The most complex form of angioplasty. 2,500+ cases. All three crossing strategies — antegrade wire escalation, antegrade dissection re-entry, and retrograde — available in a single operator's hands.
Designed for patients too high-risk for bypass surgery. Full haemodynamic support — IABP, Impella, ECMO — available for the most fragile cases.
Redo and rescue interventions. Systematic review of why the prior attempt failed — wire selection, sizing, calcium modification, technique — before designing the re-intervention.
Specialist planning, IVUS guidance, and haemodynamic support readiness for the most critical coronary vessel.
Rotablation and Intravascular Lithotripsy (IVL). IVUS-guided lesion preparation before stenting in heavily calcified anatomy.
Navigating through collateral channels to reach the blockage from behind — the most technically demanding of all CTO crossing strategies.
Including the world-first K14 Stingray CART technique — published in Catheterization and Cardiovascular Interventions, 2023. K14 stands for Kalyanasundaram.
Leg artery blockages and peripheral CTOs. Critical limb ischaemia interventions and complex below-the-knee disease.
ASD/PFO closure, valvuloplasties, paravalvular leak repair. Structural heart fellowship trained at Cleveland Clinic.
Yes, in the majority of cases. A 100% blocked artery — known as a Chronic Total Occlusion — can be reopened percutaneously by a high-volume CTO PCI specialist trained in all three crossing strategies (antegrade wire escalation, antegrade dissection re-entry, and retrograde). Dr. Arun Kalyanasundaram has performed over 2,500 such procedures at international benchmark success rates.
Bypass surgery (CABG) is open-heart surgery that uses a graft to route blood around blocked arteries. Angioplasty (PCI) is a minimally invasive catheter-based procedure that opens the blocked artery itself using balloons and stents. Modern complex PCI — including CTO PCI and CHIP — can treat many cases that previously required surgery, with shorter recovery and lower procedural mortality in appropriately selected patients.
Patients declined for bypass surgery are often candidates for Complex High-Risk PCI (CHIP). CHIP is a specialised form of angioplasty designed for patients considered too high-risk for surgery, using mechanical circulatory support — IABP, Impella, or ECMO — to treat the most fragile patients safely. This is a core part of Dr. Arun's practice at Promed Hospital, Chennai.
Intravascular ultrasound (IVUS) is a miniature ultrasound probe placed inside the coronary artery during angioplasty. It allows precise measurement of vessel size, calcium burden, and stent expansion — far more accurately than angiography alone. IVUS-guided PCI has been shown in multiple trials to reduce major adverse cardiac events compared with angiography-guided PCI. Dr. Arun uses IVUS routinely, not selectively, in all complex cases.
Yes. A failed prior angioplasty or in-stent restenosis is treatable in the majority of cases. The first step is a systematic review of why the previous attempt failed — wire selection, sizing, calcium modification, or technique. A re-intervention plan is then designed to address the specific cause. Dr. Arun routinely treats patients sent for failed prior PCI from across India and internationally.
K14 Stingray CART is a CTO crossing technique invented and published by Dr. Arun Kalyanasundaram in Catheterization and Cardiovascular Interventions in 2023. It modifies the antegrade dissection re-entry approach to solve a previously unsolved failure mode in the Stingray re-entry step. K14 stands for Kalyanasundaram. It is one of a small number of named CTO PCI techniques in the world.
Severely calcified arteries that cannot be treated with standard angioplasty require advanced calcium modification — rotational atherectomy (Rotablation) to grind down hard calcium, or intravascular lithotripsy (IVL) which uses sonic pressure waves to fracture calcium. The choice depends on calcium pattern and vessel anatomy, ideally assessed by IVUS or OCT imaging before stent placement.
The right treatment depends on your specific anatomy, lesion complexity, and overall clinical context — not on what is most commonly done in your local cath lab. A second opinion is the recommended first step if your existing treatment plan involves bypass surgery, has labelled your blockage as untreatable, or follows a failed prior procedure. Remote written second opinions are available within 2-3 business days.
