Treatment of in-stent chronic total occlusions with blunt microdissection.

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) can be a technical challenge with an average success rate much lower than other lesion types. In-stent restenosis CTOs have inherent features that may be favorable for using the blunt microdissection catheter and may help to improve procedural success. Two successful PCI cases of in-stent restenosis CTO using the blunt microdissection device are presented here. The respective lengths and durations of occlusions are: 40 mm and 1 year, 110 mm and 3 months. Both cases failed initial crossing attempts with conventional and specialized coronary guidewires. Only one other reported case study focused on native coronary in-stent restenosis CTO and the use of the blunt microdissection catheter. This current study presents the use of the blunt microdissection technique in both native coronary and bypass graft in-stent restenosis CTOs. This report adds to the overall experience with this promising approach to a subpopulation of CTO patients with in-stent restenosis.