Re-entering the true lumen after an antegrade wire has gone subintimal is one of the most challenging parts of chronic total occlusion work. It is equal parts planning, technical skill, and adaptability. This guide walks through practical options, preparation, device use, and troubleshooting to help...
The moment your antegrade wire slips into the subintimal space is one of the most common and challenging junctions in chronic total occlusion work. This is where technique, planning, and calm decision making separate a controlled re-entry from a prolonged, futile battle. The goal is...
This article explains a reproducible method to fashion a snare using a guide catheter extension and an angioplasty balloon for retrieval or bailout maneuvers during percutaneous procedures. The technique is useful when a dedicated loop snare is unavailable or when additional reach and direction control...
The Live Bailout Technique is a pragmatic, on-the-spot method to create a covered stent when a factory-made covered stent is not immediately available in the catheterization laboratory. I use this approach occasionally as an emergency bailout for coronary perforation. The aim is simple: convert two...
Cannulating coronary arteries is a fundamental skill in interventional cardiology. Precision, patience, and small technical adjustments often make the difference between a smooth, safe angiogram and a difficult or potentially traumatic attempt. This guide collects practical tips and tactical maneuvers for engaging the left and...
Chronic total occlusions of the right coronary artery are often deceptively simple on one view and complex on another. The procedural plan must balance anatomy, collateral supply, and the risk of losing important branches such as the posterior descending artery. This case illustrates a stepwise...
A Complete and Patient-Friendly Guide You Can Trust Heart blockages are scary — especially when your doctor says the words “CTO” or “Complex PCI.”Patients often imagine that these are “bigger,” “riskier,” or “risk-means-danger” procedures. But here’s the truth: ➡️ Today, CTO-PCI and Complex PCI are safer, more successful,...
Percutaneous coronary intervention (PCI) has advanced dramatically in the last decade, especially in the management of chronic total occlusions (CTOs). At the same time, planned complex non-CTO PCI has also evolved, driven by newer-generation stents, high-definition intravascular imaging, and more experienced operators. In 2025, interventional cardiologists...
Coronary PCI with an Indegenous IVL is becoming an essential strategy for tackling heavily calcified coronary lesions. In this article I, representing Interventional Strategies, describe our practical experience, device characteristics, imaging-guided decision making, and case-based outcomes using a locally produced intravascular lithotripsy (IVL) catheter. This...
In this detailed clinical discussion, Dr. Sharath Reddy, a consultant cardiologist, takes us through a complex case of chronic total occlusion (CTO) of the right coronary artery (RCA) in a post-coronary artery bypass graft (CABG) patient. The focus is on the application of facilitated antegrade...
