Analysis reveals effective strategies for managing uncrossable coronary chronic total occlusions, suggesting interventions minimize radiation exposure.
During percutaneous coronary intervention, one of the most difficult lesions to treat is a coronary chronic total occlusion (CTO). A substantial number of these CTOs-up to 9% of cases are uncrossable lesions, which are impassable with conventional guidewires, balloons, or microcatheters. Because these lesions are frequently calcified and tortuous, there is a higher likelihood of procedural failure, longer procedure times, and increased radiation exposure. The management of uncrossable lesions follows a systematic approach, beginning with initial strategies like improved guide catheter support and microcatheter use, and is followed by second-line plaque modification techniques like laser, rotational and orbital atherectomy. Third-line strategies, such as dissection re-entry, are employed as a last option. This article provides an in-depth analysis of the different methods and tools available for treating uncrossable CTO lesions.
No takes yet. Share an insight, caveat, or question.
Dash et al. (2026) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: