When and how to do retrograde or subintimal recanalization (Zertifizierung: Modul A Spezialkurs)

Recanalisation of complete occlusions is usually performed by the subintimal approach using a hydrophilic wire irrespective of site. It is difficult to know how much of a recanalisation path is truly luminal or extraluminal but clues can be obtained from the shape and ease of passage of the wire and the lack of indentation on the balloon when in the subintimal space. Subintimal recanalisation may be performed antegradely or retrogradely or both as in the “Safari” technique (Gandini et al). Access to the subintimal space is achieved just before the occlusion. A shaped catheter such as a cobra is often used and th…