ABSTRACT
The most important task when reopening a total occlusion is to gain guidewire access into the lumen immediately distal to the occluded segment. The idea to recanalize a difficult occlusion by creating a subintimal dissection which will reenter the true lumen of the vessel in a distal segment of the artery is the basic principle of a very much utilized technique in peripheral angioplasty of total occlusions. In the subintimal plane, the guidewire assumes a characteristic ‘wide loop’ configuration, the diameter of which will appear similar to or larger than the luminal diameter of the artery. The most appropriate vessel where the subintimal tracking and reentry approach is utilized is the right coronary artery. The fact that the right coronary artery has few important branches proximal to the crux makes this procedure suitable. The fact that long and multiple stents have been implanted may suggest extending the duration of double antiplatelet therapy.
