Angled Microcatheter Assisted Antegrade Dissection Re-Entry Technique for Tortuous Totally Occluded Coronary Arteries.

Background: Subacute total occlusion in the setting of a tortuous vessel can be a therapeutic challenge. we demonstrate a safe and successful approach to deploy drug eluting stent of this complex lesion by using angled microcatheter.

Case presentation: A 61-year-old male with multiple atherosclerotic risk factors diagnosed with NSTEMI secondary to subacute total occlusion of the mid right coronary artery (RCA) with collaterals filling from septal perforators arising from mid left anterior descending artery. Due to severe tortuosity of RCA, the wire inside of Corsair microcatheter kept directing away from the lumen. Therefore, Corsair was exchanged for 90-degree SuperCross™ angled microcatheter that was rotated to direct its opening towards the lumen. A Confianza pro 12 wire was used to puncture into the lumen from the subinitimal position. SuperCross™ microcatheter was advanced over the wire into the lumen and eventually drug eluting stents were deployed successfully.

Conclusion: While facing subacute total occlusion with proximal end in a tortuous artery, SuperCross™ microcatheter assisted dissection reentry could be attempted after failure of antegrade wire escalation technique.

Learning objective: Facilitate the use of SuperCross™ microcatheter assisted dissection reentry as a successful approach for subacute total occlusion in tortuous vessels.