Devices for treating coronary occlusions are under constant development; innovation in this field is very active.
In coronary intervention of such lesions, unknown coronary architecture represents a great problem that, even in the hands of experiences operators, can lead to the guidewire sticking in the subintimal space, unable to reach the true distal bed.
Complex re-entry techniques exist. Anoxia Inc. (USA), in collaboration with Dr Mauro Carlino, from Milan, have developed the coronary dilation Dual Guide Wire Balloon. The balloon is 20 mm long and comes in several diameters. It has a monorail distal port, for rapid exchange, and a coaxial port. When the guidewire reaches the subintimal space, the balloon is advanced (diameter selection according to vessel diameter) and is inflated in the subintimal space. Through the coaxial port, a polymeric guidewire of intermediate grammage is advanced and exits proximal to the balloon, the balloon is deflated, and several fenestrations are created in the tissue weakened by the dissection to facilitate passage to the distal true lumen.
This device is not yet commercially available to allow us to try it, although we have been performing such a technique for a while, using a conventional method without specific devices. Time and experience will tell if this is the solution for re-entry.
Palabras clave: fenestración anterógrada reentrada, oclusión coronaria crónica total. Keywords: antegrade fenestration re-entry, chronic total occlusion.