Complete Revascularization of Multiple Coronary CTOs in a Single Session Using Hydrodynamic Contrast Recanalization

HDR is a novel CTO crossing technique that uses contrast modulation beyond the boundary of the proximal cap to facilitate the passage of polymer-jacketed wires. Reported advantages of HDR include a faster crossing time and side branch preservation. Using HDR, we recanalized multiple CTOs in an elderly patient in under 3 h, achieving single-session complete revascularization that improved clinical outcomes and minimized repeat procedural risks. This case highlights the potential role of HDR as a safe and efficient adjunct to conventional CTO PCI techniques in achieving optimal outcomes.