Title

Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review

Authors

Eugene B. Wu
Emmanouil S. Brilakis
Kambis Mashayekhi
Etsuo Tsuchikane
Khaldoon Alaswad, Henry Ford Health SystemFollow
Mario Araya
Alexandre Avran
Lorenzo Azzalini
Avtandil M. Babunashvili
Baktash Bayani
Michael Behnes
Ravinay Bhindi
Nicolas Boudou
Marouane Boukhris
Nenad Z. Bozinovic
Leszek Bryniarski
Alexander Bufe
Christopher E. Buller
M. Nicholas Burke
Achim Buttner
Pedro Cardoso
Mauro Carlino
Ji-Yan Chen
Evald Hoej Christiansen
Antonio Colombo
Kevin Croce
Felix Damas de Los Santos
Tony de Martini
Joseph Dens
Carlo di Mario
Kefei Dou
Mohaned Egred
Basem Elbarouni
Ahmed M. ElGuindy
Javier Escaned
Sergey Furkalo
Andrea Gagnor
Alfredo R. Galassi
Roberto Garbo
Gabriele Gasparini
Junbo Ge
Lei Ge
Pravin Kumar Goel
Omer Goktekin
Nieves Gonzalo
Luca Grancini
Allison Hall
Franklin Leonardo Hanna Quesada
Colm Hanratty
Stefan Harb
Scott A. Harding
Raja Hatem
Jose P.S. Henriques
David Hildick-Smith
Jonathan M. Hill
Angela Hoye
Wissam Jaber
Farouc A. Jaffer
Yangsoo Jang
Risto Jussila
Artis Kalnins
Arun Kalyanasundaram
David E. Kandzari
Hsien-Li Kao
Dimitri Karmpaliotis
Hussien Heshmat Kassem
Jaikirshan Khatri
Paul Knaapen
Ran Kornowski
Oleg Krestyaninov
A.V. Ganesh Kumar
Pablo Manuel Lamelas
Seung-Whan Lee
Thierry Lefevre
Raymond Leung
Yu Li
Yue Li
Soo-Teik Lim
Sidney Lo
William Lombardi
Anbukarasi Maran
Margaret McEntegart
Jeffrey Moses
Muhammad Munawar
Andres Navarro
Hung M. Ngo
William Nicholson
Anja Oksnes
Goran K. Olivecrona
Lucio Padilla
Mitul Patel
Ashish Pershad
Marin Postu
Jie Qian
Alexandre Quadros
Nidal Abi Rafeh
Truls Råmunddal
Vithala Surya Prakasa Rao
Nicolaus Reifart
Robert F. Riley
Stephane Rinfret
Meruzhan Saghatelyan
George Sianos
Elliot Smith
Anthony Spaedy
James Spratt
Gregg Stone
Julian W. Strange
Khalid O. Tammam
Craig A. Thompson
Aurel Toma
Jennifer A. Tremmel
Ricardo Santiago Trinidad
Imre Ungi
Minh Vo
Vu Hoang Vu
Simon Walsh
Gerald Werner
Jaroslaw Wojcik
Jason Wollmuth
Bo Xu
Masahisa Yamane
Luiz F. Ybarra
Robert W. Yeh
Qi Zhang

Document Type

Article

Publication Date

8-24-2021

Publication Title

Journal of the American College of Cardiology

Abstract

The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.

PubMed ID

34412818

Volume

78

Issue

8

First Page

840

Last Page

853

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