TY - JOUR
T1 - Advances in percutaneous coronary intervention for chronic total occlusions
T2 - current antegrade dissection and reentry techniques and updated algorithm
AU - Berkhout, T.
AU - Claessen, B. E.
AU - Dirksen, M. T.
N1 - Publisher Copyright: © 2020, The Author(s).
PY - 2021/1
Y1 - 2021/1
N2 - Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is considered relatively complex with low success rates and high complication rates. Treating a CTO with PCI using the hybrid algorithm increases success rates with acceptable complication rates. An essential part of the hybrid algorithm is antegrade dissection and reentry (ADR). In PCI of a non-CTO coronary lesion, the guidewire over which the stent is advanced and placed stays within the true lumen of the coronary artery. ADR techniques make it possible to cross the lesion through the wall of the coronary artery, the subintimal space, thus creating a small bypass within the architecture of the coronary artery and restoring antegrade blood flow. ADR increases success rates, especially in more difficult CTO procedures. In the last decade, new materials and techniques have been introduced in quick succession, which are summarised in this review. Consequently an updated ADR algorithm is presented, which can support the CTO operator during an ADR procedure.
AB - Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is considered relatively complex with low success rates and high complication rates. Treating a CTO with PCI using the hybrid algorithm increases success rates with acceptable complication rates. An essential part of the hybrid algorithm is antegrade dissection and reentry (ADR). In PCI of a non-CTO coronary lesion, the guidewire over which the stent is advanced and placed stays within the true lumen of the coronary artery. ADR techniques make it possible to cross the lesion through the wall of the coronary artery, the subintimal space, thus creating a small bypass within the architecture of the coronary artery and restoring antegrade blood flow. ADR increases success rates, especially in more difficult CTO procedures. In the last decade, new materials and techniques have been introduced in quick succession, which are summarised in this review. Consequently an updated ADR algorithm is presented, which can support the CTO operator during an ADR procedure.
KW - Clinical competence
KW - Coronary angiography
KW - Coronary occlusions, therapy
KW - Decision support techniques
KW - Humans
KW - Percutaneous coronary intervention, methods
UR - http://www.scopus.com/inward/record.url?scp=85095454825&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s12471-020-01509-8
DO - https://doi.org/10.1007/s12471-020-01509-8
M3 - Review article
C2 - 33156509
SN - 1568-5888
VL - 29
SP - 52
EP - 59
JO - Netherlands heart journal
JF - Netherlands heart journal
IS - 1
ER -