Prevalence, Presentation and Treatment of ‘Balloon Undilatable’ Chronic Total Occlusions: Insights from a Multicenter US Registry

Abstract

Balloon undilatable CTOs are common and are associated with lower success and higher complication rates.

Coronary lithotripsy for failed rotational atherectomy, cutting balloon, scoring balloon, and ultra‐high‐pressure non‐compliant balloon

“…On the one hand, orbital atherectomy (OA) is discouraged in the setting of ISR lesions, whereas laser atherectomy (ELCA) is attractive in ISR but underused in de novo lesions due to the risk of dissections or perforations. On the other hand, RA is effective in both settings, although is related to higher risk for complications in ISR . Furthermore, intravascular imaging plays an essential role in the management of calcified lesion, providing pivotal information including calcium deposits location and distribution, optimal/suboptimal vessel preparation, stent sizing, and optimization …”

“…Recently, Tajti et al created an algorithm including all devices and techniques available for the management of undilatable stenosis in CTO PCI . According to that algorithm, ELCA could have been a valid tool in such a case for plaque modification, although not available in our institute.…”

Coronary chronic total occlusions: How to dilate the tough ones

“…Tajti et al in the present issue of the Journal have highlighted a number of characteristics of balloon undilatable CTO lesions and their relationship with procedural outcomes. The authors defined them as those that could not be expanded despite multiple balloon inflations with a 1:1 sized balloon at a maximum inflation pressure up to 20 atm after successful guidewire crossing, and balloon advancement within the target lesion.…”

“…The authors highlight the utilization of escalation of therapies and their success rates in these complex lesions with a particular mention of perforation importance, avoidance, and treatment ). Indeed, this is the most feared complication of a CTO intervention.…”

Intravascular lithotripsy for stent under‐expansion: Panacea or Pandora's box?

“…Balloon undilatable lesions are lesions that fail to expand despite highpressure balloon inflations. Balloon undilatable lesions are common (they represented 12% of chronic total occlusion percutaneous coronary interventions[PCI] in one series)1 and usually occur in the setting of severe calcification. Balloon undilatable lesions can be challenging to treat, especially when they occur within a previously placed stent, which is why ensuring adequate lesion expansion is critical prior to stent implantation.…”