A reentry technique is an endovascular maneuver used to restore access to the true lumen of a vessel after unintended subintimal passage of a guidewire or catheter during angioplasty or stenting.
🧠Context of Use
Most commonly used in chronic total occlusions (CTOs) of peripheral, coronary, or cerebrovascular arteries.
In carotid or vertebral arteries, subintimal entry is sometimes unavoidable in near-occlusion or heavily calcified lesions.
A reentry device or angled catheter is used to penetrate the intimal layer and redirect the guidewire into the true lumen distally.
🛠️ Types of Reentry Techniques
Device-Assisted (Dedicated Tools):
Outback™, Pioneer Plus™, OffRoad™, etc.
Often with needle-based targeting or IVUS guidance.
Wire-Based Manual Techniques:
Looping the wire in the subintimal space and probing for reentry
“Knuckle wire” technique
“Reentry with support catheter”
đź“Ś Indications
Subintimal dissection during angioplasty of:
Common/Internal Carotid Artery (CCA/ICA)
Superficial femoral artery (SFA)
Coronary arteries (CTO PCI)
Salvage of misdirected guidewire path
Crossing flush occlusions without a proximal stump
⚠️ Risks & Considerations
Perforation
Distal embolization
Dissection propagation
Need for embolic protection in cerebral circulation
“Reentry techniques are the vascular equivalent of re-entering orbit after drifting off-course — high-stakes, high-skill, and best done with the right tools.”