<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2954-3835</journal-id>
<journal-title><![CDATA[Cardiovascular and metabolic science]]></journal-title>
<abbrev-journal-title><![CDATA[Cardiovasc. metab. sci]]></abbrev-journal-title>
<issn>2954-3835</issn>
<publisher>
<publisher-name><![CDATA[Asociación Nacional de Cardiólogos de México A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2954-38352024000100027</article-id>
<article-id pub-id-type="doi">10.35366/115002</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[External calcium modification technique to overcome a balloon uncrossable chronic total occlusion: a report of two cases and review of the literature]]></article-title>
<article-title xml:lang="es"><![CDATA[Técnica de modificación externa del calcio para superar una oclusión total crónica no superable con balón]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hashalemi]]></surname>
<given-names><![CDATA[Arash]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Karagoz]]></surname>
<given-names><![CDATA[Ahmet]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bayani]]></surname>
<given-names><![CDATA[Baktash]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Calar]]></surname>
<given-names><![CDATA[Nihan Turhan]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zoghi]]></surname>
<given-names><![CDATA[Mehdi]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ucar]]></surname>
<given-names><![CDATA[Melisa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Erfan General Hospital Department of Cardiology ]]></institution>
<addr-line><![CDATA[Tehran ]]></addr-line>
<country>Iran</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Samsun University Faculty of Medicine Department of Cardiology]]></institution>
<addr-line><![CDATA[Samsun ]]></addr-line>
<country>Turkey</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Mehr Hospital Department of Cardiology ]]></institution>
<addr-line><![CDATA[Mashhad ]]></addr-line>
<country>Iran</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Dr. Sadi Konuk Training and Research Hospital Department of Cardiology ]]></institution>
<addr-line><![CDATA[Istanbul Bakirkoy]]></addr-line>
<country>Turkey</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Ege University Hospital Department of Cardiology ]]></institution>
<addr-line><![CDATA[Izmir ]]></addr-line>
<country>Turkey</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Samsun University Faculty of Medicine Samsun University Education and Research Hospital Department of Cardiology]]></institution>
<addr-line><![CDATA[Samsun ]]></addr-line>
<country>Turkey</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2024</year>
</pub-date>
<volume>35</volume>
<numero>1</numero>
<fpage>27</fpage>
<lpage>30</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2954-38352024000100027&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2954-38352024000100027&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2954-38352024000100027&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Chronic total occlusion is the most challenging part of percutaneous coronary intervention. In balloon uncrossable lesions, the wire can be advanced throughout the lesion to the distal part of the vessel, while the balloon can not.  Case report:  In this scenario, there are very few options to perform. Herein, we present two cases of balloon uncrossable chronic total occlusion, in which all the other methods were unsuccessful.  Conclusion:  We called this technique «external calcium modification» in which a balloon uncrossable lesion was overcome by cracking the calcified plaque via balloon inflation in the subintimal area over an intentionally directed wire around the calcium in subintimal space.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  La oclusión total crónica es la parte más desafiante de la intervención coronaria percutánea. En lesiones que no se pueden cruzar con balón, el alambre puede avanzar a lo largo de la lesión hasta la parte distal del vaso, mientras que el balón no.  Reporte de un caso:  En este escenario, hay muy pocas opciones para realizar. En este documento presentamos dos casos de oclusión total crónica no superable con balón en los que todos los demás métodos no tuvieron éxito.  Conclusión:  Llamamos a esta técnica «modificación externa del calcio» en la que la lesión que no se puede cruzar con el balón se superó rompiendo la placa calcificada mediante el inflado del balón en el área subintimal sobre un alambre dirigido intencionalmente alrededor del calcio en el espacio subintimal.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[chronic total occlusion]]></kwd>
<kwd lng="en"><![CDATA[balloon]]></kwd>
<kwd lng="en"><![CDATA[uncrossable lesion]]></kwd>
<kwd lng="en"><![CDATA[external calcium modification]]></kwd>
<kwd lng="es"><![CDATA[oclusión total crónica]]></kwd>
<kwd lng="es"><![CDATA[balón]]></kwd>
<kwd lng="es"><![CDATA[lesión incruzable]]></kwd>
<kwd lng="es"><![CDATA[modificación externa del calcio]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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