Limited antegrade subintimal tracking (LAST)

Limited antegrade subintimal tracking (LAST)

Limited antegrade subintimal tracking: Subintimal tracking is often resorted to cross chronic total occlusions (CTO). A relatively stiff wire is pushed gradually till it forms a knuckle (loop) subitimaly beyond the distal end of the lesion. After that re-entry is achieved using a wire with an acute distal bend [1]. The long term results of the technique and potential adverse outcome like restenosis and aneurysm formation are yet to be available.

In the case reported, by Michael TT et al [1], Fielder XT (Asahi Intecc) wire was advanced until a knuckle formed at its tip, which crossed into the subintimal space of the chronic total occlusion. Then a Confianza Pro 12 (Abbott Vascular) guidewire was used to re-enter the distal true lumen. It may be noted that an initial attempt with a Confianza Pro 12 had failed to cross the chronic total occlusion. Occasionally with the help of a Venture catheter (St Jude, Minneapolis Minnesota) is needed for Confianza Pro 12 to cross the lesion by the LAST technique.

LAST technique was mentioned by Lombardi WL in an article in Journal of Invasive Cardiology in 2009 as a personal communication from Craig Thompson [2] along with other methods of retrograde PCI.

Reference

  1. Michael TT, Papayannis AC, Banerjee S, Brilakis ES. Subintimal dissection/reentry strategies in coronary chronic total occlusion interventions. Circ Cardiovasc Interv. 2012;5:729-38.
  2. Lombardi WL. Retrograde PCI: what will they think of next? J Invasive Cardiol. 2009 Oct;21(10):543.