most commonly affected vessel; 12 patients (37.5%) had BART as the first choice while 20 (62.5%) as an alternative after failure with other techniques. Technique and procedure success was achieved in 28 cases (87.5%). Procedure-associated complications included cardiac tamponade (n = 1), femoral artery hematoma (n = 1), and subintimal hematoma (n = 1). There were no major cardiac adverse events.

Conclusion: BART is an effective and safe recanalization method for CTOs that are difficult to treat with other techniques, offering improved outcomes.