title: The Difference Between Success and Failure: Subintimal Stenting Around an Occluded Stent for Treatment of a Chronic Total Occlusion Due to In-Stent Restenosis.
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.
authors: Department of Cardiology, King's College Hospital, Hambleden E Wing, Denmark Hill, London SE5 9RS, United Kingdom. jamesroy@nhs.net.
authors: James
authors: J
authors: Roy
authors: Andrew
authors: A
authors: Lucking
authors: Julian
authors: J
authors: Strange
authors: James C
authors: JC
authors: Spratt
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D054059:Coronary Occlusion / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D023903:Coronary Restenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017755:Prosthesis Fitting / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D015607:Stents / Q000009:adverse effects; D041623:Tomography, Optical Coherence / Q000379:methods; D016896:Treatment Outcome