Open Sesame Technique for chronic total occlusion

Angioplasty for chronic total occlusion (CTO) of the coronary artery is still technically challenging. New techniques to improve the success rate are still required. The inability to penetrate guidewires into the CTO lesion through the proximal cap is one of the most difficult situations. When any guidewire cannot penetrate into the CTO lesion, and if the lesion has both a hard proximal cap and a side branch ramifying at the proximal end of the lesion, the insertion of stiff guidewires and/or balloon inflation in the side branch may induce a geometrical shift of the hard plaque. This in turn enables the entry of a guidewire into the CTO lesion. This procedure has been termed the “Open Sesame Technique.” © 2009 Wiley‐Liss, Inc.