Vascular healing following subintimal tracking and reentry for chronic total occlusion percutaneous coronary intervention

A 78-year-old man with angina and ischemic cardiomyopathy presented for LAD CTO PCI. After several failed techniques, the LAD was recanalized with subintimal tracking and reentry (STAR) with subsequent balloon angioplasty of the false lumen. No stent was deployed and the patient did not follow-up for 10-months for definitive PCI. On follow-up, IVUS findings suggested the presence of a new external elastic lamina in the false lumen (side-by-side to the true lumen), indicating favorable healing. PCI was performed with an excellent angiographic result. Our case highlights a mechanism of vascular healing following dissection and re-entry-based recanalization of an LAD CTO.