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 language | English (US) |
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Title of host publication | Debulking in Cardiovascular Interventions and Revascularization Strategies |
Subtitle of host publication | Between a Rock and the Heart |
Publisher | Elsevier |
Pages | 439-454 |
Number of pages | 16 |
ISBN (Electronic) | 9780128214510 |
DOIs | |
State | Published - Jan 1 2022 |
Externally published | Yes |
Keywords
- Balloon-undilatable lesions
- Calcification
- Chronictotal occlusions
- Laser
- Lithotripsy
- Orbital/rotational atherectomy
ASJC Scopus subject areas
- General Medicine