"Subintimal external crush" technique for a "balloon uncrossable" chronic total occlusion

Area of Science:

• Cardiovascular Interventions
• Interventional Cardiology
• Vascular Biology

Background:

• Chronic total occlusion (CTO) revascularization is complex, with lesion crossing being a primary barrier.
• Failure to advance balloon catheters, termed "balloon uncrossable" CTO, represents a subset of challenging cases.
• Existing techniques may be insufficient for certain CTO morphologies.

Observation:

• A case of a "balloon uncrossable" CTO is presented.
• The inability to advance a balloon catheter to the lesion site was the limiting factor for revascularization.
• A novel approach was employed to overcome this specific challenge.

Findings:

• Successful balloon crossing was achieved after subintimal dilation.
• The "external crushing" technique significantly modified the CTO atheromatous plaque.
• This plaque modification facilitated subsequent balloon catheter advancement.

Implications:

• This case demonstrates a potential new strategy for treating "balloon uncrossable" CTOs.
• The "external crushing" technique may enhance CTO revascularization success rates.
• Further research is warranted to evaluate the broader applicability and long-term outcomes of this approach.