TY - JOUR
T1 - A percutaneous treatment algorithm for crossing coronary chronic total occlusions
AU - Brilakis, Emmanouil S.
AU - Grantham, J. Aaron
AU - Rinfret, Stéphane
AU - Wyman, R. Michael
AU - Burke, M. Nicholas
AU - Karmpaliotis, Dimitri
AU - Lembo, Nicholas
AU - Pershad, Ashish
AU - Kandzari, David E.
AU - Buller, Christopher E.
AU - Demartini, Tony
AU - Lombardi, William L.
AU - Thompson, Craig A.
N1 - Funding Information:
Dr. Brilakis has received speaker honoraria from St. Jude Medical and Terumo; research support from Abbott Vascular and InfraReDx; and his spouse is an employee of Medtronic. Dr. Grantham has received grants and honoraria from Abbott Vascular , BridgePoint Medical , and Vascular Solutions , all paid directly to Saint Luke's Hospital Foundation. Dr. Rinfret has received honoraria for proctorship from Abbott Vascular and BridgePoint Medical and honoraria for conference from Terumo and BridgePoint Medical. Dr. Wyman is a consultant/honoraria from Abbott Vascular, BridgePoint Medical, Terumo, and Boston Scientific; and has equity in BridgePoint Medical. Dr. Burke is a consultant for BridgePoint Medical and Terumo Medical. Dr. Karmpaliotis is on the speaker's bureau of Abbott Vascular and Medtronic; and is a consultant for BridgePoint Medical. Dr. Lembo is on the speaker's bureau of Medtronic; he is on the advisory board of Abbott Vascular and Medtronic; and he is a proctor for BridgePoint Medical. Dr. Pershad has received speaker honoraria from Medtronic and Abbott Vascular; and consulting fees from BridgePoint Medical. Dr. Kandzari's institution (Piedmont Heart Institute) has received educational grants from BridgePoint Medical ; and he has received research/grant support from and is a consultant for Abbott Vascular , Medtronic CardioVascular , and Boston Scientific . Dr. Buller is a consultant for Abbott Vascular and AstraZeneca. Dr. DeMartini is a consultant for and on the speaker's bureau of Abbott Vascular. Dr. Lombardi is a consultant for Abbott Vascular, BridgePoint Medical, and Medtronic; has received speaker honoraria from Abbott Vascular, Medtronic, Boston Scientific, and Terumo (all funds paid to his institution - PeaceHealth); and has equity in BridgePoint Medical. Dr. Thompson is a consultant for Abbott Vascular, BridgePoint Medical, Terumo, and Volcano; and has equity in BridgePoint Medical. State-of-the-Art Paper
PY - 2012/4
Y1 - 2012/4
N2 - Coronary chronic total occlusions (CTOs) are frequently identified during coronary angiography and remain the most challenging lesion group to treat. Patients with CTOs are frequently left unrevascularized due to perceptions of high failure rates and technical complexity even if they have symptoms of coronary disease or ischemia. In this review, the authors describe a North American contemporary approach for percutaneous coronary interventions for CTO. Two guide catheters are placed to facilitate seamless transition between antegrade wire-based, antegrade dissection re-entry-based, and retrograde (wire or dissection re-entry) techniques, the "hybrid" interventional strategy. After dual coronary injection is performed, 4 angiographic parameters are assessed: 1) clear understanding of location of the proximal cap using angiography or intravascular ultrasonography; 2) lesion length; 3) presence of branches, as well as size and quality of the target vessel at the distal cap; and 4) suitability of collaterals for retrograde techniques. On the basis of these 4 characteristics, an initial strategy and rank order hierarchy for technical approaches is established. Radiation exposure, contrast utilization, and procedure time are monitored throughout the procedure, and thresholds are established for intraprocedural strategy conversion to maximize safety, efficiency, and effectiveness.
AB - Coronary chronic total occlusions (CTOs) are frequently identified during coronary angiography and remain the most challenging lesion group to treat. Patients with CTOs are frequently left unrevascularized due to perceptions of high failure rates and technical complexity even if they have symptoms of coronary disease or ischemia. In this review, the authors describe a North American contemporary approach for percutaneous coronary interventions for CTO. Two guide catheters are placed to facilitate seamless transition between antegrade wire-based, antegrade dissection re-entry-based, and retrograde (wire or dissection re-entry) techniques, the "hybrid" interventional strategy. After dual coronary injection is performed, 4 angiographic parameters are assessed: 1) clear understanding of location of the proximal cap using angiography or intravascular ultrasonography; 2) lesion length; 3) presence of branches, as well as size and quality of the target vessel at the distal cap; and 4) suitability of collaterals for retrograde techniques. On the basis of these 4 characteristics, an initial strategy and rank order hierarchy for technical approaches is established. Radiation exposure, contrast utilization, and procedure time are monitored throughout the procedure, and thresholds are established for intraprocedural strategy conversion to maximize safety, efficiency, and effectiveness.
KW - chronic total occlusion
KW - devices
KW - percutaneous coronary intervention
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U2 - 10.1016/j.jcin.2012.02.006
DO - 10.1016/j.jcin.2012.02.006
M3 - Review article
C2 - 22516392
AN - SCOPUS:84859806300
SN - 1936-8798
VL - 5
SP - 367
EP - 379
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 4
ER -