CASE REPORT article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
In-Stent Carlino: A Novel Bailout for Device-Uncrossable In-Stent Chronic Total Occlusions
Ahmad Samir 1,2
Hossameldin Hussein 2
1. Cardiac Center Hail, Hail, Saudi Arabia
2. Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
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Abstract
Background and Aims: In-stent chronic total occlusion (IS-CTO) remains a challenging subset frequently demonstrating device uncrossability despite successful wire crossing. In-stent Carlino technique can serve as a feasible and safe bailout strategy for device-uncrossable IS-CTOs. Methods: We present two cases of complex IS-CTOs where successful wire crossing was achieved but device delivery failed despite exhausting appropriate support techniques. In-stent Carlino was performed using controlled contrast injection (0.5 mL) through a wedged microcatheter to create hydraulic plaque modification. Results: Both cases achieved successful device delivery following in-stent Carlino application. The technique facilitated microcatheter advancement and subsequent lesion treatment without complications. The metallic stent framework and dense neoatherosclerotic tissue provided natural containment, preventing extension of the dissection to extraplaque. Conclusions: In-stent Carlino offers an effective bailout for device-uncrossable IS-CTOs with improved safety compared to conventional Carlino applications due to natural containment by the stent architecture.
Summary
Keywords
Carlino, device-uncrossable, hydraulic modification, in-stent chronic total occlusion, Micocatheter
Received
15 September 2025
Accepted
31 December 2025
Copyright
© 2025 Samir and Hussein. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Ahmad Samir
Disclaimer
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