Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention: A Global Expert Consensus Document
Emmanouil S. Brilakis,Kambis Mashayekhi,Etsuo Tsuchikane,Nidal Abi Rafeh,Khaldoon Alaswad,Mario Araya,Alexandre Avran,Lorenzo Azzalini,Avtandil M. Babunashvili,Baktash Bayani,Ravinay Bhindi,Nicolas Boudou,Marouane Boukhris,Nenad Božinović,Leszek Bryniarski,Alexander Bufe,Christopher E. Buller,M. Nicholas Burke,Heinz Joachim Büttner,Pedro Cardoso,Mauro Carlino,Evald Høj Christiansen,Antonio Colombo,Kevin Croce,Félix Damas de los Santos,Tony De Martini,Joseph Dens,Carlo Di Mario,Kefei Dou,Mohaned Egred,Ahmed ElGuindy,Javier Escaned,Sergey Furkalo,Andrea Gagnor,Alfredo R. Galassi,Roberto Garbo,Junbo Ge,Pravin K. Goel,Omer Goktekin,Luca Grancini,J. Aaron Grantham,Colm G. Hanratty,Stefan Harb,Scott A. Harding,José P.S. Henriques,Jonathan Hill,Farouc A. Jaffer,Yangsoo Jang,Risto Jussila,Artis Kalnins,Arun Kalyanasundaram,David E. Kandzari,Hsien Li Kao,Dimitri Karmpaliotis,Hussien Heshmat Kassem,Paul Knaapen,Ran Kornowski,Oleg Krestyaninov,A. V.Ganesh Kumar,Peep Laanmets,Pablo Lamelas,Seung-Whan Lee,Thierry Lefèvre,Yue Li,Soo Teik Lim,Sidney Lo,William Lombardi,Margaret McEntegart,Muhammad Munawar,José A. Navarro Lecaro,Hung M. Ngo,William J. Nicholson,Göran K. Olivecrona,Lucio Padilla,Marin Postu,Alexandre Schaan de Quadros,Franklin Hanna Quesada,Vithala Surya Prakasa Rao,Nicolaus Reifart,Meruzhan Saghatelyan,Ricardo Santiago,George Sianos,Elliot J. Smith,James C. Spratt,Gregg W. Stone,Julian Strange,Khalid Tammam,Imre Ungi,Minh Vo,Vu Hoang Vu,Simon J Walsh,Gerald S. Werner,Jason R Wollmuth,Eugene B. Wu,R. Michael Wyman,Bo Xu,Masahisa Yamane,Luiz F. Ybarra,Robert W. Yeh,Qi Zhang,Stéphane Rinfret +100 more
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In this paper, the authors identified seven common principles that are widely accepted as best practices for chronic total occlusion percutaneous coronary intervention (PCI) in CTO-PCI.Abstract:
Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.read more
Citations
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Journal ArticleDOI
SCAI position statement on optimal percutaneous coronary interventional therapy for complex coronary artery disease
Robert F. Riley,Timothy D. Henry,Ehtisham Mahmud,Ajay J. Kirtane,Emmanouil S. Brilakis,Abhinav Goyal,Cindy L. Grines,William Lombardi,Anbukarasi Maran,Tanveer Rab,Jennifer A. Tremmel,Alexander G. Truesdell,Robert W. Yeh,David Zhao,Farouc A. Jaffer +14 more
TL;DR: Robert F. Riley MD, MS, FSCAI | Timothy D. Truesdell MD, F SCAI | Robert W.
Journal ArticleDOI
Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review
Eugene B. Wu,Emmanouil S. Brilakis,Kambis Mashayekhi,Etsuo Tsuchikane,Khaldoon Alaswad,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,Félix Damas de los Santos,Tony De Martini,Joseph Dens,Carlo Di Mario,Kefei Dou,Mohaned Egred,Basem Elbarouni,Ahmed ElGuindy,Javier Escaned,Sergey Furkalo,Andrea Gagnor,Alfredo R. Galassi,Roberto Garbo,Gabriele Gasparini,Junbo Ge,Lei Ge,Pravin K. Goel,Omer Goktekin,Nieves Gonzalo,Luca Grancini,Allison B. Hall,Franklin Hanna Quesada,Colm G. Hanratty,Stefan Harb,Scott A. Harding,Raja Hatem,José P.S. Henriques,David Hildick-Smith,Jonathan 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 Lamelas,Seung-Whan Lee,Thierry Lefèvre,R. Leung,Yu Li,Yue Li,Soo Teik Lim,Sidney Lo,William Lombardi,Anbukarasi Maran,Margaret McEntegart,Jeffrey W. Moses,Muhammad Munawar,Andres Navarro,Hung M. Ngo,William J. Nicholson,Anja Øksnes,Göran K. Olivecrona,Lucio Padilla,Mitul Patel,Ashish Pershad,Marin Postu,Jie Qian,Alexandre Schaan de Quadros,Nidal Abi Rafeh,Truls Råmunddal,Vithala Surya Prakasa Rao,Nicolaus Reifart,Robert F. Riley,Stéphane Rinfret,Meruzhan Saghatelyan,George Sianos,Elliot J. Smith,Anthony Spaedy,James C. Spratt,Gregg W. Stone,Julian Strange,Khalid Tammam,Craig Thompson,Aurel Toma,Jennifer A. Tremmel,Ricardo Santiago Trinidad,Imre Ungi,Minh Vo,Vu Hoang Vu,Simon J Walsh,Gerald S. Werner,Jarosław Wójcik,Jason R Wollmuth,Bo Xu,Masahisa Yamane,Luiz F. Ybarra,Robert W. Yeh,Qi Zhang +124 more
TL;DR: In this paper, a global chronic total occlusion crossing algorithm was developed, which is followed by a careful angiographic review focusing on proximal cap morphology, occlusions segment, distal vessel quality, and collateral circulation.
Journal ArticleDOI
Contemporary Issues in Chronic Total Occlusion Percutaneous Coronary Intervention.
Lorenzo Azzalini,Dimitri Karmpaliotis,Ricardo Santiago,Kambis Mashayekhi,Carlo Di Mario,Stéphane Rinfret,William J. Nicholson,Mauro Carlino,Masahisa Yamane,Etsuo Tsuchikane,Emmanouil S. Brilakis +10 more
TL;DR: In this article , the authors provide a comprehensive review of the most recent developments in the indications, preprocedural planning, technical aspects, complication management, and future directions of CTO percutaneous coronary intervention.
Journal ArticleDOI
Outcomes with retrograde versus antegrade chronic total occlusion revascularization.
Michael Megaly,Abdelrahman Ali,Marwan Saad,Marwan Saad,Mohamed Omer,Iosif Xenogiannis,Gerald S. Werner,Dimitri Karmpaliotis,Juan J. Russo,Masahisa Yamane,Roberto Garbo,Andrea Gagnor,Imre Ungi,Stéphane Rinfret,Ashish Pershad,Jarosław Wójcik,Santiago Garcia,Kambis Mashayekhi,Georgios Sianos,Alfredo R. Galassi,M. Nicholas Burke,Emmanouil S. Brilakis +21 more
TL;DR: The aim of the study was to evaluate the outcomes of retrograde versus antegrade approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Journal ArticleDOI
Long-Term Outcomes of Chronic Total Occlusion Recanalization Versus Percutaneous Coronary Intervention for Complex Non-Occlusive Coronary Artery Disease.
Lorenzo Azzalini,Mauro Carlino,Barbara Bellini,Claudia Marini,Vittorio Pazzanese,Evelina Toscano,Mario Gramegna,Silvia Moscardelli,Ludovica Bognoni,Matteo Montorfano +9 more
TL;DR: CTO PCI is associated with lower success rates and higher risk for coronary perforation and tamponade compared with complex non-CTO PCI, and this finding was confirmed on multivariable analysis.
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TL;DR: A North American contemporary approach for percutaneous coronary interventions for CTO using two guide catheters to facilitate seamless transition between antegrade wire-based, antegrade dissection re-entry- based, and retrograde techniques, the "hybrid" interventional strategy is described.
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Procedural Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: A Report From the NCDR (National Cardiovascular Data Registry)
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TL;DR: CTO PCI is currently performed infrequently in the United States for stable coronary artery disease and is associated with lower procedural success and higher complication rates compared with non-CTO PCI.
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