Rapid Entry and Advanced Coronary Handling (REACH) Technique: A Novel Use of the Guide Extension Catheter.

BACKGROUND

In complex percutaneous coronary interventions, the use of multiple coronary guidewires is often required. Delivering a second guidewire can be challenging and carries inherent risks, particularly in cases involving complex anatomy or bifurcation lesions where side branch recrossing is necessary after main branch stenting. Dual-lumen catheters may be used in such scenarios; however, device removal after wire delivery typically requires a guidewire extension or, preferably, a trapping balloon, techniques that are less commonly employed by many interventionalists.

AIMS: The Rapid Entry and Advanced Coronary Handling (REACH) technique is proposed as an alternative approach for complex wire delivery.

METHODS

It involves advancing a second guidewire through the cylinder of a guide extension catheter under fluoroscopic guidance, directly into the coronary segment engaged by the extension. The technique is described in detail, supported by step-by-step illustrations, a bench test, and recorded cases that demonstrate its various applications. A comprehensive overview of its advantages and limitations is provided.

CONCLUSION

In selected cases, the REACH technique may represent a reproducible and potentially cost-efficient alternative to the dual-lumen catheter for complex wire delivery. While limitations exist, its simplicity and practicality make it a valuable addition to the interventional toolkit.