Global Chronic Total Occlusion Crossing Algorithm

Wu, Eugene B.; Brilakis, Emmanouil S.; Mashayekhi, Kambis; Tsuchikane, Etsuo; Alaswad, Khaldoon; Araya, Mario; Avran, Alexandre; Azzalini, Lorenzo; Бабунашвили, А. М.; Bayani, Baktash; Behnes, Michael; Bhindi, Ravinay; Boudou, Nicolas; Boukhris, Marouane; Božinović, Nenad; Bryniarski, Leszek; Bufe, Alexander; Buller, Christopher E.; Burke, M. Nicholas; Buttner, Achim; Cardoso, Pedro; Carlino, Mauro; Chen, Ji Yan; Christiansen, Evald; Colombo, Antonio; Croce, Kevin; Santos, Félix Damas de los; Martini, Tony De; Dens, Joseph; Mario, Carlo Di; Dou, Kefei; Egred, Mohaned; Elbarouni, Basem; ElGuindy, Ahmed; Escaned, Javier; Furkalo, Sergey; Gagnor, Andrea; Galassi, Alfredo R.; Garbo, Roberto; Gasparini, Gabriele L.; Ge, Junbo; Ge, Liang; Goel, Pravin K.; Göktekín, Ömer; Gonzalo, Nieves; Grancini, Luca; Hall, Allison B.; Quesada, Franklin Leonardo Hanna; Hanratty, Colm G.; Harb, Stefan; Harding, Scott; Hatem, Raja; Henriques, José P.S.; Hildick‐Smith, David; Hill, Jonathan; Hoye, Angela; Jaber, Wissam; Jaffer, Farouc A.; Jang, Yangsoo; Jussila, Risto; Kalniņš, Artis; Kalyanasundaram, Arun; Kandzari, David E.; Kao, Hsien‐Li; Karmpaliotis, Dimitri; Kassem, Hussien Heshmat; Khatri, Jaikirshan; Knaapen, Paul; Kornowski, Ran; Krestyaninov, Oleg; Kumar, Ashish; Lamelas, Pablo; Lee, Seung Whan; Lefèvre, Thierry; Leung, Raymond; Liu, Yu; Li, Yue; Lim, Soo Teik; Lo, S.; Lombardi, William; Maran, Anbukarasi; McEntegart, Margaret; Moses, Jeffrey W.; Munawar, Muhammad; Navarro, Andrés; Ngo, Hung Manh; Nicholson, William J.; Øksnes, Anja; Olivecrona, Göran; Padilla, Lucio; Patel, Mitul; Pershad, Ashish; Postu, Marin; Qian, Jie; Quadros, Alexandre Schaan de; Rafeh, Nidal Abi; Råmunddal, Truls; Rao, Vithala Surya Prakasa; Reifart, Nicolaus; Riley, Robert F.; Rinfret, Stéphane; Saghatelyan, Meruzhan; Sianos, George; Smith, Elliot J.; Spaedy, Anthony; Spratt, James C.; Stone, Gregg W.; Strange, Julian; Tammam, Khalid; Thompson, Craig A.; Toma, Aurel; Tremmel, Jennifer A.; Trinidad, Ricardo Santiago; Ungi, Imre; Vo, Minh; Vu, Vu Hoang; Walsh, Simon; Werner, Gerald; Wójcik, Jarosław; Wollmuth, Jason; Xu, Bo; Yamane, Masahisa; Ybarra, Luiz Fernando; Yeh, Robert W.; Zhang, Qi

doi:10.1016/j.jacc.2021.05.055

Cited by 148 publications

(57 citation statements)

References 25 publications

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“…However, these data are merely hypothesis generating and must be confirmed in a prospective randomized trial. Success rate in the current registry is comparable with other similar registries, such as PROGRESS-CTO, OPEN-CTO, RECHARGE registry, EUROCTO-registry, and jCTO registry with success rates ranging from 85 to 89% ( 20 ). Furthermore, a high jCTO score was observed in the current study (3.1 ± 1.2 and 3.4 ± 1.0).…”

Section: Discussionsupporting

confidence: 74%

“…In low volume sites, very low success rates of < 50% are observed ( 19 ). Therefore, we argue that the interpretation of the data in the present study underlines the global consensus reached by CTO-operators from 50 countries that CTO-operators must be able to handle many different techniques and scenarios to optimize the success rate ( 20 ). A collection of CTO procedures at fewer sites will probably facilitate a higher success rate without an increase in complication rate ( 17 , 19 ).…”

Section: Discussionmentioning

confidence: 66%

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Cost-Effectiveness in Patients Undergoing Revascularization of Chronic Total Occluded Coronary Arteries—A Cohort Study

Holck

Winther²,

Mogensen³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundRevascularization of patients with chronic total occluded coronary arteries (CTO) is recommended if they have symptoms despite medical treatment. The cost-effectiveness of treatment with percutaneous coronary intervention (PCI) was investigated in this cohort study.Materials and MethodsThe study was designed as a cohort study enrolling all patients undergoing PCI for a CTO in the Central Region of Denmark and recorded in the EUROCTO database. Major adverse cardio- and cerebrovascular events (MACCE) and admissions for cardiac symptoms were collected in the Western Denmark Heart Registry and through medical Journal Audits. Exposure was defined as successful revascularization of all CTO lesions compared with having one or more remaining CTOs after PCI attempt(s). Cost-effectiveness was evaluated as the net benefit (NB) at the patient level 3 years after treatment and through cost-effectiveness planes. The cost was defined as the cumulative cost of the index procedure and admissions due to MACCE and cardiac symptoms. Effectiveness was defined as the difference in MACCE for the primary analysis and the difference in death and symptomatic admissions for the secondary.ResultsBetween 2009 and 2019, 441 patients with ≥ 3 years of follow-up were treated with PCI for at least one CTO lesion (342 in the successful arm and 99 in the unsuccessful arm). The technical success rate was 85.4%. In total, 155 MACCE and 184 symptomatic admissions occurred in the follow-up period. The mean total cost was EUR 11.719 (11.034; 12.406) in the successful group vs. EUR 13.565 (11.899; 15,231) (p = 0.02) in the unsuccessful group. Net-benefit was EUR 1.846 (64; 3,627) after successful revascularization for MACCE. The adjusted analysis found an NB of EUR 1,481 (–118; 3,079). Bootstrap estimates showed cost-effectiveness planes in favor of successful revascularization.ConclusionPatients fully revascularized for all CTO lesions had a more cost-efficient treatment. However, results need confirmation in a randomized controlled trial due to the risk of residual confounding after adjustment.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 66%

Cost-Effectiveness in Patients Undergoing Revascularization of Chronic Total Occluded Coronary Arteries—A Cohort Study

Holck

Winther²,

Mogensen³

et al. 2022

Front. Cardiovasc. Med.

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“…Compared with them, TD-ADR enables the puncture to be at a more proximal part and allows a pinpoint puncture of the intended part in the vertical direction, because the target and the guidewire tip are clearly visible using the IVUS observation ( Figure 4 ). The global CTO algorithm has recently been reported ( Figure 5A ), 4 but we hope that it will be changed to the following algorithm including the use of AO-IVUS ( Figure 5B ). The procedural details are shown in Supplementary material online , Video S2 .…”

Section: Discussionmentioning

confidence: 99%

Tip detection-antegrade dissection and reentry using intravascular ultrasound in chronic total occlusion intervention: first human case report

Suzuki

Okamura

Nagai

et al. 2022

European Heart Journal - Case Reports

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Background It has been considered impossible to perform antegrade dissection and reentry (ADR) by simply puncturing with a guidewire using the intravascular ultrasound (IVUS) observation without the support of the Stingray system. Case summary A 78-year-old man suffered from effort angina pectoris due to a chronic total occlusion (CTO) lesion in the left circumflex coronary artery. A retry percutaneous coronary intervention for the CTO lesion was attempted at our hospital. The J-CTO score was 3. The first guidewire entered the subintimal space. We moved onto StingrayADR using the angiographic observation, but the guidewire could not be led into the true lumen. AnteOwl WR-IVUS (AO-IVUS) observation revealed a distal true lumen in which the inner lumen was maintained 5 mm beyond the CTO exit. We decided to perform the tip detection-ADR using the AO-IVUS observation. The tip detection method allowed the tip of the penetration wire to puncture the wall between the subintima and the true lumen in an exactly vertical direction, resulting in the successful creation of a reentry point. The CTO lesion was dilated with one drug-eluting stent, and normal antegrade blood flow was achieved. Discussion Since the tip detection method enables accurate punctures, it may allow for ADR by simply puncturing using a guidewire. Due to this method being performed using the IVUS observation, it is likely more reliable than Stingray-ADR using the angiographic observation.

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“…Several scores and algorithms were described to predict the feasibility and to guide the CTO recanalization. All of these scores included blunt and/or ambiguous cap and presence of calcification as predictors for a difficult CTO ( 1 ). Proximal cap ambiguity is present in approximately one-third of CTO lesions.…”

Section: Discussionmentioning

confidence: 99%

Lithoplasty-Facilitated Proximal Cap Penetration of a Calcified Chronic Total Occlusion Coronary Lesion

et al. 2022

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Global Chronic Total Occlusion Crossing Algorithm

Cited by 148 publications

References 25 publications

Cost-Effectiveness in Patients Undergoing Revascularization of Chronic Total Occluded Coronary Arteries—A Cohort Study

Cost-Effectiveness in Patients Undergoing Revascularization of Chronic Total Occluded Coronary Arteries—A Cohort Study

Tip detection-antegrade dissection and reentry using intravascular ultrasound in chronic total occlusion intervention: first human case report

Lithoplasty-Facilitated Proximal Cap Penetration of a Calcified Chronic Total Occlusion Coronary Lesion

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