Chronic total occlusions (CTO) are common, and found in approximately one third of patients with significant coronary artery disease who undergo angiography. CTO constitute one of the main criteria when selecting between angioplasty and bypass surgery. Angioplasty for CTO is intricate and requires excellent operator skill, but even when performed under the best circumstances, it is plagued by lower success rates when compared to non-total occlusions. The main difficulty with CTO lies not with choosing which stent to use, but rather occurs during earlier steps of crossing the lesion and advancing the wire into the true lumen of the distal vessel. Having accomplished this, the rates of restenosis are prohibitively high. Mehran, Dangas and an international team of experienced operators offer the reader sound advice on the evaluation and management of CTO in both the coronary and peripheral vascular systems. Their practical guidance should aid all those working with this difficult subset of patients.
Table of Contents
List of Contributors, Foreword, Martin B Leon, Preface, 1 Patient selection and general approach to CTO revascularization, 2 Guidewire techniques and technologies: hydrophilic versus stiff wire selection, 3 Advanced techniques for antegrade advancement of wires, 4 Retrograde and bilateral techniques, 5 Subintimal tracking and reentry: the STAR technique, 6 Technical options for uncrossable lesions, 7 Rotational atherectomy, 8 Role of the CROSSER Catheter, 9 The role of fibrinolytic therapy in the management of chronic total occlusions, 10 Drug-eluting stents for chronic total occlusions: the European experience, 11 Drug-eluting stents for chronic total occlusions: the North American and Asian experience, 12 Prevention of complications: when to stop–retry–redirect to other therapy, 13 Complications related to radiation and contrast media exposure, 14 Procedural and technical complications, 15 Peripheral CTO recanalization and revascularization techniques, 16 Role of excimer laser, 17 Role of antegrade blunt dissection for coronary and peripheral chronic total occlusions, 18 Role of an optical reflectometry and radiofrequency ablation device: coronary chronic total occlusions, 19 Role of an optical reflectometry and radiofrequency ablation device: peripheral chronic total occlusions, 20 Tackling chronic total occlusions: training standards and recommendations, Index
George D Dangas MD PhD Associate Professor of Medicine Director of Postgraduate Training Columbia University Medical Center Cardiovascular Research Foundation New York, NY USA
Roxana Mehran MD Associate Professor of Medicine Director, Outcomes Research Data Coordination and Analysis Center for Interventional Vascular Therapy Columbia University Medical Center Cardiovascular Research Foundation New York, NY USA
Jeffrey W Moses MD Professor of Medicine Director of the Center for Interventional Vascular Therapy Columbia University Medical Center Cardiovascular Research Foundation New York, NY USA