Uncrossable lesions are those that cannot be crossed with a balloon after successful guidewire crossing. These lesions are challenging and are commonly encountered in tortuous and calcified arteries as well as chronic total occlusions. They are the second most common barrier to successful PCI in CTO intervention after inability to cross the CTO segment with a guidewire. Procedures involving balloon uncrossable lesions during routine and CTO PCI utilise longer procedural times, radiation dose and contrast volumes with a lower likelihood of procedural success. In this article, we describe a pragmatic approach of managing balloon uncrossable lesions utilising the most contemporary equipment available in an algorithmic fashion beginning with simple, cost effective techniques right up to complex strategies for advanced operators. In addition, some of these lesions, even when crossed by any technique, they may remain difficult to dilate and prepare for stent insertion. We describe an approach of how to manage these undilatable lesions.

中文翻译：

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不可交叉和不可扩张的病变 - 优化 PCI 结果的实用方法。

无法穿过的病灶是指导丝成功穿过后无法用球囊穿过的病灶。这些病变具有挑战性，常见于曲折和钙化的动脉以及慢性完全闭塞。在无法使用导丝穿过 CTO 段之后，它们是 CTO 干预中成功 PCI 的第二大障碍。在常规和 CTO PCI 期间涉及球囊不可交叉病变的手术使用更长的手术时间、辐射剂量和造影剂体积，手术成功的可能性较低。在本文中，我们描述了一种实用的方法，利用最先进的设备以算法方式管理球囊无法穿越的病变，从简单、具有成本效益的技术到高级操作员的复杂策略。此外，其中一些病变，即使通过任何技术进行交叉，它们仍可能难以扩张并为支架插入做准备。我们描述了如何管理这些不可扩张的病变的方法。