Snare-Assisted LAceration of Subintimal Hematoma (SLASH): A Novel Technique for Side Branch Preservation in Bifurcation Chronic Total Occlusion Percutaneous Coronary Intervention.

Background: Side branch compromise due to extraplaque hematoma often complicates chronic total occlusion (CTO) percutaneous coronary intervention (PCI) involving a bifurcation at the distal cap.

Aims: To evaluate the feasibility and short-term outcomes of Snare-Assisted LAceration of Subintimal Hematoma (SLASH), a novel technique designed to mitigate this problem.

Methods: SLASH involves retrograde true lumen wiring across the distal bifurcation into a distal side branch, followed by successful antegrade dissection/re-entry into the same branch. A microsnare is then delivered antegradely and used to capture a retrogradely advanced externalization guidewire. Once snared, controlled traction is applied, inducing a longitudinal laceration of the vessel media and intima, which decompresses the subintimal hematoma at the bifurcation. We conducted a multicenter evaluation to assess the procedural feasibility and outcomes of this technique.

Results: SLASH was performed in 12 complex CTO PCI cases (mean J-CTO score 3.5 ± 0.67). SLASH was successful in 10 (83%) cases, while technical and procedural success was achieved in 9 (75%) cases. In 2 cases, SLASH was unsuccessful due to an inability to deliver the microsnare sheath or failure to snare the retrograde guidewire. No cases of coronary perforation, emergent surgery, or other major procedural complications were observed. In one case, retrograde wire entrapment at a distal graft anastomosis was successfully resolved with rotational atherectomy-induced wire fracture.

Conclusion: SLASH is a feasible and effective technique for hematoma decompression and revascularization in bifurcation CTO PCI. Further multicenter studies are warranted to validate its reproducibility, safety, and long-term efficacy.