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Percutaneous Treatment of Chronic Total Occlusions

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Catheter-Based Cardiovascular Interventions

Abstract

PCI is indicated for patients with a CTO who have ongoing symptoms despite medical therapy and evidence of associated viable myocardium. A successful procedure will improve quality of life and may also incur a survival benefit as there is improved tolerance to future cardiac events. The major limitation of CTO-PCI remains the relatively lower procedural success rate as compared with therapy of non-occluded lesions, predominantly related to the inability to cross the lesion with a guidewire. The success rate of CTO-PCI is highly dependent on operator expertise, and consideration should be made to refer patients with more complex lesions to specialist interventional cardiologists with a particular interest in CTOs. There are many tips and tricks to complex CTO-PCI that should be appreciated, and these are best learnt from working alongside an expert operator. It is critical to have a thorough understanding of the properties of specialist equipment particularly guidewires, and incorporation of specialised techniques, tools such as IVUS guidance, and newer devices like the Tornus and Corsair catheters has been shown to increase the success rate to >80%.

It is extremely important to plan the strategy for CTO-PCI in advance of the procedure. This means that high-quality diagnostic angiography is vital and should evaluate not only the occlusion itself but also include long acquisitions to clearly delineate the degree of retrograde filling and identify the presence, size and course of collateral vessels. Close attention must be made to ensure that the CTO-PCI procedure is performed safely and effectively; once recanalised, the use of drug-eluting stents improves the long-term results of PCI.

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Authors and Affiliations

  1. Department of Cardiology, Castle Hill Hospital, Hull, UK

    Tamas Ungvari M.D. & Angela Hoye M.B., Ch.B., Ph.D.

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  1. Tamas Ungvari M.D.
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  2. Angela Hoye M.B., Ch.B., Ph.D.
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Correspondence to Angela Hoye M.B., Ch.B., Ph.D. .

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  1. , Dept. of Internal Medicine, Gesundheitszentrum Bitterfeld-Wolfen, Friedrich-Ludwig-Jahn-Straße 2, Bitterfeld-Wolfen, 06749, Germany

    Peter Lanzer

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Ungvari, T., Hoye, A. (2013). Percutaneous Treatment of Chronic Total Occlusions. In: Lanzer, P. (eds) Catheter-Based Cardiovascular Interventions. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27676-7_33

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  • DOI: https://doi.org/10.1007/978-3-642-27676-7_33

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