TY - JOUR
T1 - Approach to CTO Intervention
T2 - Overview of Techniques
AU - Karatasakis, Aris
AU - Danek, Barbara Anna
AU - Karmpaliotis, Dimitri
AU - Alaswad, Khaldoon
AU - Vo, Minh
AU - Carlino, Mauro
AU - Patel, Mitul P.
AU - Rinfret, Stéphane
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
Emmanouil S. Brilakis reports personal fees from Abbott Vascular, Asahi, Cardinal Health, Elsevier, GE Healthcare, and St. Jude Medical; research grant support from InfraRedx and Boston Scientific; and spouse is an employee of Medtronic.
Funding Information:
Stéphane Rinfret reports grants from Medtronic and Abbott Vascular and personal fees from Boston Scientific.
Publisher Copyright:
© 2017, Springer Science+Business Media New York.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Successful percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) has been associated with significant clinical benefits, but remains technically demanding. Failure to cross the CTO with a guidewire is the most common cause of CTO PCI failure. CTO crossing can be achieved in the antegrade or retrograde direction and can be accomplished by maintaining true lumen position throughout or via subintimal dissection/reentry techniques. A procedural plan should be created prior to the procedure through careful angiographic review of four key parameters: (a) morphology of the proximal occlusion cap; (b) length of the occlusion; (c) quality of the distal vessel and presence of bifurcation at the distal cap; and (d) suitability of collateral circulation for retrograde crossing. Dual coronary injection is recommended in all cases with contralateral collaterals for detailed characterization of the lesion. If one approach fails to progress, a quick transition to the next approach is encouraged to maximize efficacy and efficiency. Procedural complications, including vessel perforation, may occur more frequently in CTO as compared with non-CTO PCI; hence, availability of necessary equipment and expertise in treating such complications are essential.
AB - Successful percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) has been associated with significant clinical benefits, but remains technically demanding. Failure to cross the CTO with a guidewire is the most common cause of CTO PCI failure. CTO crossing can be achieved in the antegrade or retrograde direction and can be accomplished by maintaining true lumen position throughout or via subintimal dissection/reentry techniques. A procedural plan should be created prior to the procedure through careful angiographic review of four key parameters: (a) morphology of the proximal occlusion cap; (b) length of the occlusion; (c) quality of the distal vessel and presence of bifurcation at the distal cap; and (d) suitability of collateral circulation for retrograde crossing. Dual coronary injection is recommended in all cases with contralateral collaterals for detailed characterization of the lesion. If one approach fails to progress, a quick transition to the next approach is encouraged to maximize efficacy and efficiency. Procedural complications, including vessel perforation, may occur more frequently in CTO as compared with non-CTO PCI; hence, availability of necessary equipment and expertise in treating such complications are essential.
KW - Antegrade dissection/reentry
KW - Antegrade wire escalation
KW - Chronic total occlusion
KW - Percutaneous coronary intervention
KW - Retrograde
KW - Techniques
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U2 - 10.1007/s11936-017-0501-2
DO - 10.1007/s11936-017-0501-2
M3 - Review article
C2 - 28105600
AN - SCOPUS:85009959816
SN - 1092-8464
VL - 19
JO - Current Treatment Options in Cardiovascular Medicine
JF - Current Treatment Options in Cardiovascular Medicine
IS - 1
M1 - 1
ER -