By George D. Dangas, Roxana Mehran, Jeff Moses, Martin B. Leon
Chronic overall occlusions (CTO) are universal, and located in nearly one 3rd of sufferers with major coronary artery illness who endure angiography. CTO represent one of many major standards whilst settling on among angioplasty and pass surgical procedure. Angioplasty for CTO is complicated and requires very good operator ability, yet even if played less than the easiest conditions, it is plagued via decrease good fortune premiums when put next to non-total occlusions. the most trouble with CTO lies now not with choosing which stent to take advantage of, yet quite happens in the course of earlier steps of crossing the lesion and advancing the twine into the genuine lumen of the distal vessel. Having comprehensive this, the premiums of restenosis are prohibitively excessive. Mehran, Dangas and a world group of skilled operators provide the reader sound suggestion at the assessment and administration of CTO in either the coronary and peripheral vascular platforms. Their functional advice may still relief all these operating with this tough subset of patients.
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Extra info for Handbook of Chronic Total Occlusions
Sample text
A retrograde wire was advanced through a septal collateral channel up to the distal CTO end (E). Penetration of the CTO end was achieved, and balloon dilatations at the bifurcation of the distal right coronary artery, the posterior descending artery, as well as in the distal right coronary segment were performed over the retrograde wire (F and G). Thereafter, the antegrade wire (white arrow) could be placed easily in the posterior descending artery (H). The rest of the procedure was then performed in an antegrade manner with balloon dilatation of the CTO site followed by stent implantation.
11. Schaper W, Ito WD. Molecular mechanisms of coronary collateral vessel growth. Circ Res 1996; 79(5):911–19. 12. Katsuragawa M, Fujiwara H, Miyamae M, Sasayama S. qxp 6/4/2007 6:40 PM Page 47 Retrograde and combination techniques 13. 14. 15. 16. 17. 18. 19. 47 abrupt types of occlusion and short and long occluded segments. J Am Coll Cardiol 1993; 21(3):604–11. Srivatsa S, Holmes D Jr. The histopathology of angiographic chronic total coronary artery occlusions and changes in neovascular pattern and intimal plaque composition associated with progressive occlusion duration.
Previous lesion subsets that were once thought to be untreatable by percutaneous intervention are now being successfully opened as physician experience and guidewire innovations continue to improve. An individualized lesion-based approach is necessary when treating chronic coronary occlusions, because the anatomy of total occlusions varies. Proper knowledge of the advantages and limitations of the different guidewires, in particular the nuances between hydrophilic and stiffer guidewires, is essential to improving the likelihood of procedural success.