Approach to CTO Intervention: Overview of Techniques
Recommended Citation
Karatasakis A, Danek BA, Karmpaliotis D, Alaswad K, Vo M, Carlino M, Patel MP, Rinfret S, Brilakis ES. Approach to CTO intervention: Overview of techniques. Curr Treat Options Cardiovasc Med. Jan 2017;19(1):1.
Document Type
Article
Publication Date
1-1-2017
Publication Title
Current treatment options in cardiovascular medicine
Abstract
OPINION STATEMENT: 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.
PubMed ID
28105600
Volume
19
Issue
1
First Page
1
Last Page
1
