Chronic Total Occlusion Wiring: A State-of-the-Art Guide From The Asia Pacific Chronic Total Occlusion Club
Journal
Heart Lung and Circulation
Journal Volume
28
Journal Issue
10
Pages
1490-1500
Date Issued
2019
Author(s)
Abstract
Objective: Despite the advances in wire technology and development of algorithm-driven methodology for chronic total occlusion (CTO) intervention, there is a void in the literature about the technical aspects of CTO wiring. The Asia Pacific CTO Club, a group of 10 experienced operators in the Asia Pacific region, has tried to fill this void with this state-of-the-art review on CTO wiring. Methods: This review explains, for proximal cap puncture: choices of wires, shaping of the wire, use of dual lumen catheter, and method of step-down of wire penetration force for successful wiring. In wiring the CTO body, the techniques of loose tissue tracking, intentional intimal plaque tracking, and intentional subintimal wiring are described in detail. For distal lumen wiring, a blunt distal cap, presence of a distal cap side branch, calcium, and sharp tapered distal stump predict cap toughness, and wire penetration force should be stepped-up in these cases. The importance of choosing between redirection, parallel wiring, and Stingray (Boston Scientific, Marlborough, MA, USA) for angiographic guidance is discussed along with which will be more successful. On the retrograde side, the problems encountered with distal cap puncture and methods to overcome these problems are explained. The method of wiring the CTO body through a retrograde approach depending on the morphology of the CTO is described. Different reverse controlled antegrade and retrograde tracking (CART) wiring methods – including end balloon wiring, side balloon entry, and conventional reverse CART – are explained in detail. Conclusion: This is a systematic CTO wiring review, which is believed to be beneficial for CTO operators worldwide. ? 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)
Subjects
Chronic total occlusion; Percutaneous coronary intervention; Wiring
SDGs
Other Subjects
artery puncture; Asia; atherosclerotic plaque; blood vessel permeability; chronic total occlusion; coronary angiography; equipment design; human; intravascular ultrasound; percutaneous coronary intervention; practice guideline; priority journal; Review; algorithm; cardiology; chronic disease; coronary artery occlusion; incidence; medical society; Pacific islands; percutaneous coronary intervention; procedures; transluminal coronary angioplasty; Algorithms; Angioplasty, Balloon, Coronary; Asia; Cardiology; Chronic Disease; Coronary Angiography; Coronary Occlusion; Humans; Incidence; Pacific Islands; Percutaneous Coronary Intervention; Societies, Medical
Publisher
Elsevier Ltd
Type
review