Deep Dive Rendezvous as a Novel Alternative Technique for Conventional Externalization in Retrograde Chronic Total Occlusion Interventions.

Chronic total occlusion percutaneous coronary intervention (CTO-PCI) has made significant progress with the retrograde approach, particularly when antegrade techniques are insufficient or not clinically indicated. Despite its advantages, the conventional externalization process carries some notable challenges, including procedural complexity, increased equipment requirements, and elevated risk of rupture of fragile collateral vessels. This article examines the "Deep Dive Rendezvous" or DDR technique that we propose in great detail. This novel interventional solution builds on the previously elaborated rendezvous approaches, however, with the added value of offering an enhanced guidewire support through deep intubation into the retrograde system. By refining the rendezvous technique, we propose DDR as a streamlined and effective alternative to conventional externalization. This technique has the potential to reduce risks of procedural complications, preserve collateral vessel integrity, and diminish the need for additional equipment or introduction of complex procedural steps. In conclusion, the versatility of this technique extends to serving as both a primary strategy and a bailout solution, making it a valuable option in cases where conventional externalization is either impractical or unsafe during the retrograde CTO-PCI.