ABSTRACT
Successful recanalization of chronic total occlusions (CTOs) in native coronary arteries is no doubt one of the most technically challenging lesion subsets. This chapter focuses on issues related to major technical complications and solutions. The true incidence of guidewire-related coronary perforation is most likely higher than reported because some instances remain unrecognized and are self-limited. Coronary artery perforation represents a disruption of the vessel wall through the intima, media, and adventitia. Risk factors for coronary perforation during standard percutaneous coronary intervention can be classified as patient-related, procedure-related, and device-related risk factors. CTO lesions are one of the toughest lesions with severe calcifications. As technology advances, operators have tried crossing and clearing more difficult CTO lesions. When manipulating the stiff guidewire for CTO lesions, guidewires often enter into the subintimal space. Rough manipulation with wire could induce an intramural hematoma.
