Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review
Authors
Eugene B Wu ; Emmanouil S Brilakis ; Kambis Mashayekhi ; Etsuo Tsuchikane ; Khaldoon Alaswad ; Mario Araya ; Alexandre Avran ; Lorenzo Azzalini ; Avtandil M Babunashvili ; Baktash Bayani ; Michael Behnes ; Ravinay Bhindi ; Nicolas Boudou ; Marouane Boukhris ; Nenad Z Bozinovic ; Leszek Bryniarski ; Alexander Bufe ; Christopher E Buller ; M Nicholas Burke ; Achim Buttner ; Pedro Cardoso ; Mauro Carlino ; Ji-Yan Chen ; Evald Hoej Christiansen ; Antonio Colombo ; Kevin Croce ; Felix Damas de Los Santos ; Tony de Martini ; Joseph Dens ; Carlo di Mario ; Kefei Dou ; Mohaned Egred ; Basem Elbarouni ; Ahmed M ElGuindy ; Javier Escaned ; Sergey Furkalo ; Andrea Gagnor ; Alfredo R Galassi ; Roberto Garbo ; Gabriele Gasparini ; Junbo Ge ; Lei Ge ; Pravin Kumar Goel ; Omer Goktekin ; Nieves Gonzalo ; Luca Grancini ; Allison Hall ; Franklin Leonardo Hanna Quesada ; Colm Hanratty ; Stefan Harb ; Scott A Harding ; Raja Hatem ; Jose P S Henriques ; David Hildick-Smith ; Jonathan M Hill ; Angela Hoye ; Wissam Jaber ; Farouc A Jaffer ; Yangsoo Jang ; Risto Jussila ; Artis Kalnins ; Arun Kalyanasundaram ; David E Kandzari ; Hsien-Li Kao ; Dimitri Karmpaliotis ; Hussien Heshmat Kassem ; Jaikirshan Khatri ; Paul Knaapen ; Ran Kornowski ; Oleg Krestyaninov ; A V Ganesh Kumar ; Pablo Manuel Lamelas ; Seung-Whan Lee ; Thierry Lefevre ; Raymond Leung ; Yu Li ; Yue Li ; Soo-Teik Lim ; Sidney Lo ; William Lombardi ; Anbukarasi Maran ; Margaret McEntegart ; Jeffrey Moses ; Muhammad Munawar ; Andres Navarro ; Hung M Ngo ; William Nicholson ; Anja Oksnes ; Goran K Olivecrona ; Lucio Padilla ; Mitul Patel ; Ashish Pershad ; Marin Postu ; Jie Qian ; Alexandre Quadros ; Nidal Abi Rafeh ; Truls Råmunddal ; Vithala Surya Prakasa Rao ; Nicolaus Reifart ; Robert F Riley ; Stephane Rinfret ; Meruzhan Saghatelyan ; George Sianos ; Elliot Smith ; Anthony Spaedy ; James Spratt ; Gregg Stone ; Julian W Strange ; Khalid O Tammam ; Craig A Thompson ; Aurel Toma ; Jennifer A Tremmel ; Ricardo Santiago Trinidad ; Imre Ungi ; Minh Vo ; Vu Hoang Vu ; Simon Walsh ; Gerald Werner ; Jaroslaw Wojcik ; Jason Wollmuth ; Bo Xu ; Masahisa Yamane ; Luiz F Ybarra ; Robert W Yeh ; Qi Zhang
Citation
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol.78(8) : 840-853, 2021-08
chronic total occlusion ; global ; percutaneous coronary intervention ; treatment algorithm
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.