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Brilakis, Emmanouil S; Mashayekhi, Kambis; Tsuchikane, Etsuo; Alaswad, Khaldoon; Araya, Mario; Avran, Alexandre; Azzalini, Lorenzo; Bayani, Baktash; Behnes, Michael; Bhindi, Ravinay; Boudou, Nicolas; Boukhris, Marouane; Bryniarski, Leszek; Burke, M Nicholas; Buttner, Achim; Cardoso, Pedro; Carlino, Mauro; Chen, Ji-Yan; Christiansen, Evald Hoej; Colombo, Antonio; Croce, Kevin; de Los Santos, Felix Damas; de Martini, Tony; Dens, Joseph; di Mario, Carlo; Dou, Kefei; Egred, Mohaned; ElGuindy, Ahmed M; Furkalo, Sergey; Galassi, Alfredo R; Garbo, Roberto; Gasparini, Gabriele; Ge, Junbo; Ge, Lei; Goel, Pravin Kumar; Grancini, Luca; Hall, Allison; Hanna Quesada, Franklin Leonardo; Hanratty, Colm; Harb, Stefan; Harding, Scott A; Hatem, Raja; Henriques, Jose P S; Hildick-Smith, David; Hill, Jonathan M; Hoye, Angela; Jaber, Wissam; Jaffer, Farouc A; Jussila, Risto; Kalnins, Artis; Kalyanasundaram, Arun; Kandzari, David E; Kao, Hsien-Li; Karmpaliotis, Dimitri; Khatri, Jaikirshan; Knaapen, Paul; Krestyaninov, Oleg; Kumar, A V Ganesh; Lamelas, Pablo Manuel; Lee, Seung-Whan; Lefevre, Thierry; Leung, Raymond; Li, Yu; Li, Yue; Lim, Soo-Teik; Lo, Sidney; Maran, Anbukarasi; Moses, Jeffrey; Navarro, Andres; Nicholson, William; Oksnes, Anja; Olivecrona, Goran K; Patel, Mitul; Pershad, Ashish; Postu, Marin; Qian, Jie; Quadros, Alexandre; Rafeh, Nidal Abi; Råmunddal, Truls; Prakasa Rao, Vithala Surya; Reifart, Nicolaus; Riley, Robert F; Saghatelyan, Meruzhan; Sianos, George; Smith, Elliot; Spaedy, Anthony; Spratt, James; Strange, Julian W; Tammam, Khalid O; Thompson, Craig A; Toma, Aurel; Tremmel, Jennifer A; Ungi, Imre; Vo, Minh; Vu, Vu Hoang; Walsh, Simon; Werner, Gerald; Ybarra, Luiz F; Yeh, Robert W; Zhang, Qi
Journal of the American College of Cardiology, 08/2021, Letnik: 78, Številka: 8Journal Article
The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.
