Support with a twist: New approaches in CTOs and complex lesions.

One-third of patients undergoing coronary angiography have coronary chronic total occlusions (CTOs) with the incidence increasing with age. Successful recanalization of a CTO is associated with a reduction in the future need for coronary artery bypass graft surgery (CABG), improvement in left ventricular function, and angina status as well as long-term survival. Success rates for treating CTOs with conventional techniques have remained unchanged over time averaging 65%-70% in experienced hands, well below the success rates for non-occlusive coronary lesions. The antegrade approach is utilized in standard balloon angioplasty. Modification of this technique has been used with an anchoring balloon to more successfully open up CTOs. We describe a new device that in addition to allowing increased support, also centers one in the lumen for both coronary and peripheral intervention. <Learning objective: Coronary total occlusions (CTOs) are the biggest reason patients are sent for coronary bypass when multi-vessel coronary disease is found. In most peripheral artery disease (PAD) patients, at least one peripheral vessel is 100% occluded. Current device designs have improved success rates in treating coronary and peripheral CTOs. The CrossLock™ catheter centers the lumen and gives better support to a chronically occluded vessel. The reader will find this device helpful in treating coronary and peripheral complex disease.>.