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Review
. 2018 Jul-Aug;70(4):548-555.
doi: 10.1016/j.ihj.2018.01.021. Epub 2018 Jan 10.

Coronary chronic total occlusion intervention: A pathophysiological perspective

Debabrata Dash  1
Affiliations
Review

Coronary chronic total occlusion intervention: A pathophysiological perspective

Debabrata Dash. Indian Heart J. 2018 Jul-Aug.

Abstract

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is the last frontier in coronary intervention. PCI of CTO carries multiple advantages, such as significant improvement in symptoms, improvement in abnormal wall motion and left ventricular function and, possibly, increased long-term survival. As of today the procedural success is markedly improved because of technical innovations and is limited to highly experienced operators. To enhance the overall success rate from a worldwide perspective, a thorough understanding of its pathophysiology is critical to further development of newer techniques and technologies. In this review, the author outlines in-depth the evidence that underpins our understanding of CTO pathophysiology and its insight into CTO intervention that incorporates various steps and techniques to cross the lesion.

Keywords: Chronic total occlusion; Pathophysiology; Percutaneous coronary intervention.

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Figures

Fig. 1
Fig. 1
Short segment CTO with tapered stump with mild or no calcification.
Fig. 2
Fig. 2
Coronary angiogram depicting occluded RCA with Grade 2 collateral channel. A. Short segment CTO with tapered stump and microchannels B. Navigation of Fielder XT guidewire with Finecross C. Final result with deployment of drug eluting stent after successful microchannel tracking.
Fig. 3
Fig. 3
Long segment CTO with heavy calcium. A. Deflection of guidewire into subintimal space because of heavy calcium B. Employment of parallel wire (2nd wire being stiffer and tapered tip) technique for successful navigation into true lumen.
Fig. 4
Fig. 4
Side branch IVUS guided wire crossing. A. Manipulation of second guidewire using IVUS catheter in RV branch in CTO of RCA B. Second guidewire is in true lumen of RCA as depicted in IVUS imaging C. Final result after overlapping DES implantation
Fig. 5
Fig. 5
Algorithm of global approach to CTO PCI, .
See this image and copyright information in PMC

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