Work

Successful recanalization of a calcified, collateral-poor LAD-CTO via repeat antegrade dissection and re-entry guided by intravascular ultrasound after prior subintimal plaque modification: a case report

Year: 2026

Type: article

Abstract: BACKGROUND: Chronic total occlusion (CTO) of the left anterior descending artery (LAD) with poor collateral circulation poses significant procedural challenges. Subintimal plaque modification (SPM) followed by repeat antegrade dissection and re-entry (ADR) under intravascular ultrasound (IVUS) guidance may enhance recanalization success. CASE PRESENTATION: A 53-year-old male with prior non-ST-elevation myocardial infarction underwent failed initial percutaneous coronary intervention (PCI) for a stump-free, heavily calcified LAD-CTO with poor collaterals. After SPM, repeat angiography at 3 months revealed improved vessel architecture. IVUS-guided ADR was successfully performed, achieving full revascularization. At 4-year follow-up, the patient remained asymptomatic without major adverse cardiac events (MACE). CONCLUSION: In complex LAD-CTO lesions, SPM combined with IVUS-guided repeat ADR represents a viable bailout strategy, particularly when conventional antegrade/retrograde approaches fail.

Source: BMC Cardiovascular Disorders

DOI: 10.1186/s12872-026-05738-4

Authors: Ziqi Li, Xuefei Mu, Bin Qi, Quanmin Jing, Yaling Han

Institution: General Hospital of Shenyang Military Region

Language: English

Topic: Coronary Interventions and Diagnostics

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,090