Double stick approach for chronic total occlusion of coronary arteries

To describe experience of double stick access to arterial system with contralateral injection of the opposite artery to visualize the distal cross filling vessel when a totally occluded vessel has no antegrade flow. Study Design: A Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Cardiology / National Institute of Heart Disease Rawalpindi from Jan 2009 to Aug 2010. Material and Methods: Retrospective analysis of 20 coronary angiograms performed for CTO at the cardiac catheterization laboratory of AFIC/NIHD were included in the study. Double stick access was gained through femoral artery in the groin 1cm apart. Results: Twenty patients with chronic total occlusions underwent PCI with contralateral injection technique. Out of them 70% were male and 30 % were female. The mean age was 53.65 years. Multivessel coronary artery disease was seen in 45% of patients. Left anterior descending artery lesion was present in 60%, while right coronary artery lesion in 40%. There was no LCX lesion. Single wire was used in 55% of cases while 40% required a second wire which was stiffer and heavier than the previous one. Pilot 50 was successful in 70% and 10 % required cross it 200. Predilation was done in all cases using multiple balloons. DES was used in 93.75 % cases of CTO. The procedure was successful in 80% while in 20% it was unsuccessful. There was no death during the procedure, nor any other peri procedural or access site complications. Conclusion: We conclude that double stick approach with contralateral injection is a safe and effective way to cross total occlusion. (author)