Wilson, W; Spratt, JC
(2014)
Advances in procedural techniques--antegrade.
Curr Cardiol Rev, 10 (2).
pp. 127-144.
ISSN 1875-6557
https://doi.org/10.2174/1573403x10666140331142016
SGUL Authors: Spratt, James
Abstract
There have been many technological advances in antegrade CTO PCI, but perhaps most importantly has been the evolution of the "hybrid' approach where ideally there exists a seamless interplay of antegrade wiring, antegrade dissection re-entry and retrograde approaches as dictated by procedural factors. Antegrade wire escalation with intimal tracking remains the preferred initial strategy in short CTOs without proximal cap ambiguity. More complex CTOs, however, usually require either a retrograde or an antegrade dissection re-entry approach, or both. Antegrade dissection re-entry is well suited to long occlusions where there is a healthy distal vessel and limited "interventional" collaterals. Early use of a dissection re-entry strategy will increase success rates, reduce complications, and minimise radiation exposure, contrast use as well as procedural times. Antegrade dissection can be achieved with a knuckle wire technique or the CrossBoss catheter whilst re-entry will be achieved in the most reproducible and reliable fashion by the Stingray balloon/wire. It should be avoided where there is potential for loss of large side branches. It remains to be seen whether use of newer dissection re-entry strategies will be associated with lower restenosis rates compared with the more uncontrolled subintimal tracking strategies such as STAR and whether stent insertion in the subintimal space is associated with higher rates of late stent malapposition and stent thrombosis. It is to be hoped that the algorithms, which have been developed to guide CTO operators, allow for a better transfer of knowledge and skills to increase uptake and acceptance of CTO PCI as a whole.
Item Type: |
Article
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Additional Information: |
Copyright © 2014 Bentham Science Publishers
This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/), which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited. |
Keywords: |
Animals, Cardiac Catheterization, Chronic Disease, Coronary Angiography, Coronary Occlusion, Humans, Stents, Treatment Outcome, Animals, Humans, Chronic Disease, Coronary Angiography, Treatment Outcome, Stents, Coronary Occlusion, Cardiac Catheterization, Cardiovascular System & Hematology |
SGUL Research Institute / Research Centre: |
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) |
Journal or Publication Title: |
Curr Cardiol Rev |
ISSN: |
1875-6557 |
Language: |
eng |
Dates: |
Date | Event |
---|
May 2014 | Published | 20 January 2014 | Accepted |
|
Publisher License: |
Creative Commons: Attribution 2.5 |
PubMed ID: |
24694104 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/111675 |
Publisher's version: |
https://doi.org/10.2174/1573403x10666140331142016 |
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