Iterative steerable sharp recanalization as an escalation strategy for chronic venous stent occlusions

Chronic venous stent occlusions represent a difficult subset of venous disease which can result from endothelialized stent struts, dense neointimal hyperplasia, and loss of a discernible intraluminal channel. These occlusions can lead to symptoms of recurrent venous hypertension, debilitating extremity symptoms, or loss of vascular access. Conventional blunt recanalization techniques frequently fail, as guidewires deflect into subintimal planes or collateral pathways or are unable to traverse dense, organized thrombus. These cases necessitate escalation to sharp recanalization strategies. The report describes sharp recanalization of chronic in-stent venous occlusions using the TipsStar Steerable Cannula.