TITLE:
Chronic total occlusions for intermediate volume operators: An antegrade step-up algorithm allows high success in easy and intermediate difficult CTO lesions
AUTHORS:
Joren Maeremans, Philippe Selleslagh, Luigi Di Serafino, Emanuele Barbato, Joseph Dens
KEYWORDS:
Percutaneous Coronary Intervention; Chronic Total Occlusion; Interventional Cardiology; Coronary Angioplasty; Guidewires
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.3 No.9,
December
17,
2013
ABSTRACT: To
improve the success rates of chronic total occlusion (CTO) intervention, a large range of CTO-dedicated
guidewires (GWs), devices and techniques have been developed. However, such an
abundant choice of materials confuses inexperienced operators. Therefore, the
usefulness of a simple antegrade treatment algorithm with a limited set of GWs,
for easy to intermediate lesions, was investigated. Between November 2011 and
March 2013, 105 patients were included, who underwent CTO PCI following the
algorithm. Lesions were classified according to the Multicenter CTO Registry of
Japan score. Overall technical success was achieved in 77%. Study endpoint was
successful GW crossing within 30 min and was reached in 57%. High success rates
were achieved in easy (81%) and intermediate (64%) lesion types. In both types,
a soft wire could successfully cross in 57% and 51% respectively, with the
Fielder XT®(Asahi Intecc Co.) capable of crossing
most commonly (90%). The proposed treatment algorithm simplifies the percutaneous
treatment of easy to intermediate CTO lesions. However, it merits further
evaluation, especially for operators/centers who perform a low to intermediate
amount of CTO PCI.