An algorithmic approach to balloon-uncrossable coronary lesions.

Area of Science:

• Interventional Cardiology
• Vascular Medicine

Background:

• Balloon uncrossable coronary lesions pose a significant challenge in percutaneous coronary intervention.
• These lesions resist balloon passage even after successful guidewire crossing.

Purpose of the Study:

• To present a systematic, algorithmic approach for treating balloon uncrossable coronary lesions.
• To outline strategies for lesion modification and enhanced support.

Main Methods:

• The approach begins with small balloons and progresses to increased guide catheter support.
• It includes advanced techniques like microcatheters, wire cutting/puncture, laser, atherectomy, and subintimal modification.
• Both sequential and simultaneous application of techniques are described.

Main Results:

• The described algorithmic approach facilitates the successful treatment of challenging balloon uncrossable coronary lesions.
• A range of techniques, from basic to advanced, are employed to overcome lesion resistance.

Conclusions:

• A structured, algorithmic strategy is effective for managing balloon uncrossable coronary lesions.
• The combination of lesion modification and support enhancement techniques ensures successful intervention.