Manual of Coronary Chronic Total Occlusion Interventions

Table of Contents:

Dedication

List of Contributors

Foreword

1. CTO Interventions: Definition, Prevalence, Indications, Guidelines

1.1 CTO Definition

1.2 Prevalence of CTOs

1.3 Indications and Potential Clinical Benefits of CTO PCI

1.4 Guidelines for CTO PCI

1.5 Appropriateness Use Criteria in CTO PCI

1.6 Contraindications to CTO PCI

1.7 Summary and Conclusions

References

2. Equipment

2.1 Sheaths

2.2 Guide Catheters

2.3 Microcatheters

2.4 Guidewires

2.5 Dissection/Re-Entry Equipment

2.6 Snares

2.7 “Uncrossable-Undilatable” Lesion Equipment

2.8 Intravascular Ultrasound

2.9 Complication Management Equipment

2.10 Radiation Protection

2.11 The “CTO cart”

References

3. The Basics: Timing, Dual Injection, Studying the Lesion, Access, Anticoagulation, Guide Support, Trapping

3.1 Timing

3.2 Dual Injection

3.3 Studying the Lesion

3.4 Vascular Access

3.5 Anticoagulation

3.6 Techniques to Increase Guide Catheter Support (Large Bore Guide, Active Guide Support, Guide Catheter Extensions, Anchor Techniques

3.7 Trapping

References

4. Antegrade Wire Escalation: The Foundation of CTO PCI

4.1 Special Situations

References

5. Antegrade Dissection/Re-entry

5.1 Knuckle Wire

5.2 CrossBoss

5.3 Stingray-Based Re-entry

5.4 Wire-Based Re-entry

References

6. The Retrograde Approach

6.1 Historical Perspective

6.2 Advantages of the Retrograde Approach

6.3 Special Equipment

6.4 Step-by-Step Description of the Procedure

6.5 Retrograde True Lumen Puncture

6.6 Retrograde Dissection/Re-entry

6.7 Antegrade Crossing

6.8 Special Retrograde CTO PCI Scenarios

References

7. Putting it all Together: The “Hybrid” Approach

7.1 Description of the “Hybrid” Algorithm

7.2 Impact of the “Hybrid” Approach

References

8. “Balloon Uncrossable” CTOs

8.1 Simultaneous Use of Strategies

References

9. “Balloon Undilatable” CTOs

9.1 Special Case Scenario: Stented “Balloon Undilatable” Lesions

References

10. Radiation Management During CTO PCI

10.1 Why is Radiation Management Important?

10.2 Essentials of Radiation Dose Management

10.3 Conclusions

References

11. Stenting of CTO Lesions

11.1 Stent Type

11.2 Stent Optimization

11.3 Antiplatelet Therapy After CTO Stenting

References

12. Complications

12.1 Acute Complications

12.2 Long-Term Complications

12.3 Conclusion

References

13. How to Build a Successful CTO Program

References

Appendix 1. Equipment Commonly Utilized in CTO Interventions

Appendix 2. Commonly Used Acronyms in CTO Interventions

Index