Molecular, Gene, and Cellular Mechanisms
INTRODUCTION Heart failure is an ancient diagnosis. Some of the earliest known descriptions are attributed to Hippocrates, circa 460–370 BCE. He reported dozens of clinical case histories with examples of…
Complications
Abstract Complications of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be classified according to timing (as acute and long-term) and according to location (cardiac coronary, cardiac noncoronary, and…
The Retrograde Approach
Abstract The retrograde approach to chronic total occlusion (CTO) crossing differs from the antegrade approach because the occlusion is approached from the distal vessel. The retrograde approach can be divided…
Complex Lesion Subsets
Abstract There are several complex subsets of chronic total occlusion (CTO) lesions, such as CTOs with proximal cap ambiguity, impenetrable proximal or distal cap, flush aortoostial CTOs, ostial circumflex and…
Antegrade Dissection/Reentry
Abstract Dissection/reentry can be achieved either in the antegrade or the retrograde direction. Antegrade dissection can be achieved using knuckled guidewires or using the CrossBoss catheter. Antegrade reentry can be…
The Basics: Timing, Dual Injection, Studying the Lesion, Access, Anticoagulation, Guide Support, Trapping, Pressure and Electrocardiogram Monitoring
Abstract Knowledge and application of eight basic principles and techniques are critical for safely and successfully performing chronic total occlusion (CTO) percutaneous coronary interventions (PCIs). First, CTO PCIs should be…
Putting It All Together: The Hybrid Approach
Abstract The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention provides guidance on selection of the optimal CTO crossing strategy in a stepwise fashion. First, dual injection is…
“Balloon-Uncrossable” and “Balloon-Undilatable” Chronic Total Occlusions
Abstract Balloon-uncrossable chronic total occlusions (CTOs) are lesions that cannot be crossed with a balloon after successful guidewire crossing and confirmation of guidewire placement into the distal true lumen. Such…
Radiation Management During Chronic Total Occlusion Percutaneous Coronary Intervention
Abstract Radiation injury can occur after chronic total occlusion intervention, hence strategies to minimize radiation exposure are critical and should be applied from the outset of the procedure. The total…
