How to Fix Common Problems Encountered in CTO PCI: The Expanded Hybrid Approach

There remains a pressing need in the interventional cardiology community to narrow the existing gap in the success rates, safety, and efficiency of chronic total occlusion percutaneous coronary intervention (CTO-PCI) relative to non CTO-PCI. Success rates for non CTO-PCI are high (>98 %). The success rates of CTO-PCI at experienced CTO-PCI centers are catching up (>90 %) but are likely much lower (50–70 %) at the vast majority of other PCI centers. Complication rates appear to be equal between CTO and non-CTO procedures at experienced CTO centers but may not be at others. CTO-PCI is associated with higher procedural time, contrast use, radiation exposure and supply cost than non CTO PCI even at experienced CTO-PCI centers. Thus, a wide variability in the CTO-PCI cases being attempted persists in large part due to these gaps. This chapter provides an overview of the new expanded hybrid approach, commonly employed by successful CTO operators.

[1]  G. Wright,et al.  Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. , 2012, Journal of the American College of Cardiology.

[2]  J. Spertus,et al.  Chronic total occlusion angioplasty in the United States. , 2009, JACC. Cardiovascular interventions.

[3]  J. Jayne,et al.  Retrograde techniques and the impact of operator volume on percutaneous intervention for coronary chronic total occlusions an early U.S. experience. , 2009, JACC. Cardiovascular interventions.

[4]  J. Moses,et al.  Use of a novel crossing and re-entry system in coronary chronic total occlusions that have failed standard crossing techniques: results of the FAST-CTOs (Facilitated Antegrade Steering Technique in Chronic Total Occlusions) trial. , 2012, JACC. Cardiovascular interventions.

[5]  D. Kandzari,et al.  Development of a high‐volume, multiple‐operator program for percutaneous chronic total coronary occlusion revascularization: procedural, clinical, and cost‐utilization outcomes , 2013, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[6]  E. Brilakis,et al.  Faster, easier, safer: “guideliner reverse CART” for retrograde chronic total occlusion interventions , 2014, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[7]  Subhash Banerjee,et al.  Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies. , 2013, JACC. Cardiovascular interventions.

[8]  C. Di Mario,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). , 2015, The Journal of invasive cardiology.

[9]  Y. Hayashi,et al.  Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. , 2011, JACC. Cardiovascular interventions.

[10]  O. Katoh,et al.  A novel modification of the retrograde approach for the recanalization of chronic total occlusion of the coronary arteries intravascular ultrasound-guided reverse controlled antegrade and retrograde tracking. , 2010, JACC. Cardiovascular interventions.

[11]  K. Mitsudo,et al.  A new retrograde wiring technique for chronic total occlusion , 2009, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[12]  R. Christofferson,et al.  Subintimal guidewire tracking during successful percutaneous therapy for chronic coronary total occlusions: Insights from an intravascular ultrasound analysis , 2012, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[13]  B. Rangan,et al.  Application of the "hybrid approach" to chronic total occlusion interventions: a detailed procedural analysis. , 2014, Journal of interventional cardiology.

[14]  Subhash Banerjee,et al.  Crossing the “balloon uncrossable” chronic total occlusion: Tornus to the rescue , 2011, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[15]  A. Colombo,et al.  CTO recanalization by intraocclusion injection of contrast: The microchannel technique , 2008, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[16]  W. Lombardi,et al.  Validation and incremental value of the hybrid algorithm for CTO PCI , 2014, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[17]  E. Brilakis,et al.  A percutaneous treatment algorithm for crossing coronary chronic total occlusions. , 2012, JACC. Cardiovascular interventions.

[18]  E. Tsuchikane,et al.  New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique. , 2006, The Journal of invasive cardiology.

[19]  J. Grantham,et al.  Subintimal space plaque modification for "balloon-uncrossable" chronic total occlusions. , 2014, The Journal of invasive cardiology.

[20]  I. Barbash,et al.  The state of the excimer laser for coronary intervention in the drug-eluting stent era. , 2013, Cardiovascular revascularization medicine : including molecular interventions.

[21]  Y. Hayashi,et al.  In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J-CTO Registry (Multicenter CTO Registry in Japan). , 2010, JACC. Cardiovascular interventions.