Complex CTOs

Side-by-side schematic of two crossing strategies for a long femoropopliteal CTO: subintimal (left), guidewire looping between plaque and wall; intraluminal (right), wire through the plaque.

Complex CTOs

CTO REVASCULARIZATION Series — Part 2B

Once the Target Arterial Path is chosen, the technical question becomes how to cross the CTO. In long femoropopliteal occlusions the relationship between intraluminal and subintimal recanalization is more nuanced than the textbook sequence suggests — three scenarios worth distinguishing.

Schematic representation of a long femoropopliteal chronic total occlusion exceeding 15-25 cm, the morphological hallmark of TASC II D and GLASS FP grade 4 lesions

Complex CTOs

CTO REVASCULARIZATION Series: Part 2A

Before discussing how to cross a long or multilevel CTO, we need a more fundamental question: which vessel do we recanalize? The strategic framework of the 2019 Global Vascular Guidelines — Target Arterial Path, GLASS, and the role of the angiosome — defines everything that follows.