Hybrid 2.0: Subintimal plaque modification for facilitation of future success in chronic total occlusion percutaneous coronary intervention

Abstract

The Subintimal Tracking and Reentry (STAR) technique is not suitable for routine use during chronic total occlusion percutaneous coronary intervention due to side branch loss and long stent length, leading to high restenosis and re-occlusion rates.

Stuck Between a Rock and a Hard Place

“…A snare could have been used, but the risk of wire section was estimated to be high. The external subintimal plaque modification technique has been described in CTO PCI and used in the management of “balloon uncrossable” lesions ( 5 ). This CTO technique should be kept in mind as a bailout strategy in case of failure of standard retrieval techniques for entrapped RA burrs.…”

Get Out of Jail

“…4 This technique has initially been described in CTO PCI to manage balloon uncrossable and undilatable lesions. 5 These CTO skills should be kept in mind as a valuable bailout strategy when dealing with entrapped material in the coronary arteries, thus avoiding potentially morbid urgent surgery.…”

Angiographic Characteristics and Outcomes of Percutaneous Coronary Intervention of Reattempted Chronic Total Occlusion: Potential Contributing Factors to Procedural Success

“…Although a CTO-PCI failure in a dedicated session can be disappointing for the operator, the proximal cap modification as a consequence of attempting to cross the lesion or due to balloon dilatation can facilitate the way for a second attempt and may eventually increase the final success rate [ 13 ]. This is a bailout strategy known as SPM when the antegrade wire cannot successfully enter into true lumen and balloon dilatation in subintimal space is performed in order to restore some antegrade flow.…”