An algorithmic approach to balloon‐uncrossable coronary lesions. Issue 6 (31st August 2020)

• Record Type: Journal Article
• Authors: Elrayes, Mahmoud M.; Xenogiannis, Iosif; Nikolakopoulos, Ilias; Vemmou, Evangelia; Wollmuth, Jason; Abi Rafeh, Nidal; Karmpaliotis, Dimitri; Gasparini, Gabriele L.; Burke, Martin Nicholas; Brilakis, Emmanouil S.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 97:Issue 6(2021)
• Page Start: E817
• Page End: E825
• Publication Date: 2020-08-31
• Subjects: atherectomy -- balloon‐uncrossable -- CTO -- laser -- PCI; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.29215
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Balloon uncrossable coronary lesions are lesions that cannot be crossed with a balloon after successful guidewire crossing. The strategies used to facilitate the treatment of such lesions can be classified into strategies that provide lesion modification and strategies that increase support. We describe a systematic, algorithmic approach to treat balloon uncrossable lesions, starting with use of small balloons, followed by increase in guide catheter support, use of microcatheters, wire cutting or puncture techniques, laser, atherectomy, and subintimal modification techniques. Sequential and simultaneous application of the aforementioned techniques can result in successful treatment of these challenging lesions.