Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention : A Global Expert Consensus Document
(2019) In Circulation 140(5). p.420-433- Abstract
Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all... (More)
Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.
(Less)
- author
- author collaboration
- publishing date
- 2019-07-30
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- coronary occlusion, methods, outcome, percutaneous coronary intervention, treatment
- in
- Circulation
- volume
- 140
- issue
- 5
- pages
- 14 pages
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- pmid:31356129
- scopus:85064845892
- ISSN
- 0009-7322
- DOI
- 10.1161/CIRCULATIONAHA.119.039797
- language
- English
- LU publication?
- no
- id
- 11a234da-8667-4d0c-95ac-8f54e383f624
- date added to LUP
- 2021-02-02 17:55:40
- date last changed
- 2024-06-27 07:56:53
@article{11a234da-8667-4d0c-95ac-8f54e383f624,
abstract = {{<p>Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.</p>}},
author = {{Brilakis, Emmanouil S. and Mashayekhi, Kambis and Tsuchikane, Etsuo and Abi Rafeh, Nidal and Alaswad, Khaldoon and Araya, Mario and Avran, Alexandre and Azzalini, Lorenzo and Babunashvili, Avtandil M. and Bayani, Baktash and Bhindi, Ravinay and Boudou, Nicolas and Boukhris, Marouane and Božinović, Nenad and Bryniarski, Leszek and Bufe, Alexander and Buller, Christopher E. and Burke, M. Nicholas and Büttner, Heinz Joachim and Cardoso, Pedro and Carlino, Mauro and Christiansen, Evald H. and Colombo, Antonio and Croce, Kevin and Damas De Los Santos, Felix and De Martini, Tony and Dens, Joseph and DI Mario, Carlo and Dou, Kefei and Egred, Mohaned and Elguindy, Ahmed M. and Escaned, Javier and Furkalo, Sergey and Gagnor, Andrea and Galassi, Alfredo R. and Garbo, Roberto and Ge, Junbo and Goel, Pravin Kumar and Goktekin, Omer and Grancini, Luca and Grantham, J. Aaron and Hanratty, Colm and Harb, Stefan and Harding, Scott A. and Henriques, Jose P.S. and Hill, Jonathan M. and Jaffer, Farouc A. and Jang, Yangsoo and Olivecrona, Göran K. and Xu, Bo}},
issn = {{0009-7322}},
keywords = {{coronary occlusion; methods; outcome; percutaneous coronary intervention; treatment}},
language = {{eng}},
month = {{07}},
number = {{5}},
pages = {{420--433}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Circulation}},
title = {{Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention : A Global Expert Consensus Document}},
url = {{http://dx.doi.org/10.1161/CIRCULATIONAHA.119.039797}},
doi = {{10.1161/CIRCULATIONAHA.119.039797}},
volume = {{140}},
year = {{2019}},
}