Abstract
There have been many technological advances in antegrade CTO PCI, but perhaps most importantly has been the evolution of the “hybrid’ approach where ideally there exists a seamless interplay of antegrade wiring, antegrade dissection re-entry and retrograde approaches as dictated by procedural factors. Antegrade wire escalation with intimal tracking remains the preferred initial strategy in short CTOs without proximal cap ambiguity. More complex CTOs, however, usually require either a retrograde or an antegrade dissection re-entry approach, or both. Antegrade dissection re-entry is well suited to long occlusions where there is a healthy distal vessel and limited “interventional” collaterals. Early use of a dissection re-entry strategy will increase success rates, reduce complications, and minimise radiation exposure, contrast use as well as procedural times. Antegrade dissection can be achieved with a knuckle wire technique or the CrossBoss catheter whilst re-entry will be achieved in the most reproducible and reliable fashion by the Stingray balloon/wire. It should be avoided where there is potential for loss of large side branches. It remains to be seen whether use of newer dissection re-entry strategies will be associated with lower restenosis rates compared with the more uncontrolled subintimal tracking strategies such as STAR and whether stent insertion in the subintimal space is associated with higher rates of late stent malapposition and stent thrombosis. It is to be hoped that the algorithms, which have been developed to guide CTO operators, allow for a better transfer of knowledge and skills to increase uptake and acceptance of CTO PCI as a whole.
Keywords: Antegrade dissection re-entry, chronic total occlusion, knuckle wire, CrossBoss catheter, Stingray balloon.
Call for Papers in Thematic Issues
Advances in Managing Cardiogenic Shock and the Value of Percutaneous Mechanical Circulatory Support.
Despite the advances in cardiology, the outcomes of patients with cardiogenic shock remain poor. There is an increasing interest and use of mechanical circulatory support for patients with cardiogenic shock. Additionally, the complexity of coronary interventions has increased during the last decade with the potential of treating more high-risk patients ...read more
The era of cardiac medication and implantable devices therapy in heart failure treatment continues
The heart failure (HF) remains a serious public health problem and affects 64 million people worldwide. Although advances in medical therapy and device assistance have significantly improved HF outcomes, the implications of HF are still dramatic. In recent years, innovative developments have been made in HF treatment management, based on ...read more
Related Books
Blood Oxidant Ties: The Evolving Concepts in Myocardial Injury and Cardiovascular Disease
Advancements in Cardiovascular Research and Therapeutics: Molecular and Nutraceutical Perspectives
Herbal Medicine: Back to the Future
Cardiac Care and COVID-19: Perspectives in Medical Practice
Nanomedicinal Approaches Towards Cardiovascular Disease
Herbal Medicine: Back to the Future
23
