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Uncrossable and undilatable lesions—A practical approach to optimizing outcomes in PCI

Lookup NU author(s): Dr Mohaned Egred



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© 2020 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.Uncrossable lesions are those that cannot be crossed with a balloon after successful guidewire crossing. These lesions are challenging and are commonly encountered in tortuous and calcified arteries as well as chronic total occlusions. They are the second most common barrier to successful PCI in CTO intervention after inability to cross the CTO segment with a guidewire. Procedures involving balloon uncrossable lesions during routine and CTO PCI utilise longer procedural times, radiation dose and contrast volumes with a lower likelihood of procedural success. In this article, we describe a pragmatic approach of managing balloon uncrossable lesions utilising the most contemporary equipment available in an algorithmic fashion beginning with simple, cost effective techniques right up to complex strategies for advanced operators. In addition, some of these lesions, even when crossed by any technique, they may remain difficult to dilate and prepare for stent insertion. We describe an approach of how to manage these undilatable lesions.

Publication metadata

Author(s): McQuillan C, Jackson MWP, Brilakis ES, Egred M

Publication type: Article

Publication status: Published

Journal: Catheterization and Cardiovascular Interventions

Year: 2020

Pages: epub ahead of print

Online publication date: 26/05/2020

Acceptance date: 12/05/2020

Date deposited: 08/06/2020

ISSN (print): 1522-1946

ISSN (electronic): 1522-726X

Publisher: John Wiley and Sons Inc.


DOI: 10.1002/ccd.29001

PubMed id: 32453918


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