Ipsilateral vs. contralateral vs. no collateral (antegrade only) chronic total occlusion percutaneous coronary interventions: What is the right choice for your practice?

Azzalini, Lorenzo; Brilakis, Emmanouil S.

doi:10.1002/ccd.27005

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…Preference should be given to septal collaterals (due to lower risk in case of perforation as compared with epicardial channels) 50,57,58 and diseased/occluded saphenous vein grafts (which do not present side branches and therefore allow easy navigation) 58 . Epicardial collaterals should be considered only by very experienced operators and, in any case, as a second-line option 59 . Fortunately, septal channels are most frequently found in both right coronary artery (72%) and left anterior descending (52%) CTOs 60 .…”

Section: Retrograde Approachmentioning

confidence: 99%

Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club

Galassi

Werner²,

Boukhris³

et al. 2019

EuroIntervention

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220

143

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Since its inception in December 2006, the EuroCTO Club has strived to provide the framework for stateof-the-art chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in Europe and nearby regions. Among its initiatives, the EuroCTO Club has published a set of recommendations regarding the technical aspects of CTO PCI, whose last edition dates to 2012. The EuroCTO Club consensus document discusses CTO PCI clinical indications, techniques and equipment use, as well as the qualifications of operators/centres. Given the considerable amount of progress made by this subspecialty in recent years, there is a need for an updated document that includes data from recent clinical trials and registries, information on novel devices and techniques, and an up-to-date revision on the training requirements to approach CTO PCI. The current updated consensus document of the EuroCTO Club reflects the expertise of European operators to promote the widespread application of state-of-the-art CTO PCI, not only in Europe but also across neighbouring communities.

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Section: Retrograde Approachmentioning

confidence: 99%

Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club

Galassi

Werner²,

Boukhris³

et al. 2019

EuroIntervention

Self Cite

220

143

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“…The first reason is the increasing utilization of mother‐and‐child catheters, which are advanced antegradely in close proximity with the proximal cap of the occlusion and are more easily engaged by the retrograde wire. Secondly, snaring requires specific skills and might additionally cause hemodynamic instability through significant shear stress due to forceful pulling of the retrograde wire through collaterals branches .…”

Section: Discussionmentioning

confidence: 99%

Intracoronary snaring of the retrograde guidewire: How to overcome extreme takeoff angles in chronic total occlusion percutaneous coronary intervention

Azzalini

Carlino

Colombo

2017

Cathet Cardio Intervent

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Extreme angulation of coronary artery takeoff represents a challenge for wiring and device advancement in percutaneous coronary intervention (PCI). This anatomic feature is particularly adverse in cases of chronic total occlusion (CTO) of the ostial-proximal segment of the target vessel. In this setting, the retrograde approach can help getting access to the occlusion. However, difficulties might arise at the critical step of wire externalization, due to the need to overcome the extreme ostial angle. Here, we describe a case of successful CTO PCI of the proximal circumflex artery, which presented an extreme angle at its takeoff. Due to inability to perform antegrade wiring of the occlusion, the retrograde approach was undertaken via epicardial collaterals from the right coronary artery. Since conventional attempts at re-entering the antegrade guiding catheter failed due to the aforementioned extreme angle, the retrograde wire was snared in the mid left anterior descending artery, and externalization was performed. This case demonstrates the usefulness of coronary snares in the CTO operator's toolkit and shows how such devices can be used to safely and successfully complete challenging retrograde procedures.

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“…Use of epicardial collaterals is usually reserved for highly experienced operators and centers (Figure 1). 85 …”

Section: Retrograde Approachmentioning

confidence: 99%

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Tajti

Brilakis

2018

JAHA

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Ipsilateral vs. contralateral vs. no collateral (antegrade only) chronic total occlusion percutaneous coronary interventions: What is the right choice for your practice?

Cited by 8 publications

References 4 publications

Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club

Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club

Intracoronary snaring of the retrograde guidewire: How to overcome extreme takeoff angles in chronic total occlusion percutaneous coronary intervention

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

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