Treatment of inadvertent subintimal stenting during intervention of a coronary chronic total occlusion

We present a case of percutaneous coronary intervention of a chronic total occlusion of the right coronary artery. The lesion could not be crossed with a balloon after guidewire crossing, necessitating repeat crossing using a different pathway. Stent implantation resulted in ST-segment elevation due to inadvertent stent deployment into the subintimal space without distal outflow. A polymer-jacketed guidewire was used to enter the distal branches of the right coronary artery, restoring antegrade flow and resulting in resolution of ST-segment changes.