![]() ![]() Additionally, one of the two OTW lumens has two exit ports located 180° apart. The ReCross microcatheter is the only DLM with two OTW lumens, making guidewire exchange possible through both lumens. The NHancer Rx’s distal shaft design provides the smallest dual lumen crossing profile (2.3 F), allowing for catheter trapping using a conventional balloon in a 6-F guide. The Twinpass Torque microcatheter has a stainless-steel braided shaft designed to enhance torque control and deliverability. Table 2 summarizes the major characteristics and differences between available DLMs. All current DLMs are compatible with 5-F guiding catheters and have a hydrophilic coating to improve delivery. Two radiopaque markers are positioned to identify the exit ports of both lumens. The distance from the catheter tip (RX port) and OTW port varies depending on the catheter. Most contemporary DLMs have both an RX lumen, in which the distal port is at the distal tip of the catheter, and an OTW lumen, in which the distal port is located more proximally. Two additional DLMs are currently available outside the United States: FineDuo (Terumo Europe) and the Crusade (Kaneka Medical Products). There are currently five DLMs available in the United States and FDA approved for coronary use: Twinpass and Twinpass Torque (Teleflex), NHancer Rx (IMDS), Sasuke (Asahi Intecc USA, Inc.), and ReCross (IMDS). In this scenario, the subintimal wire (through the rapid-exchange port) acts as a guide and provides support to the second working wire (through the over the wire port) that can be manipulated to find the true lumen. DLMs may be helpful when a parallel wire technique is needed during antegrade CTO PCI. 6 DLMs have several useful applications when employed in the context of CTO PCI ( Table 1). 5 The presence of bifurcation lesions in the context of CTO, which occurs occasionally, increases the complexity of these lesions greatly. The technical success of CTO PCI has improved recently due to the development of novel techniques and devices, 1,5 however, the inability to cross the CTO remains the most common cause of failure. Chronic Total OcclusionsĬTOs still represent one of the most challenging lesion subsets for percutaneous intervention. DLMs can also provide additional support when rewiring difficult side branches through prior stent struts. This technique was first developed by Kawasaki et al in 2008, 4 but it has been modified to incorporate DLMs to facilitate wiring of narrow, angulated side branches. In this instance, a microcatheter-assisted reverse wire (RW) technique can be employed to facilitate wiring of the side branch. DLMs can be particularly helpful in challenging side branch wiring due to highly angulated (angles ≥ 150°) side branches, or those with unfavorable take-off angles when conventional wiring techniques have failed. 3 It remains one of the most challenging subsets of lesions, often due to difficulty in wiring of the side branch. Their application is most useful in the setting of PCI for bifurcation lesions, CTOs, and a combination of the two ( Table 1).Ĭoronary bifurcation PCI accounts for approximately 20% of all PCI procedures and is associated with increased procedural cost, higher complication rates, and worse outcomes. The role for DLMs is expanding and will likely continue to grow with the increase in complexity of PCI. Martins Filho from this issue for additional reading. 2 This article focuses on the currently available DLMs and their applications. However, all share the common feature of two distinct lumens to facilitate the precise handling of two separate guidewires. ![]() Each device has unique design characteristics. Several DLMs are currently available and the role for their utilization is expanding. 1 Dual lumen microcatheters (DLMs) have recently been introduced to further facilitate PCI of complex anatomy. The use of novel techniques and devices, such as microcatheters, has become essential in increasing the success rate of these more complex interventions. Additionally, there has been an uptake in the treatment of chronic total occlusions (CTOs), which pose a particular challenge for percutaneous revascularization as opposed to bypass. Patients undergoing PCI are older, have more comorbidities, prior coronary bypass grafts, and more heavily calcified and tortuous lesions that often involve coronary bifurcations. The complexity of percutaneous coronary intervention (PCI) in the current era has increased significantly. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |