J Cardiovasc Interv.  2025 Apr;4(2):81-95. 10.54912/jci.2024.0032.

Managing Balloon-Uncrossable and Undilatable Coronary Lesions: Unravelling the Mystique

• Dash D
• Mody R
• Dash U
• Hasanfatta N

• KMID: 2566689
• DOI: http://doi.org/10.54912/jci.2024.0032

Abstract

Uncrossable lesions are defined as stenoses that cannot be crossed with a balloon despite successful guidewire crossing. These lesions are commonly observed in calcified and tortuous arteries, as well as in chronic total occlusions (CTOs), posing significant technical challenges. They are the second most common cause of percutaneous coronary intervention (PCI) failure in CTO cases, with the primary cause being the failure of the guidewire to cross the CTO segment. PCI procedures involving these lesions typically require longer procedural times, increased radiation exposure, and greater volumes of contrast, all while offering a reduced chance of procedural success. Furthermore, some of these lesions may remain difficult to dilate and prepare for stent placement even after they have been crossed. The authors propose a novel approach to facilitate the crossing of such balloon-uncrossable and undilatable lesions.

Keyword

Percutaneous coronary intervention; Stents; Atherectomy; Lasers