For a while now, several models of dual-lumen microcatheters have been available to interventional cardiology units to address common problems that occur in everyday practice. These devices can be used in certain bifurcations to access difficult-to-reach side branches with unfavorable angles, in complex coronary dissections, and, above all, in interventions for chronic total occlusion to facilitate the LAST (limited antegrade subintimal tracking) technique1. The dual lumen microcatheters that are currently available are characterised by a rapid exchange monorail lumen that runs to the tip of the catheter and a coaxial lumen with lateral exit port.
A different microcatheter is available, with two coaxial lumens (RECROSS; IMDS); one of these runs to the tip of the microcatheter and the other runs to two lateral exit ports at 8 and 12 mm from the tip, positioned 180° from each other. This modification solves one of the problems of conventional microcatheters when the lateral port is not directed toward the area of interest: the ostium of the side branch, the true lumen in a dissection, or intraplaque in an occluded segment. Having a second port facing the opposite direction allows the user to withdraw the coronary guidewire via the opposite side while still looking at the area of interest.
This microcatheter has a 1.5 Fr tip, hydrophilic coating and a stylet for increased support and access to more difficult areas.
Nonetheless, whenever using these devices, it is essential to have a good three-dimensional orientation of the architecture of the vessel we are working in, to obtain the maximum efficiency from the microcatheter.
References
1 . Michael TT, Papayannis AC, Banerjee S, Brilakis ES. Subintimal Dissection/Re-entry Strategies in Coronary Chronic Total Occlusion Interventions. Circ Cardiovasc Interv. 2012;5:729–738.
Keywords Chronic total occlusions, microcatheter, dual-lumen microcatheter, rre-entry
