Figure 8: “Back-up” using a guide catheter to treat a patient with a CTO with no dimple in the ostial LAD.
In patients with ostial LAD CTOs and no dimpling, it is easy for the wire tip to fall out of position at the target perforation point. Similarly, when back-up doesn’t work and it is hard to penetrate the distal fibrous cap, you can make your penetration by inserting a J1 short tip deep into the CTO, getting it co-axial to the lesion and using back-up.