Chronic total occlusions: The impact of calcific deposits on the performance and outcomes of percutaneous coronary interventions

Iosif Xenogiannis, Emmanouil S. Brilakis

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Moderate or severe calcification is common in coronary chronic total occlusions (CTOs) (35%-59%) and may hinder every step of CTO percutaneous coronary intervention (PCI), namely crossing, equipment delivery, and stent expansion and has been associated with lower success and higher risk of complications. The presence of calcium is among the most common parameters associated with CTO PCI failure and is included in most of the CTO PCI scores. The use of stiff, highly penetrating guidewires is often needed for crossing heavily calcified CTOs, as is the use of advanced crossing techniques, such as antegrade dissection and reentry and the retrograde approach. Meticulous lesion preparation (with standard and plaque modification balloons and sometimes atherectomy) can facilitate equipment delivery and stent expansion. Emerging techniques, such as coronary lithotripsy and very high pressure, are expected to increase success without compromising safety.

Original languageEnglish (US)
Title of host publicationDebulking in Cardiovascular Interventions and Revascularization Strategies
Subtitle of host publicationBetween a Rock and the Heart
PublisherElsevier
Pages439-454
Number of pages16
ISBN (Electronic)9780128214510
DOIs
StatePublished - Jan 1 2022
Externally publishedYes

Keywords

  • Balloon-undilatable lesions
  • Calcification
  • Chronictotal occlusions
  • Laser
  • Lithotripsy
  • Orbital/rotational atherectomy

ASJC Scopus subject areas

  • Medicine(all)

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