Manual of Coronary Chronic Total Occlusion Interventions

Dedication

List of Contributors

Foreword

1. CTO Interventions: Definition, Prevalence, Indications, Guidelines

1.1 CTO Definition

1.2 Prevalence of CTOs

1.3 Indications and Potential Clinical Benefits of CTO PCI

1.4 Guidelines for CTO PCI

1.5 Appropriateness Use Criteria in CTO PCI

1.6 Contraindications to CTO PCI

1.7 Summary and Conclusions

References

2. Equipment

2.1 Sheaths

2.2 Guide Catheters

2.3 Microcatheters

2.4 Guidewires

2.5 Dissection/Re-Entry Equipment

2.6 Snares

2.7 "Uncrossable-Undilatable Lesion Equipment

2.8 Intravascular Ultrasound

2.9 Complication Management Equipment

2.10 Radiation Protection

2.11 The "CTO cart

References

3. The Basics: Timing, Dual Injection, Studying the Lesion, Access, Anticoagulation, Guide Support, Trapping

3.1 Timing

3.2 Dual Injection

3.3 Studying the Lesion

3.4 Vascular Access

3.5 Anticoagulation

3.6 Techniques to Increase Guide Catheter Support (Large Bore Guide, Active Guide Support, Guide Catheter Extensions, Anchor Techniques

3.7 Trapping

References

4. Antegrade Wire Escalation: The Foundation of CTO PCI

4.1 Special Situations

References

5. Antegrade Dissection/Re-entry

5.1 Knuckle Wire

5.2 CrossBoss

5.3 Stingray-Based Re-entry

5.4 Wire-Based Re-entry

References

6. The Retrograde Approach

6.1 Historical Perspective

6.2 Advantages of the Retrograde Approach

6.3 Special Equipment

6.4 Step-by-Step Description of the Procedure

6.5 Retrograde True Lumen Puncture

6.6 Retrograde Dissection/Re-entry

6.7 Antegrade Crossing

6.8 Special Retrograde CTO PCI Scenarios

References

7. Putting it all Together: The "Hybrid Approach

7.1 Description of the "Hybrid Algorithm

7.2 Impact of the "Hybrid Approach

References

8. "Balloon Uncrossable CTOs

8.1 Simultaneous Use of Strategies

References

9. "Balloon Undilatable CTOs

9.1 Special Case Scenario: Stented

Emmanouil S. Brilakis, MD, PhD, FACC, FAHA, FESC, FSCAI
Dr. Brilakis is Director of the Center for Complex Coronary Interventions at the Minneapolis Heart Institute and adjunct Professor of Medicine at the University of Texas Southwestern Medical School. After graduating from Lycee Leonin de Patissia, Dr. Brilakis received his medical degree from the National Kapodistrian University of Athens, Greece. He trained in Internal Medicine, Cardiovascular Diseases and Interventional Cardiology at the Mayo Clinic. He also completed a Masters in Clinical Research at the Mayo Clinic and a PhD in Clinical Research at the National Kapodistrian University of Athens, Greece. He served as Director of the VA North Texas Healthcare System Cardiac Catheterization Laboratories from 2004 to 2016.

Dr. Brilakis leads a large clinical trial group investigating treatment of chronic total occlusions, prevention and treatment of saphenous vein graft disease, prevention and management of complications, intracoronary imaging, antiplatelet treatment optimization post coronary stenting, radiation safety in the catheterization laboratory, and implementation of novel technologies in healthcare.
He is Associate Editor for Circulation and on the editorial board of several other journals, a Trustee of the Society of Cardiovascular Angiography and Interventions and on the Board of Directors of the Cardiovascular Innovations Foundation. He has authored or co-authored over 450 manuscripts and receives funding from the Department of Veterans Affairs and industry. He and is lecturing and proctoring at several institutions in the United States and abroad.

"In addition to its comprehensive and up-to-date coverage of all aspects of CTO intervention, this easy-to-read, practical book serves as a valuable manual that helps novices learn CTO intervention techniques, and allows experienced operators to hone their skills." Rating: 5 Stars-- Doody.com, April 4, 2014 "Interventional cardiologists explain a new algorithmic approach to chronic total occlusion (CTO) intervention. Rather than reviewing angiograms and deciding whether a patient should get revascularization, the cardiologist will look at the ischemic burden and the patient's symptoms and use the angioram to determine how best to achieve revascularization. Among the topics are equipment, the retrograde approach, "balloon undilatable" CTOs, stenting CTO lesions."-- ProtoView.com, January 2014