Endovascular recanalization of chronic total occlusion of the subclavian artery: fifteen years of technological evolution

Fifteen years ago, endovascular recanalization of chronic total occlusion of the subclavian artery relied largely on coronary guidewires and conventional catheters. An early series achieved technical success in 46 of 56 patients (82.1%). Today, dedicated crossing wires, support catheters, improved imaging, and a wider choice of stents provide additional options for complex lesions. Yet published series report variable technical success and patency, and differences in patient selection and follow-up limit comparisons between treatment eras. This review revisits earlier techniques, examines what has changed in practice, and discusses persistent challenges, particularly heavily calcified and ostial occlusions near the vertebral artery. Technological progress has broadened treatment options, but its independent contribution to long-term outcomes remains uncertain.