ABSTRACT
The antegrade advancement of wires through a chronic total occlusion (CTO) is not only dependent on the type of wires used but also on the utilization of several special techniques that can enhance procedural success. The seesaw wiring technique, another type of parallel wiring technique, should be called an ‘alternative parallel wiring’. When the wire is unable to be advanced in the hard CTO lesion, the guiding catheter and/or the support microcatheter necessarily gets pushed back during wire handling. Intravascular ultrasound sometimes plays an important role for procedural success of CTO, because it can provide us with the cross-sectional morphology and size information that we cannot obtain with fluoroscopy. Several specialized techniques can complement the classic single-wire manipulation in a CTO. The parallel wire technique takes advantage of the lessons learned during passage of the first wire into the subintimal space, and uses that wire as a continuous landmark.
