Subintimal Dissection/Reentry Strategies in Coronary Chronic Total Occlusion Interventions

 Tesfaldet T. Michael, MD, MPH; Aristotelis C. Papayannis, MD; Subhash Banerjee, MD; Emmanouil S. Brilakis, MD, PhD

Subintimal dissection/reentry techniques are increasingly being used for crossing coronary chronic total occlusions both antegradely (using a knucle wire or the Bridgepoint system) or retrogradely (using the controlled antegrade and retrograde tracking and dissection, and reverse controlled antegrade and retrograde tracking and dissection technique). Subintimal dissection/reentry techniques can increase procedural success rates, but their subsequent clinical outcomes are poorly studied, and they appear to be associated with high rates of in-stent restenosis and repeat target lesion revascularization. In the present review, we describe in detail the chronic total occlusions subintimal dissection/reentry techniques, clarify the related terminology and summarize the published studies in this area and the current gaps of knowledge.

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