In-stent Carlino—a novel bailout for device-uncrossable in-stent chronic total occlusions
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By
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Ahmad Samir
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Hossameldin Hussein
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May 12, 2026
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Clinical Scorecard: The In-Stent Carlino Technique: An Innovative Solution for Device-Uncrossable In-Stent Chronic Total Occlusions
At a Glance
| Category | Detail |
|---|
| Condition | In-stent chronic total occlusion (IS-CTO) |
| Key Mechanisms | Hydraulic plaque modification using controlled contrast injection |
| Target Population | Patients with IS-CTOs experiencing device uncrossability |
| Care Setting | Percutaneous coronary intervention (PCI) |
Key Highlights
- IS-CTOs often present device uncrossability due to dense neoatherosclerosis.
- The in-stent Carlino technique effectively manages device uncrossability.
- Hydraulic modification minimizes the risk of subintimal dissection.
- Natural containment by the stent framework enhances safety.
Guideline-Based Recommendations
Diagnosis
- Coronary angiography (CAG) to assess IS-CTOs.
Management
- Utilize in-stent Carlino technique for device-uncrossable IS-CTOs.
Monitoring & Follow-up
- Post-procedural angiographic assessment for TIMI flow restoration.
Risks
- Potential for subintimal dissection if conventional techniques are used.
Patient & Prescribing Data
Patients with IS-CTOs and prior unsuccessful attempts at device delivery.
Controlled hydraulic modification can facilitate device delivery and lesion treatment.
Clinical Best Practices
- Employ advanced support techniques prior to in-stent Carlino application.
- Monitor for complications during and after the procedure.
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