Chronic total occlusion (CTO) angioplasty is
one of the most challenging procedures
remaining for the interventional operator.
Recanalizing CTOs can improve exercise
capacity, symptoms, left ventricular function
and possibly reduce mortality. Multiple strategies
such as escalating wire, parallel wire, seesaw,
contralateral injection, subintimal tracking
and re-entry (STAR), retrograde wire techniques
(controlled antegrade retrograde subintimal
tracking, CART), reverse CART, confluent
balloon, rendezvous in coronary, and other
techniques have all been described. Selection
of the most appropriate approach is based on
assessment of vessel course, length of occluded
segment, presence of bridging collaterals, presence
of bifurcating side branches at the occlusion
site, and other variables. Today, with significant
operator expertise and the use of available
techniques, the literature reports a 50-95%
success rate for recanalizing CTOs.
Percutaneous coronary intervention, chronic total occlusion.
Farrukh Hussain, Cardiac Catheterization Lab., St. Boniface General Hospital, University of Manitoba, Canada. Tel. +1.204.237.2023 – Fax: +1.204.233.2157. E-mail: fhussain@sbgh.mb.ca
2011-12-05
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