What equipment should be available?

The equipment necessary for performing chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be grouped into 12 categories: sheaths, guide catheters, microcatheters, guidewires, dissection/re-entry equipment, guide catheter extensions, snares, equipment for "balloon uncrossable" and "balloon undilatable" lesions, intravascular imaging, equipment for managing complications, equipment for minimizing operator radiation exposure, and stents. Use of an over-the-wire system is important for CTO PCI along with carefully selected guidewires based on the characteristics of occlusion. Antegrade dissection/ re-entry is optimally performed using the CrossBoss catheter and Stingray balloon and wire. Guide catheter support can be significantly improved by using guide catheter extensions and other dedicated devices. Snares may be needed for externalization of the retrograde guidewire. Familiarity with the algorithm and equipment needed to treat balloon "uncrossable" and undilatable lesions is also important. Intravascular ultrasound can facilitate CTO crossing. Covered stents and coils are important to have available in case of perforation. Use of radiation shields can reduce operator radiation exposure and use of drug-eluting stents (especially second generation) is preferred.