Global Chronic Total Occlusion Crossing Algorithm

• Author(s): Wu, EB ; Brilakis, ES ; Mashayekhi, K ; Tsuchikane, E ; Alaswad, K ; Araya, M ; Avran, A ; Azzalini, L ; Babunashvili, AM ; Bayani, B ; Behnes, M ; Bhindi, R ; Boudou, N ; Boukhris, M ; Bozinovic, NZ ; Bryniarski, L ; Bufe, A ; Buller, CE ; Burke, MN ; Buttner, A ; Cardoso, P ; Carlino, M ; Chen, JY ; Christiansen, EH ; Colombo, A ; Croce, K ; de los Santos, FD ; de Martini, T ; Dens, J ; di Mario, C ; Dou, K ; Egred, M ; Elbarouni, B ; ElGuindy, A ; Escaned, J ; Furkalo, S ; Gagnor, A ; Galassi, AR ; Garbo, R ; Gasparini, G ; Ge, J ; Ge, L ; Goel, P ; Goktekin, O ; Gonzalo, N ; Grancini, L ; Hall, A ; Hanna Quesada, F ; Hanratty, C ; Harb, S ; Harding, S. ; Hatem, R ; Henriques, J ; Hildick-Smith, D ; Hill, J ; Hoye, A ; Jaber, W ; Jaffer, F ; Jang, Y ; Jussila, R ; Kalnins, A ; Kalyanasundaram, A ; Kandzari, D ; Kao, HL ; Karmpaliotis, D ; Kassem, HH ; Khatri, J ; Knaapen, P ; Kornowski, R ; Krestyaninov, O ; Kumar, A ; Lamelas, P ; Lee, SW ; Lefevre, T ; Leung, R ; Li, Y ; Li, Y ; Lim, ST ; Lo, S ; Lombardi, W ; Maran, A ; McEntegart, M ; Moses, J ; Munawar, M ; Navarro, A ; Ngo, H ; Nicholson, W ; Oksnes, A ; Olivecrona, G ; Padilla, L ; Patel, M ; Pershad, A ; Postu, M ; Qian, J ; Quadros, A ; Rafeh, NA ; Råmunddal, T ; Prakasa Rao, VS ; Reifart, N ; Riley, RF ; Rinfret, S ; Saghatelyan, M ; Sianos, G ; Smith, E ; Spaedy, A ; Spratt, J ; Stone, G ; Strange, JW ; Tammam, KO ; Thompson, CA ; Toma, A ; Tremmel, JA ; Trinidad, RS ; Ungi, I ; Vo, M ; Vu, VH ; Walsh, S ; Werner, G ; Wojcik, J ; Wollmuth, J ; Xu, B ; Yamane, M ; Ybarra, LF ; Yeh, RW ; Zhang, Q
• Date: 2021
• Persistent ID: http://hdl.handle.net/10400.26/37429
• Origin: Lusíadas Saúde
• Subject(s): Algoritmos; Oclusão Coronária; Algorithms; Coronary Occlusion
• Document Type: Journal article
• Language: English
• Contributor(s): Repositório Comum

Description

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.