Antegrade Techniques for Coronary Chronic Total Occlusion Recanalization: A Current Appraisal

Referred to as the "last frontier" in percutaneous coronary intervention, coronary chronic total occlusion (CTO) remains one of the most challenging lesion subsets treated by interventionists.However, improved skills among experienced operators, combined with the adoption of new dedicated devices, tools, and sophisticated strategies, have dramatically increased procedural success and improved outcomes.Antegrade wire escalation (AWE) is the most commonly preferred initial CTO crossing technique and is well suited for short (< 20 mm) occlusions with an unambiguous proximal cap.In contrast, AWE is less likely to succeed in longer, more complex lesions.Antegrade dissection and re-entry (ADR) permits safe and efficient crossing of longer (> 20 mm) CTOs and those with ambiguous anatomy.Device-based ADR (e.g., the Stingray system; Boston Scientific, Marlborough, MA, USA) offers a targeted method for successfully re-entering the true lumen, preserving important side branches compared to wire-based ADR techniques.