Document Detail


A percutaneous treatment algorithm for crossing coronary chronic total occlusions.
MedLine Citation:
PMID:  22516392     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Coronary chronic total occlusions (CTOs) are frequently identified during coronary angiography and remain the most challenging lesion group to treat. Patients with CTOs are frequently left unrevascularized due to perceptions of high failure rates and technical complexity even if they have symptoms of coronary disease or ischemia. In this review, the authors describe a North American contemporary approach for percutaneous coronary interventions for CTO. Two guide catheters are placed to facilitate seamless transition between antegrade wire-based, antegrade dissection re-entry-based, and retrograde (wire or dissection re-entry) techniques, the "hybrid" interventional strategy. After dual coronary injection is performed, 4 angiographic parameters are assessed: 1) clear understanding of location of the proximal cap using angiography or intravascular ultrasonography; 2) lesion length; 3) presence of branches, as well as size and quality of the target vessel at the distal cap; and 4) suitability of collaterals for retrograde techniques. On the basis of these 4 characteristics, an initial strategy and rank order hierarchy for technical approaches is established. Radiation exposure, contrast utilization, and procedure time are monitored throughout the procedure, and thresholds are established for intraprocedural strategy conversion to maximize safety, efficiency, and effectiveness.
Authors:
Emmanouil S Brilakis; J Aaron Grantham; Stéphane Rinfret; R Michael Wyman; M Nicholas Burke; Dimitri Karmpaliotis; Nicholas Lembo; Ashish Pershad; David E Kandzari; Christopher E Buller; Tony DeMartini; William L Lombardi; Craig A Thompson
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  5     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-20     Completed Date:  2012-09-06     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  367-79     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Algorithms*
Angioplasty, Balloon, Coronary / adverse effects,  instrumentation,  methods*
Catheters
Chronic Disease
Clinical Competence
Coronary Angiography
Coronary Occlusion / radiography,  therapy*,  ultrasonography
Decision Support Techniques*
Equipment Design
Humans
Learning Curve
Patient Selection
Predictive Value of Tests
Treatment Outcome
Ultrasonography, Interventional

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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