Contemporary outcomes of percutaneous intervention in chronic total coronary occlusions due to in-stent restenosis.

BACKGROUND: Limited data exist on the treatment of chronic total occlusions (CTO) due to in-stent restenosis (ISR). METHODS: We reviewed the procedural techniques and outcomes of 21 consecutive interventions in CTOs due to ISR. RESULTS: Mean age was 60±8 years, and all patients were men. The target lesion was located in the right coronary artery in 38%, left anterior descending or diagonal in 48%, or circumflex/obtuse marginal in 14%. One CTO lesion was treated in each patient. Two patients (10%) had prior unsuccessful attempt for CTO intervention and 14% had prior coronary artery bypass graft surgery. The average CTO age was 6.3±4.6 years. The overall ISR CTO procedural success rate was 71%. Procedural failure was due to inability to cross the CTO lesion in all unsuccessful cases. Failure to cross in CTOs located in the left anterior descending artery was due to the presence of a large side branch proximal to the CTO, whereas in the right coronary artery it was due to tortuosity. Retrograde interventions were attempted in four patients and were successful in one. CONCLUSION: Success rates for ISR CTO interventions remain relatively low due to failure to cross the lesion. Several factors, such as long occlusion time, tortuosity, and presence of a large side branch proximal to the CTO may be associated with ISR CTO crossing failure.

Use of the Stingray guidewire and the Venture catheter for crossing flush coronary chronic total occlusions due to in-stent restenosis.

We report two cases of flush chronic total occlusion due to in-stent restenosis, in which percutaneous coronary intervention attempts via over-the-wire balloons and microcatheters failed to cross the lesion. Using the Venture catheter for support and the Stingray guidewire for enhanced penetration capacity, both lesions were successfully crossed and stented.