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Native valve infective endocarditis (IE) is rare, with an incidence of 3–7 cases per 100,000 person-years.1,2 Cardiac structural complications from local infection extension include valvular destruction, peri-annular abscess and fistula formation. Left ventricular pseudoaneurysm (LVP) from IE is exceedingly rare, occurring in <1% of cases, and is associated with high morbidity and mortality. Diagnosis is challenging due to nonspecific symptoms […]

A complex dissected chronic occlusion: targeted balloon dilatation of false lumen to access true lumen, combined localized subintimal tracking and re-entry, parallel wire, contralateral injection and a useful antegrade lumen re-entry technique

Farrukh Hussain, Mehrdad Golian, James W. Tam
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Published Online: Aug 7th 2018 Heart International 2012;7(1):e7 DOI: https://doi.org/10.4081/hi.2012.e7
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1

Abstract

Overview

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.

Keywords

Percutaneous coronary intervention, chronic total occlusion.

2

Article Information

Correspondence

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

Received

2011-12-05

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