Current approaches for treatment of coronary chronic occlusions

Abstract

Introduction: Coronary chronic total occlusions (CTO) represent a challenging subset in interventional cardiology. Areas covered: During the last decade, improvements in materials, techniques, and meticulous preprocedural lesion assessment have increased the success rate in CTO lesions. Several scores have been developed to address overall lesion evaluation and help select the most appropriate treatment strategy. In addition, specific algorithms such as the hybrid algorithm have been introduced to provide a framework for CTO operators and a rapid management of the various challenging aspects of the procedure. The hybrid approach requires operator's ability to switch from one treatment strategy to another when the first one appears to be unsuccessful. Adequate training and operators' experience remain crucial to improve the likelihood of success. Expert opinion: The aim of this review is to provide insights and guidance for operators on current approaches for treatment of CTO and complication management.

Effectiveness and safety of a novel modified homemade snare in retrograde percutaneous coronary intervention for chronic total occlusion lesions: a retrospective cohort study

“…The inclusion criteria were: (I) diagnosis of CTO, defined as total occlusion with an estimated duration of occlusion ≥3 months ( 7 , 8 , 10 ); and (II) retrograde PCI using either the MHS or a commercial snare for externalization. The exclusion criteria were: (I) acute myocardial infarction with emergency PCI within 24 h after admission; (II) received other operations besides PCI (e.g., valve replacement or CABG); or (III) critical surgery-related data missing.…”

“…Chronic total occlusion (CTO) lesions account for 15–20% of coronary atherosclerotic lesions ( 3 , 4 ). The prevalence of CTO is 30–50% in patients with CAD ( 5 , 6 ), with a higher prevalence in patients with prior coronary artery bypass graft (CABG) ( 7 ) and a prevalence of 10–15% in patients with acute myocardial infarction ( 8 ). Percutaneous coronary intervention (PCI) for CTO lesions is associated with satisfactory clinical outcomes, but PCI still poses some risks of poor outcomes for inexperienced cardiologists ( 8 - 10 ).…”

Partial Reversal of Coronary Stenosis with Intravenous Hydrogen and Oxygen Nanobubble Administration: A Case Report

“…Dietary modifications further contribute to the risk reduction strategy, emphasising the role of an appropriate diet in preventing cardiovascular events [8]. These lifestyle interventions are complemented by medical treatments including acetylsalicylic acid, statins, ACE-blockers, and beta-blockers, which have become the standard in medical therapy for CHD [9]. Despite the advancements in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), which have significantly improved the management of coronary artery disease (CAD), the importance of conservative treatment remains undiminished [10].…”

Postdischarge prognostic significance of periprocedural myocardial injury after percutaneous intervention of chronic total occlusion

“…1 Percutaneous coronary intervention (PCI) is one of the treatment options in these patients and improves patient symptoms and clinical outcome. [2][3][4][5] Advances in materials and techniques have led to an accelerated adoption of CTO PCI and improved success rates in recent years. 2 3 Markers to risk stratify patients undergoing CTO PCI may allow further improvement in clinical outcomes.…”

“…Coronary chronic total occlusions (CTOs) are found in 15%–25% of patients with stable coronary artery disease 1. Percutaneous coronary intervention (PCI) is one of the treatment options in these patients and improves patient symptoms and clinical outcome 2–5. Advances in materials and techniques have led to an accelerated adoption of CTO PCI and improved success rates in recent years 2 3.…”