Related Experiment Video
Updated: Jul 6, 2026
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Successful recanalization of in-stent coronary chronic total occlusion by subintimal tracking
Nae Hee Lee1, Yoon Haeng Cho, Hye Sun Seo
1Department of Cardiology, Soon Chun Hyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Gu, Bucheon 420-767, Korea. naeheelee@paran.com
Insights
Treating difficult chronic total occlusions (CTOs) from in-stent restenosis (ISR) can be challenging. A novel subintimal tracking technique successfully re-stented a challenging ISR-CTO case when other methods failed.
Area of Science:
- Interventional Cardiology
- Vascular Biology
- Biomedical Engineering
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) due to in-stent restenosis (ISR) presents significant technical challenges.
- Hard occlusive components within the stent lumen often impede guidewire advancement, limiting treatment success.
Observation:
- This case report details a novel approach to managing a complex ISR-CTO.
- The guidewire was successfully navigated subintimally, tracking along the outer aspect of the stent.
Findings:
- Successful re-stenting of the ISR-CTO was achieved using the subintimal tracking technique.
- This method facilitated crossing a previously impassable occlusion.
Implications:
- Subintimal tracking along the outside of the stent offers a viable alternative PCI strategy for ISR-CTO.
- This approach expands the interventional cardiologist's toolkit for complex coronary interventions.
Abstract:
Percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) caused by in-stent restenosis (ISR) is sometimes very difficult due to the presence of hard occlusive components that prevent wire passage. We report a case of CTO caused by ISR (ISR-CTO) in which the occlusion was crossed with the wire subintimally along the outside of the stent and was successfully re-stented. Subintimal tracking along the outside of the stent can be considered as another approach for PCI of ISR-CTO in cases where conventional approaches fail.