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Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review

  • Autori: Wu E.B.; Brilakis E.S.; Mashayekhi K.; Tsuchikane E.; Alaswad K.; Araya M.; Avran A.; Azzalini L.; Babunashvili A.M.; Bayani B.; Behnes M.; Bhindi R.; Boudou N.; Boukhris M.; Bozinovic N.Z.; Bryniarski L.; Bufe A.; Buller C.E.; Burke M.N.; Buttner A.; Cardoso P.; Carlino M.; Chen J.-Y.; Christiansen E.H.; Colombo A.; Croce K.; de los Santos F.D.; de Martini T.; Dens J.; di Mario C.; Dou K.; Egred M.; Elbarouni B.; ElGuindy A.M.; Escaned J.; Furkalo S.; Gagnor A.; Galassi A.R.; Garbo R.; Gasparini G.; Ge J.; Ge L.; Goel P.K.; Goktekin O.; Gonzalo N.; Grancini L.; Hall A.; Hanna Quesada F.L.; Hanratty C.; Harb S.; Harding S.A.; Hatem R.; Henriques J.P.S.; Hildick-Smith D.; Hill J.M.; Hoye A.; Jaber W.; Jaffer F.A.; Jang Y.; Jussila R.; Kalnins A.; Kalyanasundaram A.; Kandzari D.E.; Kao H.-L.; Karmpaliotis D.; Kassem H.H.; Khatri J.; Knaapen P.; Kornowski R.; Krestyaninov O.; Kumar A.V.G.; Lamelas P.M.; Lee S.-W.; Lefevre T.; Leung R.; Li Y.; Li Y.; Lim S.-T.; Lo S.; Lombardi W.; Maran A.; McEntegart M.; Moses J.; Munawar M.; Navarro A.; Ngo H.M.; Nicholson W.; Oksnes A.; Olivecrona G.K.; Padilla L.; Patel M.; Pershad A.; Postu M.; Qian J.; Quadros A.; Rafeh N.A.; Ramunddal T.; Prakasa Rao V.S.; Reifart N.; Riley R.F.; Rinfret S.; Saghatelyan M.; Sianos G.; Smith E.; Spaedy A.; Spratt J.; Stone G.; Strange J.W.; Tammam K.O.; Thompson C.A.; Toma A.; Tremmel J.A.; Trinidad R.S.; Ungi I.; Vo M.; Vu V.H.; Walsh S.; Werner G.; Wojcik J.; Wollmuth J.; Xu B.; Yamane M.; Ybarra L.F.; Yeh R.W.; Zhang Q.
  • Anno di pubblicazione: 2021
  • Tipologia: Articolo in rivista
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The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.