"Occlusion angioplasty". Light at the end of the tunnel or dead end?

Andreas Gruentzig was not quite ready to accept patients with chronic total occlusion for coronary angioplasty when this indication slipped in through the back door, albeit, it was on his mind. The waiting list between diagnostic study and angioplasty occasionally produced "surprise occlusions" found at the angioplasty session in patients accepted for a nontotal lesion, the lesion having closed silently after the diagnostic study. Patient, operator, and laboratory crew all being geared for angioplasty, the guiding catheter already introduced and the balloon prepared, an angioplasty attempt was irresistible. It succeeded in 62% of 16 such patients among the first 1,000 angioplasty cases of Andreas Gruentzig and coworkers.1 It seems odd at first that the crude, nonsteerable material used in those times yielded a success rate in total occlusions that nobody would be ashamed of today. First, all occlusions were very recent. Second, the stiffness of the original angioplasty balloons were favorable for occlusions in contrast to the floppy wires and trackable balloons used currently. In fact, one of the balloon catheters advocated for occlusion angioplasty at present resembles the ancient Gruentzig balloon.2