Atherosclerotic plaque builds up over time leading to a CTO which is commonly > 20cm in length. Conventional Guidewires are not designed to puncture through calcium or navigate through these complex heterogeneous occlusions.

Vascular clarification is characteristic of atheroscierosis and always poses a significant challenge that defines the limits of acute procedural and device success and limits the clinical durability of the intervention. Calcifications remain and will continue to be a major challenge in peripheral vascular percutaneous interventions [11] . The treatment of chronic total occlusions (CTO) in patients with peripheral arterial disease (PAD) is a complex topic with multiple treatment techniques and treatment strategies.

CTO’s are complex with a variety of lesions requiring different crossing techniques as CTO’s of the common femoral artery and superficial femoral artery can be greater than 20cm [6] .

The interventionalist tends to use several techniques and devices in the likely event that they are unable to cross a given occlusion.

CTO’s are complex, heterogeneous lesions, with varied calcific palgue caps, each of which present their own set of challenges in crossing through the plaque to further treat the underlying condition.

Calcified segments prevent guidewires passing through these blockages, instead, physicians try to go around the lesion which is technically difficult, time consuming and often leads to a failed procedure resulting in further open vascular surgery or even amputation.