Dual guidewire balloon antegrade fenestration and re‐entrytechnique for coronary chronic total occlusions percutaneouscoronary interventions

Objectives:To describe the experience of coronary chronic total occlusions (CTOs)percutaneous coronary interventions (PCI) using antegrade fenestration and re‐entry(AFR) technique with a dedicated dual guidewire balloon (DGB).Background:Antegrade dissection and re‐entry (ADR) techniques has beenemphasized in recent worldwide CTO consensus documents. We investigated thefeasibility and safety of DGB as a dedicated device to perform guidewire‐based AFR.Methods and Results:Fourteen consecutive patients with complex CTO (J‐CTOscore: 3.1 ± 0.9) underwent DGB‐AFR in the years 2020–2021. DGB‐AFR consists inadvancing the DGB over a guidewire that reached the vessel distal to the CTO in anextra plaque fashion, inflating/deflating the DGB to create fenestration betweensubintimal space and the true lumen and advancing a proximal re‐entry guidewirethrough fenestration in the true lumen. DGB‐AFR alone was successful in 10 of 14(71%) cases, a rescue wire‐based ADR was needed in two cases for re‐entry into thetrue lumen with a total success rate in 12 of 14 (86%) cases. Among all DGB‐AFRcases, four (28%) were performed as a first‐line strategy while the remaining 10(71%) cases were performed as a bail‐out strategy after failure of other antegradecrossings for 30 min of procedural time. No DGB‐related complications wereobserved.Conclusions:DGB‐AFR is a user‐friendly reliable strategy for the treatment of manyCTO lesions. It can be used as bail‐out after failure of conventional antegrade wiringtechniques, achieving high procedural success rate and low occurrence of proceduraladverse events.