"Slipstream technique"-New concept of intravascular ultrasound guided wiring technique with double lumen catheter in the treatment of coronary total occlusions.

Intravascular ultrasound (IVUS)-guided guidewire manipulation technique is often useful to cross the lesion of chronic total occlusion (CTO) antegradely and solve retrograde CTO failure cases. However, this technique is usually complex because we need many devices and it requires many steps. Some steps usually take time and/or sometimes create a large dissection space which cause the procedure to fail. To overcome a weakness in this technique, we introduce the new IVUS-guided wiring technique with double lumen catheter named "Slipstream technique" here. This technique is simple, easy, and associated with less injury. It will be helpful for penetrating into the true lumen from the subintimal space with a guidewire correctly and safely. <Learning objective: IVUS-guided wiring technique in the treatment of chronic total occlusion is usually complex. The key point of new IVUS-guided wiring technique is to put both the IVUS catheter and double lumen catheter on the same wire. This manner is simple. Moreover, it will increase the stability of double lumen catheter and be helpful to manipulate the second guidewire effectively.>.