Subintimal wire pathway: part of the game of crossing chronic total coronary occlusions

The history of percutaneous recanalisation of chronic total coronary occlusions (CTO) reaches back to the mid 1980s when, little by little, stiffer wires appeared on the market. Most of the reports of CTO results in those days included “well selected cases” and used a more liberal definition including recent occlusions, so that the reported success rates of >60% are not realistic with respect to the types of lesions treated today1. The steep improvement of success rates by dedicated CTO operators, now reaching 90% in Japan and also in Europe and other parts of the world, was made possible by the introduction ...