Rapid Entry and Advanced Coronary Handling (REACH) Technique: A Novel Use of the Guide Extension Catheter

Abstract

Background In complex percutaneous coronary interventions, the use of multiple coronary guidewires is often required. Delivering a second guidewire can be challenging and carries inherent risks, particularly in cases involving complex anatomy or bifurcation lesions where side branch recrossing is necessary after main branch stenting. Dual-lumen catheters may be used in such scenarios; however, device removal after wire delivery typically requires a guidewire extension or, preferably, a trapping balloon, techniques that are less commonly employed by many interventionalists.Aims The Rapid Entry and Advanced Coronary Handling (REACH) technique is proposed as an alternative approach for complex wire delivery.Methods It involves advancing a second guidewire through the cylinder of a guide extension catheter under fluoroscopic guidance, directly into the coronary segment engaged by the extension. The technique is described in detail, supported by step-by-step illustrations, a bench test, and recorded cases that demonstrate its various applications. A comprehensive overview of its advantages and limitations is provided.Conclusion In selected cases, the REACH technique may represent a reproducible and potentially cost-efficient alternative to the dual-lumen catheter for complex wire delivery. While limitations exist, its simplicity and practicality make it a valuable addition to the interventional toolkit.