Antegrade Wire-based Fenestration and Channel Tracking Technique: A Novel Step-Forward Antegrade Approach for Coronary Chronic Total Occlusion Recanalization

Antegrade wiring is the preferred initial strategy for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), yet success may be limited in complex lesions.To present antegrade wire-based fenestration and channel tracking (AWF-CT), a novel antegrade technique facilitating true lumen CTO crossing.AWF-CT uses controlled proximal cap fenestration with a penetration wire, followed by softwire tracking through intraplaque microchannels, enabling physiological true lumen-to-true lumen crossing.AWF-CT is a simple, vessel-preserving antegrade strategy that may enhance CTO PCI success without increasing procedural risk.