8 March, 2025

Case Study: Antegrade CTO PCI Using Asahi Gaia Next 2 Guidewire and Recross Re-Entry Catheter

Introduction Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI) is a complex procedure requiring advanced techniques and high-precision devices. The evolution of guidewires and re-entry catheters has significantly enhanced procedural success rates, especially in challenging cases. This case study explores the utilization of the newly launched Asahi Gaia Next 2 guidewire and Recross re-entry catheter in an antegrade CTO PCI approach.

Case Summary

A 67-year-old obese multimorbid female with progressive angina was diagnosed with multivessel coronary artery disease (CAD) and moderate left ventricular (LV) dysfunction. She had a long-segment calcified CTO in the distal right coronary artery (RCA) with an ambiguous proximal cap and a distal landing zone at a bifurcation. Given the anatomical challenges, a strategic antegrade technique with bilateral femoral access was planned.

Procedural Strategy

The PCI procedure was executed using the Antegrade Wire Escalation (AWE) approach, followed by Antegrade Dissection and Re-entry (ADR) to achieve revascularization.

Step 1: Initial Wire Escalation Strategy

The procedure commenced with:

• Fielder XT-A guidewire supported by a Finecross microcatheter to navigate through the lesion. However, advancement was difficult due to extensive calcification.
• Guidewire escalation was performed using the newly launched Asahi Gaia Next 2 to improve penetration through the calcified occlusion.

Step 2: Subintimal Tracking and ADR Using Recross Re-Entry Device

• Despite guidewire escalation, the lesion required an ADR approach due to the complexity of the occlusion.
• The Recross re-entry catheter was introduced to facilitate controlled dissection and re-entry at the appropriate distal site.
• Gaia Next guidewire was used for precision re-entry into the true lumen.

Step 3: Stenting and Final Outcome

• Once successful re-entry was achieved, pre-dilatation was performed with a balloon catheter, followed by drug-eluting stent placement to ensure vessel patency.
• The final angiogram revealed excellent TIMI 3 flow, and the patient had an uneventful post-procedural recovery.

Discussion: Challenges and Solutions

Challenge 1: CTO with Ambiguous Proximal Cap

The patient’s CTO lesion had an ambiguous proximal cap, making initial penetration difficult. The Asahi Gaia Next 2 guidewire proved advantageous due to its controlled penetration capability and enhanced tactile feedback.

Challenge 2: Long-Segment Calcification

Heavy calcification often limits wire progression. The Finecross microcatheter helped deliver the guidewire more effectively, and wire escalation using Gaia Next 2 allowed enhanced lesion traversal.

Challenge 3: Distal Landing Zone at Bifurcation

A controlled re-entry technique was necessary to prevent distal branch compromise. The Recross re-entry device provided precise re-entry at the desired location, reducing the risk of dissection propagation and side branch loss.

Key Takeaways

1. Guidewire Selection is Critical: The Asahi Gaia Next 2 guidewire demonstrated superior penetration and control in a heavily calcified lesion.
2. Microcatheter Support Enhances Wire Control: The Finecross microcatheter facilitated optimal wire positioning for crossing the CTO.
3. Recross Re-Entry Catheter Provides Precision in ADR: The device enabled successful re-entry while preserving the distal bifurcation anatomy.
4. Bilateral Access is Essential for Complex CTOs: This approach allowed better visualization and wire manipulation.

 

Consultation Location