Hydraulic Exchange Technique: super useful in complex PCI/CTO work. Quick way to get a microcatheter off a short wire without a 300cm wire, trapper, or trapping balloon. Connect an indeflator to the microcatheter, pressurize to 20 atm (it drops constantly, so keep bumping it back up), and just open... the Touhy and microcatheter will come out right away. The hydraulic force pushes the catheter back on its own while keeping the wire in position. I don’t do it over a hydrophilic wire as it can jump forward and cause a tip perforation. I use a workhorse wire. Video below Credit to J Aaron Grantham JAG for teaching me such valuable skills! TCTME+ Altayyeb Yousef Wail AlkashkariFSCAI,FPICSوائل القشقرى🇸🇦🇨🇦🇺🇲 MIЯVΛƬ #IC ༄ ｡° Amr Mohsen, MD Aref BinAbdulhak MD MSc Marwan Saad Abdallah El Sabbagh Musa A. Sharkawi David J. Cohen, MD, MSc Mohammed Qintar, MD MSc Muhammad Hammadah Mohammed Al-Hijji Juan Del Cid Fratti MD MSc Anton Camaj, MD Cardiovascular Research Foundation David J. Cohen, MD, MSc Mamas A. Mamas Cardiovascular Research Foundation Hooman Bakhshi Abdelkader Almanfi, MD, FACC, FSCAI إبراهيم الحربي Ibrahim Alharbi scottiejj12 Dr Alo, DO, FACCshow more

Yes and More common Name is "NANTO's TECHNIQUE" published in 1994 ..

Great technique Anas! 👏🏼 I learnt it from my colleague, @Dhoble7. It is a variation of Nanto’s technique. You can use it with PJWs too - but only if there is a ‘safety knuckle’ at the tip. Re: mechanism, it’s fascinating: Newton’s third law + fluid dynamics (drag!) in action. 😀 It works because the wire cannot move forward, so the MC must move back! The next level of this technique is burr retrieval using Dynaglide during single-operator rota!!!

The Nanto technique (per Dr. Nanto) was widely used (at least in Japan) before modern trapping balloons became available. I always used this technique when I was in Japan.

That's pretty much my standard technique, i dont bother using trapping balloons etc

Thanks! This is much better. We used to do it with a 10 ml syring while constantly injecting saline

Brilliant

Hi. This is an useful technique. A more simpler technique is to use a 3 cc syringe with contrast and connect it to the micro catheter and inject. This is much simpler and easy to use.

@AdityaMandawat Nanto technique

A technique for changing a ptca balloon catheter over a regular‐length guidewire - Nanto - 1994 - Catheterization and Cardiovascular Diagnosis - Wiley Online Library

Thank you to Dr Nantos who popularized this technique

If this is a reliable technique, shouldn’t the type of wire not matter?

No technique in interventional cardiology is bulletproof. Trapping balloons can rupture or slip, trappers can lose grip if hemostasis isn’t tight. Same principle applies to hydraulic exchange: know the limitations, use it in the right setting and with the right equipment!

Nanto's technique

@cathlabedu Very cool technique! Works extremely well from firsthand experience. Some interventionalists prefer the trapper method but this is quick and low risk.

@Obisht No matter wether it is hydrophilic or hydrophobic. Only the thing is micro catheter ox or N. The newtons third low of motion is the priciple behind it.

This is known as NANTO technique and we are using it for past 8 years

Yes it does. We are using this for past 6 years and is known as NANTO TECHNIQUE similarly one can advance MC over already parked wire by attaching an empty 10 cc syringe at its back and continuously creating a negative pressure like one use in thrombus aspiration catheter.

How about air bubbles?

@Umair2017