Minimalistic hybrid approach for the percutaneous treatment of chronic coronary total occlusions: An in‐depth analysis of the whole algorithm

Abstract

Introduction:The minimalistic hybrid approach (MHA) is an algorithm to perform chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The current study aims to evaluate the distribution of patients among the five different treatment strategies, the different techniques used in each strategy, the overall procedural success, and the safety of the MHA algorithm.Methods: Data from a consecutive series of patients with a CTO who underwent elective PCI between February 2019 and July 2021 were prospectively collected and retrospectively analyzed.Results: One hundred and forty-three CTOPCI in 135 patients were approached according to the MHA algorithm: 134 CTO (93.7%) were successfully recanalized and 9 procedures failed. About half of the procedures (48.3%) were approached using strategy A: antegrade "blind wiring" with contralateral retrograde options, making this the most popular strategy. A total of 89 procedures (62.2%) were completed with a single guiding catheter; in 86 (96.6%) a forearm approach was used. The remaining 54 cases were performed with dual access; in the majority of these patients (90.7%), a bilateral forearm approach was used. The only reason to use the femoral access was inadequate forearm access. One hundred and fiftyfour out of 197 (78.2%) access sites were 6 French sheaths. Conclusion:MHA is a stepwise approach focused on the forearm approach to reduce the number of access sites and catheter size used in CTOPCI while maintaining proficiency and safety. Operators should be warned that this approach should be adopted only by experienced CTO operators who master all the strategies of the classic hybrid algorithm and the forearm approach.

Percutaneous Coronary Intervention for Chronic Total Occlusion—Contemporary Approach and Future Directions

“…Initial results are promising, out of 56 performed CTO PCIs in a prospective study, there was 94.6% and 91.1% technical and procedural success, respectively [84]. A similar success rate was seen in the analysis of 143 CTO PCIs [85]. There is still a need for further research, but newly developed devices have shown some promise.…”

Performance of the minimalistic hybrid approach algorithm versus other conventional algorithms in the percutaneous treatment of chronic total occlusions

“…We extrapolated data from the BWG‐CTO registry, dividing CTO procedures into two groups depending on the algorithm used. Specifically, CTO PCI procedures performed using the “classic” hybrid algorithm or other algorithms not contemplated in the hybrid (with more focus on advanced antegrade techniques) were considered in the Conventional group, whereas all CTO PCIs performed following the MHA 11 were performed in one center by three different operators (PA, BS, and CZ) and were considered in the Minimalistic group. Of note, operators in both groups were proficient with the most up‐to‐date CTO crossing algorithms, and performed an annual range of 40–100 CTO procedures.…”

“…Of note, operators in both groups were proficient with the most up‐to‐date CTO crossing algorithms, and performed an annual range of 40–100 CTO procedures. The MHA algorithm has been extensively described elsewhere (see Supplemental Material and Figure for more detailed MHA description) 11,12 …”

“…The MHA algorithm has been extensively described elsewhere (see Supplemental Material and Figure S1 for more detailed MHA description). 11,12 Exclusion criteria for the present subanalysis were as follows:…”