Subintimal Angioplasty in Coronary CTO

This chapter presents the basic rationale behind subintimal angioplasty and overviews the different techniques related to this approach. The aim of subintimal angioplasty is to create a channel between the intima and the media by means of an intentional dissection. The use of this approach for the left anterior descending artery is not recommended and should be restricted to specific situations and highly experienced operators. Several techniques use the subintimal angioplasty approach. Both antegrade and retrograde approaches have been described using this concept. The chapter describes briefly the most currently used re-entry techniques by chronic total occlusion (CTO) operators. The techniques are Subintimal Tracking And Re-entry (STAR) technique, Controlled Antegrade and Retrograde subintimal Tracking (CART) technique, reverse CART, Limited Antegrade Subintimal Tracking (LAST) technique, intravascular ultrasound (IVUS) technique, and Knuckle-wire technique.