Abstract
We present a case where conventional wire and equipment passage through the proximal cap of a chronic total occlusion due to in-stent restenosis was not possible. The lesion was then safely and successfully treated by deliberate passage into the subintimal space outside the previous stent with subsequent subintimal dissection and reentry into the true lumen beyond the occlusion. We then stented around the occluded stent, effectively crushing the previous stent in the true lumen and restoring flow by stenting open the new subintimal lumen. Follow-up angiography and optical coherence tomography at 6 months demonstrated good medium-term results.
MeSH terms
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Angioplasty, Balloon, Coronary / adverse effects
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Angioplasty, Balloon, Coronary / instrumentation
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Angioplasty, Balloon, Coronary / methods
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Coronary Occlusion* / diagnosis
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Coronary Occlusion* / etiology
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Coronary Occlusion* / physiopathology
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Coronary Occlusion* / surgery
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Coronary Restenosis* / diagnosis
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Coronary Restenosis* / physiopathology
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Coronary Restenosis* / surgery
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Coronary Vessels* / diagnostic imaging
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Coronary Vessels* / pathology
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Coronary Vessels* / surgery
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Humans
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Intraoperative Complications* / diagnosis
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Intraoperative Complications* / etiology
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Male
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Middle Aged
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Prosthesis Fitting* / adverse effects
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Prosthesis Fitting* / instrumentation
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Prosthesis Fitting* / methods
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Stents / adverse effects
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Tomography, Optical Coherence / methods
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Treatment Outcome