Subintimal angioplasty in coronary CTO

This chapter presents the basics of subintimal angioplasty in different techniques for the chronic total occlusion (CTO) percutaneous coronary intervention. A detail about the coronary anatomy is fundamental in the CTO intervention and essential to success. Subintimal angioplasty aims to create a channel between the intima and the media using an intentional dissection. Subintimal angioplasty techniques should be reserved mainly for the right coronary artery and possibly the circumflex. Several techniques use the subintimal angioplasty approach. Both antegrade and retrograde approaches have been described using this concept. The chapter describes the most currently used re-entry techniques by CTO operators. Anterograde STAR must be performed only in vessels with side branches distal to the expected re-entry site. Regardless of benefits, re-entry techniques are inherently complex and potentially dangerous in non-expert hands.