Abstract
Improved equipment, development, and dissemination of novel recanalization practices and the clinical importance of complete coronary revascularization have led to a renewed interest in coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) over the past decade. In particular, utilization of various permutations of the hybrid algorithm has been associated with increasing procedural success rates at higher-volume centers. However, several common technical challenges remain using the chronic total occlusion algorithm for even the most advanced operator. In this chapter, we present an updated, comprehensive review of solutions to common problems encountered during CTO PCI, including consensus hierarchical approaches to employing these solutions.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Roy J, Hill J, Spratt JC. The “side-BASE technique”: combined side branch anchor balloon and balloon assisted sub-intimal entry to resolve ambiguous proximal cap chronic total occlusions. Catheter Cardiovasc Interv. 2017;92(1):E15–9.
Carlino M, Ruparelia N, Thomas G, et al. Modified contrast microinjection technique to facilitate chronic total occlusion recanalization. Catheter Cardiovasc Interv. 2016;87(6):1036–41.
Nicholson W, Harvey J, Dhawan R. E-CART (ElectroCautery-Assisted Re-enTry) of an aorto-ostial right coronary artery chronic total occlusion: first-in-man. JACC Cardiovasc Interv. 2016;9(22):2356–8.
Badr S, Ben-Dor I, Dvir D, et al. The state of the excimer laser for coronary intervention in the drug-eluting stent era. Cardiovasc Revasc Med. 2013;14(2):93–8.
Fairley SL, Spratt JC, Rana O, Talwar S, Hanratty C, Walsh S. Adjunctive strategies in the management of resistant, ‘undilatable’ coronary lesions after successfully crossing a CTO with a guidewire. Curr Cardiol Rev. 2014;10(2):145–57.
Azzalini L, Dautov R, Ojeda S, et al. Long-term outcomes of rotational atherectomy for the percutaneous treatment of chronic total occlusions. Catheter Cardiovasc Interv. 2017;89(5):820–8.
Brilakis ES, Grantham JA, Rinfret S, et al. A percutaneous treatment algorithm for crossing coronary chronic total occlusions. JACC Cardiovasc Interv. 2012;5(4):367–79.
Surmely JF, Tsuchikane E, Katoh O, et al. New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique. J Invasive Cardiol. 2006;18(7):334–8.
Joshi NV, Spratt JC, Wilson S, Walsh SJ, Hanratty CG. A novel utility of facilitated antegrade dissection re-entry technique to recanalize chronic total occlusions. JACC Cardiovasc Interv. 2017;10(5):e51–4.
Smith EJ, Di Mario C, Spratt JC, et al. Subintimal TRAnscatheter Withdrawal (STRAW) of hematomas compressing the distal true lumen: a novel technique to facilitate distal reentry during recanalization of chronic total occlusion (CTO). J Invasive Cardiol. 2015;27(1):E1–4.
Ochiai M, Ashida K, Araki H, Ogata N, Okabayashi H, Obara C. The latest wire technique for chronic total occlusion. Ital Heart J. 2005;6(6):489–93.
Werner GS. The BridgePoint devices to facilitate recanalization of chronic total coronary occlusions through controlled subintimal reentry. Expert Rev Med Devices. 2011;8(1):23–9.
Harding SA, Wu EB, Lo S, et al. A new algorithm for crossing chronic total occlusions from the Asia Pacific chronic total occlusion club. JACC Cardiovasc Interv. 2017;10(21):2135–43.
Carlino M, Azzalini L, Mitomo S, Colombo A. Antegrade fenestration and re-entry: a new controlled subintimal technique for chronic total occlusion recanalization. Catheter Cardiovasc Interv. 2018;92(3):497–504.
Colombo A, Mikhail GW, Michev I, et al. Treating chronic total occlusions using subintimal tracking and reentry: the STAR technique. Catheter Cardiovasc Interv. 2005;64(4):407–411; discussion 412.
Visconti G, Focaccio A, Donahue M, Briguori C. Elective versus deferred stenting following subintimal recanalization of coronary chronic total occlusions. Catheter Cardiovasc Interv. 2015;85(3):382–90.
Goleski PJ, Nakamura K, Liebeskind E, et al. Revascularization of coronary chronic total occlusions with subintimal tracking and reentry followed by deferred stenting: experience from a high-volume referral center. Catheter Cardiovasc Interv. 2019;93(2):191–8.
Hirai T, Grantham JA, Sapontis J, et al. Impact of subintimal plaque modification procedures on health status after unsuccessful chronic total occlusion angioplasty. Catheter Cardiovasc Interv. 2018;1(6):1035–42.
Carlino M, Azzalini L, Colombo A. A novel maneuver to facilitate retrograde wire externalization during retrograde chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv. 2017;89(1):E7–E12.
Brilakis ES, Grantham JA, Banerjee S. “Ping-pong” guide catheter technique for retrograde intervention of a chronic total occlusion through an ipsilateral collateral. Catheter Cardiovasc Interv. 2011;78(3):395–9.
Gasparini GL, Sanz Sanchez J, Oreglia J, Mazzarotto P. The double trapping balloon technique to facilitate retrograde wire externalization during chronic total occlusion intervention. JACC Cardiovasc Interv. 2020;13(14):e133–5.
Irving J. CTO pathophysiology: how does this affect management? Curr Cardiol Rev. 2014;10(2):99–107.
Riley RF, Walsh SJ, Kirtane AJ, et al. Algorithmic solutions to common problems encountered during chronic total occlusion angioplasty: the algorithms within the algorithm. Catheter Cardiovasc Interv. 2019;93(2):286–97.
Karacsonyi J, Tajti P, Rangan BV, et al. Randomized comparison of a CrossBoss first versus standard wire escalation strategy for crossing coronary chronic total occlusions: the CrossBoss First Trial. JACC Cardiovasc Interv. 2018;11(3):225–33.
Azzalini L, Karatasakis A, Spratt JC, et al. Subadventitial stenting around occluded stents: a bailout technique to recanalize in-stent chronic total occlusions. Catheter Cardiovasc Interv. 2018;92(3):466–76.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Riley, R.F., Sapontis, J., Marso, S.P., Lombardi, W.L., Grantham, J.A. (2022). When, Why, and How to Fix Common Problems Encountered in Chronic Total Occlusion Percutaneous Coronary Intervention: The Expanded Hybrid Approach. In: Rinfret, S. (eds) Percutaneous Coronary Intervention for Chronic Total Occlusion. Springer, Cham. https://doi.org/10.1007/978-3-031-05437-2_23
Download citation
DOI: https://doi.org/10.1007/978-3-031-05437-2_23
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-05436-5
Online ISBN: 978-3-031-05437-2
eBook Packages: MedicineMedicine (R0)