Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review
Journal
Journal of the American College of Cardiology
Journal Volume
78
Journal Issue
8
Pages
840
Date Issued
2021-08-24
Author(s)
Wu, Eugene B
Brilakis, Emmanouil S
Mashayekhi, Kambis
Tsuchikane, Etsuo
Alaswad, Khaldoon
Araya, Mario
Avran, Alexandre
Azzalini, Lorenzo
Babunashvili, Avtandil M
Bayani, Baktash
Behnes, Michael
Bhindi, Ravinay
Boudou, Nicolas
Boukhris, Marouane
Bozinovic, Nenad Z
Bryniarski, Leszek
Bufe, Alexander
Buller, Christopher E
Burke, M Nicholas
Buttner, Achim
Cardoso, Pedro
Carlino, Mauro
Chen, Ji-Yan
Christiansen, Evald Hoej
Colombo, Antonio
Croce, Kevin
de Los Santos, Felix Damas
de Martini, Tony
Dens, Joseph
di Mario, Carlo
Dou, Kefei
Egred, Mohaned
Elbarouni, Basem
ElGuindy, Ahmed M
Escaned, Javier
Furkalo, Sergey
Gagnor, Andrea
Galassi, Alfredo R
Garbo, Roberto
Gasparini, Gabriele
Ge, Junbo
Ge, Lei
Goel, Pravin Kumar
Goktekin, Omer
Gonzalo, Nieves
Grancini, Luca
Hall, Allison
Hanna Quesada, Franklin Leonardo
Hanratty, Colm
Harb, Stefan
Harding, Scott A
Hatem, Raja
Henriques, Jose P S
Hildick-Smith, David
Hill, Jonathan M
Hoye, Angela
Jaber, Wissam
Jaffer, Farouc A
Jang, Yangsoo
Jussila, Risto
Kalnins, Artis
Kalyanasundaram, Arun
Kandzari, David E
Karmpaliotis, Dimitri
Kassem, Hussien Heshmat
Khatri, Jaikirshan
Knaapen, Paul
Kornowski, Ran
Krestyaninov, Oleg
Kumar, A V Ganesh
Lamelas, Pablo Manuel
Lee, Seung-Whan
Lefevre, Thierry
Leung, Raymond
Li, Yu
Li, Yue
Lim, Soo-Teik
Lo, Sidney
Lombardi, William
Maran, Anbukarasi
McEntegart, Margaret
Moses, Jeffrey
Munawar, Muhammad
Navarro, Andres
Ngo, Hung M
Nicholson, William
Oksnes, Anja
Olivecrona, Goran K
Padilla, Lucio
Patel, Mitul
Pershad, Ashish
Postu, Marin
Qian, Jie
Quadros, Alexandre
Rafeh, Nidal Abi
Råmunddal, Truls
Prakasa Rao, Vithala Surya
Reifart, Nicolaus
Riley, Robert F
Rinfret, Stephane
Saghatelyan, Meruzhan
Sianos, George
Smith, Elliot
Spaedy, Anthony
Spratt, James
Stone, Gregg
Strange, Julian W
Tammam, Khalid O
Thompson, Craig A
Toma, Aurel
Tremmel, Jennifer A
Trinidad, Ricardo Santiago
Ungi, Imre
Vo, Minh
Vu, Vu Hoang
Walsh, Simon
Werner, Gerald
Wojcik, Jaroslaw
Wollmuth, Jason
Xu, Bo
Yamane, Masahisa
Ybarra, Luiz F
Yeh, Robert W
Zhang, Qi
Abstract
The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.
Subjects
chronic total occlusion; global; percutaneous coronary intervention; treatment algorithm
Publisher
ELSEVIER SCIENCE INC
Type
review