Tip Detection–Antegrade Dissection and Re-Entry With New Puncture Wire in CTO Intervention: Revolution Through 3D-Wiring

Kota Tanaka, Atsunori Okamura, Ryouhei Yoshikawa, Etsuo Tsuchikane, Masato Ishikawa, Satoshi Suzuki, Hiroyuki Nagai, Akinori Sumiyoshi, Masatsugu Kawahira, Tomohiro Yamasaki, Hiroaki Matsuda, Mutsumi Iwamoto, Satoshi Watanabe, Keita Yamasaki, Nobuaki Tanaka, Yasushi Koyama, Yoshitaka Iwanaga, Heitaro Watanabe

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: The authors devised the tip detection (TD) method and developed AnteOwl WR intravascular ultrasound to standardize intravascular ultrasound–based 3-dimensional wiring for intraplaque tracking in chronic total occlusion (CTO)–percutaneous coronary intervention (PCI). The TD method also allowed antegrade dissection and re-entry (ADR). Combining TD-ADR with Conquest Pro 12 Sharpened Tip (CP12ST) wire, a new ADR wire with the strongest penetration force developed to date, enabled re-entry anywhere except calcification sites. Objectives: This study investigated the efficacy and feasibility of TD-ADR by comparison of procedural outcomes with Stingray-ADR in CTO-PCI. Methods: Twenty-seven consecutive CTO cases treated by TD-ADR with CP12ST wire between August 2021 and April 2023 and 27 consecutive CTO cases treated by Stingray-ADR with Conquest 8-20 (CP20) wire between March 2018 and July 2021 were retrospectively enrolled as the TD-ADR by CP12ST wire group and Stingray-ADR by CP20 wire group, respectively, from 4 facilities that could share technical information on these procedures. Results: The success rate of the ADR procedure was significantly improved (27 of 27 cases [100%] vs 18 of 27 cases [67%], respectively; P = 0.002) and total procedural time was significantly reduced (median procedural time: 145.0 [Q1-Q3: 118.0-240.0] minutes vs 185.0 [Q1-Q3: 159.5-248.0] minutes, respectively; P = 0.028) in the TD-ADR by CP12ST wire group compared to the Stingray-ADR by CP20 wire group. There were few in-hospital major adverse cardiac and cerebrovascular events or no complications in either group. Conclusions: TD-ADR by CP12ST wire can standardize highly accurate ADR in CTO-PCI.

Original languageEnglish
Pages (from-to)359-372
Number of pages14
JournalJACC: Asia
Issue number5
Publication statusPublished - 05-2024

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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