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Angiography revealed severe stenosis and a chronic dissection of the posterior lateral artery (PLA). PCI was performed via a 6 Fr right transradial guiding catheter. Initial intravascular ultrasound (IVUS) using OptiCross HD (Boston Scientific; 3.1 Fr outer diameter [OD], 20\u2009mm transducer\u2010to\u2010tip distance [TTD]) confirmed guidewire placement in the subintimal space within the extensive chronic dissection. TD\u2010ADR was successfully performed using the OptiCross HD IVUS and a low\u2010profile Carnelian MARVEL microcatheter (1.9 Fr OD), both accommodated within the 6 Fr guide. True lumen re\u2010entry was achieved, followed by balloon dilatation, side branch management, and successful drug\u2010eluting stent deployment in the main vessel, confirmed by final angiography and IVUS.<\/jats:p>","DOI":"10.1002\/ccd.70102","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T05:42:06Z","timestamp":1756100526000},"page":"2701-2707","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Successful Tip Detection\u2010Antegrade Dissection and Re\u2010Entry for Chronic Iatrogenic Coronary Artery Dissection Using a 6Fr Guiding Catheter: A Technical Challenge Overcome"],"prefix":"10.1002","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3223-1108","authenticated-orcid":false,"given":"Bayushi Eka","family":"Putra","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Sapporo Cardiovascular Clinic, Sapporo Heart Center Sapporo Japan"},{"name":"Department of Cardiology Berkah General Hospital Pandeglang, Kabupaten Pandeglang Banten Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2392-5084","authenticated-orcid":false,"given":"Umihiko","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Sapporo Cardiovascular Clinic, Sapporo Heart Center Sapporo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0566-4298","authenticated-orcid":false,"given":"Yutaka","family":"Tadano","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Sapporo Cardiovascular Clinic, Sapporo Heart Center Sapporo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3651-6231","authenticated-orcid":false,"given":"Tsutomu","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Sapporo Cardiovascular Clinic, Sapporo Heart Center Sapporo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,24]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-47444-7"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.25270\/jic\/23.00007"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV7I1A18"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcr\/ytae378"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacasi.2023.11.017"},{"key":"e_1_2_8_7_1","unstructured":"D.Hogan \u201cASAHI Corsair\u00ae Pro Microcatheter [Internet]. Asahi Intecc Medical | Your Dreams. Woven Together \u201d Asahi Intecc Medical (2022) https:\/\/asahi-inteccusa-medical.com\/product\/asahi-corsair-pro-microcatheter\/."},{"key":"e_1_2_8_8_1","unstructured":"Terumo Europe Middle East & Africa [Internet]. [cited 2025 Apr 28] https:\/\/www.terumo-europe.com\/en-emea."},{"key":"e_1_2_8_9_1","unstructured":"\u30c6\u30eb\u30e2\u30e1\u30c7\u30a3\u30ab\u30eb\u30ca\u30d3 [Internet]. [cited 2025 Apr 28] https:\/\/medical.terumo.co.jp\/authentication?url=\/equipment\/cardiovascular-intervention\/me419."},{"key":"e_1_2_8_10_1","unstructured":"OptiCrossTM [Internet].www.bostonscientific.com. [cited 2025 Apr 28] https:\/\/www.bostonscientific.com\/jp-JP\/products\/ultrasound-imaging-system\/OptiCross.html."},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvab183"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.15420\/icr.2024.04"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70102","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70102","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T06:01:29Z","timestamp":1771221689000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,24]]},"references-count":11,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1002\/ccd.70102"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70102","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,24]]},"assertion":[{"value":"2025-05-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}