Knuckle Guidewires to Create Dissections in Chronic Total Occlusion Percutaneous Coronary Intervention: Position Statement.

Dissection and re-entry techniques are essential to achieve safe and effective chronic total occlusion recanalization. Several studies have demonstrated similar outcomes following extraplaque stenting compared with intraplaque stenting. Dissection techniques most often involve the use of knuckled wires to progress within and beyond the chronic total occlusion segment. In this expert consensus document, the authors compare the properties of different polymer-jacketed wires for their use in dissection techniques. The authors also describe 2 principal knuckle wire behaviors, the rolling and the traveling knuckles. Finally, several adjunctive techniques for safer dissection are described.

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Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr Rinfret has received consulting, speaker, and proctoring honoraria from Abiomed, Boston Scientific, Medtronic, and Teleflex. Dr Khatri has received consulting, speaker, and proctoring honoraria from Abbott, Medtronic, Terumo, Boston Scientific, and Shockwave Medical. Dr Mashayekhi has received consulting, speaker, and proctoring honoraria from Abbott Vascular, Abiomed, Asahi Intecc, AstraZeneca, Biotronik, Boston Scientific, Cardinal Health, Daiichi-Sankyo, Medtronic, OrbusNeich, Shockwave Medical, Teleflex, and Terumo. Dr Alaswad has received consulting, speaker, and proctoring honoraria from Boston Scientific and Teleflex. Dr Azzalini has received consulting fees from Teleflex, Abiomed, GE Healthcare, Abbott Vascular, Reflow Medical, and Cardiovascular Systems; serves on the advisory boards of Abiomed and GE Healthcare; and owns equity in Reflow Medical. Dr Vijayaraghavan has received consulting and proctoring fees from Acist, Abbott, Asahi Intecc, Medtronic, and Biotronik. Dr Frizzell has received consulting and speaker honoraria from Asahi Intecc, Boston Scientific, Medtronic, Reflow Medical, and Shockwave Medical. Dr Avran has received consulting, speaker, and proctoring honoraria from Abbott Vascular, Asahi Intecc, Biotronik, Boston Scientific, Medtronic, Shockwave Medical, Teleflex, and Terumo. Dr McEntegart has received consulting, speaker, and proctoring honoraria from Boston Scientific and Shockwave Medical. Dr Lombardi has received consulting fees from Asahi Intecc, Abiomed, Boston Scientific, Medtronic, Siemens, and Teleflex and has received royalties from Asahi Intecc; his spouse is a Philips employee. Dr Grantham has received speaking fees and honoraria from Boston Scientific, Medtronic, and Asahi Intecc; has received advisory board fees from Teleflex and Boston Scientific; and has received institutional research grants from Asahi Intecc, Abiomed, and Boston Scientific. Dr Brilakis has received consulting and speaker honoraria from Abbott Vascular, the American Heart Association (associate editor, Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, the Cardiovascular Innovations Foundation (Board of Directors), Cardiovascular Systems, Elsevier, GE Healthcare, IMDS, Medicure, Medtronic, Siemens, Teleflex, and Terumo; has received research support from Boston Scientific and GE Healthcare; is the owner or Hippocrates; and is a shareholder in MHI Ventures, Cleerly Health, and Stallion Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.