Intravascular ultrasound-guided recanalization of a coronary chronic total occlusion located in a stent implanted subintimally: a case report.

Successful percutaneous recanalization of coronary chronic total occlusion (CTO) results in improved survival, as well as enhanced left ventricular function, reduction of angina, and improved exercise tolerance. The procedural success rate has increased over time, but CTO recanalization does still fail in about 20% of cases. Different strategies and specific devices for CTOs have been developed with various degrees of success. We report the case of CTO after a first unsuccessful treatment attempt during which subintimal wire positioning without reentry into the distal lumen, and stent implantation were done. At the second revascularization, intravascular ultrasound guidance allowed reentry of the distal true lumen through the stent, restoring normal flow.