How and When to Perform the Retrograde Approach
Fig. 9.1 (Video 9.1). Dual injection showing a long RCA CTO, with the distal cap at a major bifurcation, and good septal collateral channels from the left system. A 6F…
How to Fix Common Problems Encountered in CTO PCI: The Expanded Hybrid Approach
1. Is the proximal cap ambiguous in its location? 2. Is the target distal vessel diseased, or is there a bifurcation at the distal cap? 3. Is the lesion length…
How to Deal with Difficult Antegrade Issues
Fig. 7.1 IVUS-guided proximal cap puncture. (a) IVUS of proximal cap. (b) Guidewire entering into proximal cap Fig. 7.2 (a, b) Scratch and go technique 2. It is not…
Complications of Chronic Total Occlusion Percutaneous Coronary Intervention
Author Year Patients Success (%) Retrograde (%) MI (%) Tamponade (%) In-hospital mortality (%) Emergent CABG (%) Suero et al. [3] 2001 2007 69.9 0 2.4 0.5 1.3 0.7 Prasad…
What Equipment Should Be Available?
Category no. Equipment Must have Good to have 1. Sheaths 45-cm long sheaths (if using femoral access) 2. Guides XB/EBU 3.0, 3.5, 3.75, 4.0 AL1, AL0.75 JR4 Y-connector with hemostatic…
When and How to Perform a Transradial Approach for CTO PCI
Radial artery access is critically important for the success of the CTO PCI Common femoral artery access is preferred during CTO PCI Post CABG patients when CTO PCI requires more…
When and How to Perform an Antegrade Dissection/Re-entry Approach using the CrossBoss and Stingray Catheters
Fig. 6.1 The CrossBoss and Stingray Dissection and Reentry System. (a) The CrossBoss catheter (Courtesy of Chad Kugler and Boston Scientific). (b) The Stingray balloon and wire for controlled re-entry…
How to Prevent and Manage Ischemic Complications During CTO PCI
Fig. 17.1 Ischemic complications during CTO PCI Ischemic Complications from Target CTO Vessel Injury Target vessel injury can cause ischemic complications when side branches or dominant ipsilateral collaterals are compromised….
Specific Basic Techniques to Master in CTO PCI
Guidewire technique Guidewire choice (tip load) Guidewire tip shape Degree of torqueing Tip force applied Sliding and drilling Fielder XT (0.8 g) 1 mm 30–45° Rapid spinning when facing resistance…
How to Manage Radiation and Contrast During Chronic Total Occlusion Percutaneous Coronary Intervention
Serum creatinine increase ≥0.5 mg/dl or ≥25 % from baseline within 72 h [4, 5] Serum creatinine rise by ≥ 0.3 mg/dl within 48 h or Serum creatinine rise ≥150 % from…
