250 pages | 21 Color Illus. | 198 B/W Illus.
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.
1. Patient selection and general approach to CTO 2. Guidewire techniques; Hydrophilic Versus Stiff wire selection 3. Advanced antegrade techniques: parallel wires, seesaw technique, anchoring balloon, IVUS guidance 4. Retrograde and combination techniques 5. Subintimal Tracking and Reentry: The STAR technique 6. Technical options for uncrossable lesions 7. Rotational Atherectomy 8. Role of the Crosser Device 9. Role of fibrinolysis 10a. Drug Eluting Stents for CTO: European Experience 10b. Drug Eluting Stents for CTO: North American and Asian experience 11. Prevention of complications: When to stop-retry-redirect to other therapy 12. Complications related to Radiation and Contrast Exposure 13. Procedural and Technical complications 14. Peripheral CTO recanalization and revascularization techniques 15. Role of Excimer Laser in coronary and peripheral CTO 16. Role of antegrade blunt dissection for coronary and peripheral CTO 17a. Role of optical reflectometry and radiofrequency ablation device: For Coronary CTO 17b. Role of optical reflectometry and radiofrequency ablation device: For Peripehral CTO 18. Tackling Chronic Total Occlusions: Training Standards and Recommendations