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Review
. 2021 Oct 20:16:e30.
doi: 10.15420/icr.2021.01. eCollection 2021 Apr.

The Impact of Calcium on Chronic Total Occlusion Management

Claudia Cosgrove  1 , Kalaivani Mahadevan  2 , James C Spratt  1 , Margaret McEntegart  3
Affiliations
Review

The Impact of Calcium on Chronic Total Occlusion Management

Claudia Cosgrove et al. Interv Cardiol. .

Abstract

Coronary artery calcification is prevalent in chronic total occlusions (CTO), particularly in those of longer duration and post-coronary artery bypass. The presence of calcium predicts lower procedural success rates and a higher risk of complications of CTO percutaneous coronary intervention. Adjunctive imaging, including pre-procedural computed tomography and intracoronary imaging, are useful to understand the distribution and morphology of the calcium. Specialised guidewires and microcatheters, as well as penetration, subintimal entry and luminal re-entry techniques, are required to cross calcific CTOs. The use of both atherectomy devices and balloon-based calcium modification tools has been reported during CTO percutaneous coronary intervention, although they are limited by concerns regarding safety and efficacy in the subintimal space.

Keywords: Chronic total occlusion; atherectomy; coronary artery calcium; intracoronary imaging; microcatheters; re-entry; subintimal space.

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Conflict of interest statement

Disclosure: The authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Chronic Total Occlusion Histology
Figure 2:
Figure 2:. CT Coronary Angiography of Calcific Chronic Total Occlusion
Figure 3:
Figure 3:. Calcific Proximal Cap on Intravascular Ultrasound
Figure 4:
Figure 4:. Balloon-assisted Subintimal Entry
See this image and copyright information in PMC

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