Balloon-Assisted Hydrodynamic Contrast Recanalization in Chronic Total Occlusion Intervention.

IMAGE(S): The images show balloon-assisted hydrodynamic contrast recanalization (HDR) for chronic total occlusion (CTO) intervention. CASE SUMMARY: A 61-year-old man underwent percutaneous coronary intervention for a right coronary artery CTO with a J-CTO score of 3. After unsuccessful proximal cap penetration using high-penetration guidewires, a modified balloon-assisted HDR maneuver was performed using an over-the-wire balloon positioned at the proximal cap. Contrast injection through the balloon lumen facilitated successful guidewire crossing into the distal vessel. Final angiography and intravascular ultrasound confirmed successful recanalization. TAKE-HOME MESSAGE: Balloon-assisted HDR may facilitate localized contrast delivery during CTO intervention and represents a potential technical modification in selected cases.