Novel 'crowbar effect' approach to improve success rate of recanalization of coronary chronic total occlusions

Background Coronary chronic total occlusions (CTO) are the most challenging lesions to treat percutaneously. Thus, consistent efforts are made to develop new approaches to treat CTO. Objective To explore the key points of a novel ``crowbar effect'' approach to improve the success rate of recanalization of CTOs. Methods One hundred and fifty-seven patients with CTO were treated with PCI using the regular antegrade guide wire approach. Of them, 36 patients (22.9%) showed that while the first guide wire was inserted into the CTO lesions, a small balloon had difficulty passing through the CTO lesions. For those patients, the new crowbar effect technique was used to allow the balloon to pass through the lesions. Results The coronary CTO vessels in 35 patients (97.2%) were completely opened. Coronary perforation occurred in 5 patients (13.8%). This perforation was properly treated and did not lead to serious complications. Conclusion The crowbar effect technique proved successful as an alternative antegrade method for opening CTO. The procedure of this novel method is easy to accomplish and success rates are high.