An algorithmic approach to balloon-uncrossable coronary lesions

Mahmoud M. Elrayes, Iosif Xenogiannis, Ilias Nikolakopoulos, Evangelia Vemmou, Jason Wollmuth, Nidal Abi Rafeh, Dimitri Karmpaliotis, Gabriele L. Gasparini, Martin Nicholas Burke, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Balloon uncrossable coronary lesions are lesions that cannot be crossed with a balloon after successful guidewire crossing. The strategies used to facilitate the treatment of such lesions can be classified into strategies that provide lesion modification and strategies that increase support. We describe a systematic, algorithmic approach to treat balloon uncrossable lesions, starting with use of small balloons, followed by increase in guide catheter support, use of microcatheters, wire cutting or puncture techniques, laser, atherectomy, and subintimal modification techniques. Sequential and simultaneous application of the aforementioned techniques can result in successful treatment of these challenging lesions.

Original languageEnglish (US)
Pages (from-to)E817-E825
JournalCatheterization and Cardiovascular Interventions
Issue number6
StatePublished - May 1 2021
Externally publishedYes


  • CTO
  • PCI
  • atherectomy
  • balloon-uncrossable
  • laser

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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