TY - JOUR
T1 - Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention
T2 - A Global Expert Consensus Document
AU - Brilakis, Emmanouil S.
AU - Mashayekhi, Kambis
AU - Tsuchikane, Etsuo
AU - Abi Rafeh, Nidal
AU - Alaswad, Khaldoon
AU - Araya, Mario
AU - Avran, Alexandre
AU - Azzalini, Lorenzo
AU - Babunashvili, Avtandil M.
AU - Bayani, Baktash
AU - Bhindi, Ravinay
AU - Boudou, Nicolas
AU - Boukhris, Marouane
AU - Božinović, Nenad
AU - Bryniarski, Leszek
AU - Bufe, Alexander
AU - Buller, Christopher E.
AU - Burke, M. Nicholas
AU - Büttner, Heinz Joachim
AU - Cardoso, Pedro
AU - Carlino, Mauro
AU - Christiansen, Evald H.
AU - Colombo, Antonio
AU - Croce, Kevin
AU - Damas De Los Santos, Felix
AU - De Martini, Tony
AU - Dens, Joseph
AU - DI Mario, Carlo
AU - Dou, Kefei
AU - Egred, Mohaned
AU - Elguindy, Ahmed M.
AU - Escaned, Javier
AU - Furkalo, Sergey
AU - Gagnor, Andrea
AU - Galassi, Alfredo R.
AU - Garbo, Roberto
AU - Ge, Junbo
AU - Goel, Pravin Kumar
AU - Goktekin, Omer
AU - Grancini, Luca
AU - Grantham, J. Aaron
AU - Hanratty, Colm
AU - Harb, Stefan
AU - Harding, Scott A.
AU - Henriques, Jose P.S.
AU - Hill, Jonathan M.
AU - Jaffer, Farouc A.
AU - Jang, Yangsoo
AU - Olivecrona, Göran K.
AU - Xu, Bo
AU - Global Expert Consensus
PY - 2019/7/30
Y1 - 2019/7/30
N2 - Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.
AB - Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.
KW - coronary occlusion
KW - methods
KW - outcome
KW - percutaneous coronary intervention
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=85064845892&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.119.039797
DO - 10.1161/CIRCULATIONAHA.119.039797
M3 - Review article
C2 - 31356129
AN - SCOPUS:85064845892
SN - 0009-7322
VL - 140
SP - 420
EP - 433
JO - Circulation
JF - Circulation
IS - 5
ER -