In contemporary practice there are three main methods that can be employed when attempting to open a chronic
total occlusion (CTO) of a coronary artery; antegrade or retrograde wire escalation, antegrade dissection re-entry and retrograde
dissection re-entry. This editorial will attempt to clarify the anatomical features that can be identified to help when
deciding which of these strategies to employ initially and help understand the reasons for this decision.
Keywords: Antegrade dissection re-entry, chronic total occlusion, hybrid algorithm, percutaneous coronary intervention.
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