Brilakis, Emmanouil S., Mashayekhi, Kambis, Tsuchikane, Etsuo, Rafeh, Nidal Abi, Alaswad, Khaldoon, Araya, Mario, Avran, Alexandre, Azzalini, Lorenzo, Babunashvili, Avtandil M., Bayani, Baktash, Bhindi, Ravinay, Boudou, Nicolas, Boukhris, Marouane, Bozinovic, Nenad Z., Bryniarski, Leszek, Bufe, Alexander, Buller, Christopher E., Burke, Nicholas, Buettner, Heinz Joachim, Cardoso, Pedro, Carlino, Mauro, Christiansen, Evald H., Colombo, Antonio, Croce, Kevin, Damas de los Santos, Felix ORCID: 0000-0001-7523-4096, De Martini, Tony, Dens, Joseph, Di Mario, Carlo, Dou, Kefei, Egred, Mohaned, ElGuindy, Ahmed M., Escaned, Javier, Furkalo, Sergey, Gagnor, Andrea, Galassi, Alfredo R., Garbo, Roberto, Ge, Junbo, Goel, Pravin Kumar, Goktekin, Omer, Grancini, Luca, Grantham, J. Aaron, Hanratty, Colm, Harb, Stefan, Harding, Scott A., Henriques, Jose P. S., Hill, Jonathan M., Jaffer, Farouc A., Jang, Yangsoo, Jussila, Risto, Kalnins, Artis, Kalyanasundaram, Arun, Kandzari, David E., Kao, Hsien-Li, Karmpaliotis, Dimitri, Kassem, Hussien Heshmat, Knaapen, Paul, Kornowski, Ran, Krestyaninov, Oleg, Kumar, A. V. Ganesh, Laanmets, Peep, Lamelas, Pablo, Lee, Seung-Whan, Lefevre, Thierry, Li, Yue, Lim, Soo-Teik, Lo, Sidney, Lombardi, William, McEntegart, Margaret, Munawar, Muhammad, Navarro Lecaro, Jose Andres, Ngo, Hung M., Nicholson, William, Olivecrona, Goran K., Padilla, Lucio, Postu, Marin, Quadros, Alexandre, Hanna Quesada, Franklin, Rao, Vithala Surya Prakasa, Reifart, Nicolaus, Saghatelyan, Meruzhan, Santiago, Ricardo, Sianos, George, Smith, Elliot, Spratt, James C., Stone, Gregg W., Strange, Julian W., Tammam, Khalid, Ungi, Imre, Vo, Minh, Walsh, Simon, Werner, Gerald S., Wolimuth, Jason R., Wu, Eugene B., Wyman, R. Michael, Xu, Bo, Yamane, Masahisa, Ybarra, Luiz F., Yeh, Robert W., Zhang, Qi and Rinfret, Stephane (2019). Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention A Global Expert Consensus Document. Circulation, 140 (5). S. 420 - 434. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1524-4539

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Abstract

Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Brilakis, Emmanouil S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mashayekhi, KambisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tsuchikane, EtsuoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rafeh, Nidal AbiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Alaswad, KhaldoonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Araya, MarioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Avran, AlexandreUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Azzalini, LorenzoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Babunashvili, Avtandil M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bayani, BaktashUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bhindi, RavinayUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boudou, NicolasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boukhris, MarouaneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bozinovic, Nenad Z.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bryniarski, LeszekUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bufe, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buller, Christopher E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Burke, NicholasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buettner, Heinz JoachimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cardoso, PedroUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Carlino, MauroUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Christiansen, Evald H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Colombo, AntonioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Croce, KevinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Damas de los Santos, FelixUNSPECIFIEDorcid.org/0000-0001-7523-4096UNSPECIFIED
De Martini, TonyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dens, JosephUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Di Mario, CarloUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dou, KefeiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Egred, MohanedUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
ElGuindy, Ahmed M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Escaned, JavierUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Furkalo, SergeyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gagnor, AndreaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Galassi, Alfredo R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Garbo, RobertoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ge, JunboUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Goel, Pravin KumarUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Goktekin, OmerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grancini, LucaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grantham, J. AaronUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hanratty, ColmUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Harb, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Harding, Scott A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Henriques, Jose P. S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hill, Jonathan M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jaffer, Farouc A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jang, YangsooUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jussila, RistoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kalnins, ArtisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kalyanasundaram, ArunUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kandzari, David E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kao, Hsien-LiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Karmpaliotis, DimitriUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kassem, Hussien HeshmatUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Knaapen, PaulUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kornowski, RanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Krestyaninov, OlegUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kumar, A. V. GaneshUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Laanmets, PeepUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lamelas, PabloUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lee, Seung-WhanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lefevre, ThierryUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Li, YueUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lim, Soo-TeikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lo, SidneyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lombardi, WilliamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
McEntegart, MargaretUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Munawar, MuhammadUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Navarro Lecaro, Jose AndresUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ngo, Hung M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nicholson, WilliamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Olivecrona, Goran K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Padilla, LucioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Postu, MarinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Quadros, AlexandreUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hanna Quesada, FranklinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rao, Vithala Surya PrakasaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reifart, NicolausUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Saghatelyan, MeruzhanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Santiago, RicardoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sianos, GeorgeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Smith, ElliotUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Spratt, James C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stone, Gregg W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Strange, Julian W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tammam, KhalidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ungi, ImreUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vo, MinhUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Walsh, SimonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Werner, Gerald S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wolimuth, Jason R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wu, Eugene B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wyman, R. MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Xu, BoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Yamane, MasahisaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ybarra, Luiz F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Yeh, Robert W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zhang, QiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rinfret, StephaneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-134505
DOI: 10.1161/CIRCULATIONAHA.119.039797
Journal or Publication Title: Circulation
Volume: 140
Number: 5
Page Range: S. 420 - 434
Date: 2019
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Place of Publication: PHILADELPHIA
ISSN: 1524-4539
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
LONG-TERM OUTCOMES; CARDIOVERTER-DEFIBRILLATOR RECIPIENTS; MULTICENTER CTO REGISTRY; RETROGRADE APPROACH; SCORING SYSTEM; INTRAVASCULAR ULTRASOUND; VENTRICULAR-ARRHYTHMIAS; PROCEDURAL OUTCOMES; COMPUTED-TOMOGRAPHY; HEALTH-STATUSMultiple languages
Cardiac & Cardiovascular Systems; Peripheral Vascular DiseaseMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/13450

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