Uncrossable and undilatable lesions-A practical approach to optimizing outcomes in PCI

Area of Science:

• Interventional Cardiology
• Vascular Biology
• Medical Device Technology

Background:

• Uncrossable lesions are a frequent complication in percutaneous coronary intervention (PCI), particularly in chronic total occlusions (CTOs).
• These lesions increase procedural complexity, time, radiation exposure, contrast use, and decrease success rates.
• They represent the second leading cause of PCI failure in CTO interventions.

Purpose of the Study:

• To present a pragmatic, algorithmic strategy for managing balloon-unைகrossable lesions during PCI.
• To detail contemporary techniques and equipment for addressing both uncrossable and undilatable lesions.
• To provide guidance for interventional cardiologists facing these challenging lesions.

Main Methods:

• Review of current literature and clinical experience with uncrossable and undilatable lesions.
• Description of an algorithmic approach, starting with simpler techniques and progressing to advanced strategies.
• Emphasis on utilizing modern interventional cardiology equipment and devices.

Main Results:

• Successful management of uncrossable lesions can be achieved through a stepwise, equipment-based approach.
• Contemporary techniques allow for effective lesion preparation even after initial guidewire crossing.
• The described strategy aims to improve procedural success rates and patient outcomes.

Conclusions:

• A structured, algorithmic approach is crucial for managing balloon-unைகrossable lesions in PCI.
• Modern interventional tools enhance the ability to successfully treat complex and resistant arterial lesions.
• Addressing uncrossable and undilatable lesions effectively improves PCI outcomes.