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a microcatheter over a second wire beyond the inflated balloon (during very short balloon deflation) in
order to facilitate distal micro-coils delivering. However, it should be considered that, during standard
PCI performed by 6F GC, only Finecross (Terumo, Japan) and Nhancer Pro X (IMDS, The Netherlands)
microcatheters could be advanced parallel to the inflated balloon without increase GC inner diameter. One
or more micro-coils are then delivered through the microcatheter and repeated checking of distal sealing
may be done during short balloon inflations.

In everyday practice, coronary perforation occurs quite infrequently when compared to CTO procedures,
but still carry out a higher incidence of adverse outcome. A complete knowledge and cath lab avalaibility of
dedicated devices, such as micro-coils and covered stent is essential. In case of such complication even more
important is a step-by-step approach together with employment of CTO derived rescue methods, such as
“ping-pong” or “balloon-microcatheter” techniques, which could improve patient’s survival.

CONCLUSION
CTO intervention is a rapidly evolving area and is commonly considered the last frontier of interventional
cardiology. Specific equipment and techniques showed a rapid evolution in last decade, thus increasing
procedural success even in less experienced centers. Nowadays, global knowledge of CTO tools is widespread
and they have become a strong and precise weapon in interventional cardiologist’s hand to face obstacles
encountered in daily PCI scenario.

DECLARATIONS
Authors’ contributions
All authors have contributed equally to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
The Author(s) 2019.

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