There are many ways to recanalize a long BTK CTO like in this case with a chronic stent occlusion within a distal femoro-tibial bypass anastomosis.
Retrograde puncture is a well established option, of course.
In this case, we decided to approach the CTO antegrade and use the 2.9 Fr GoBack Crossing catheter as support catheter to penetrate the hard in-stent occlusion. After penetration of the in-stent occlusion the integrated GoBack needle easily found the way from a subintimal space to true lumen of the posterior tibial artery.
The GoBack catheter combines maneuverable crossing catheter with reentry capability in a single product.