Percutaneous Coronary Intervention (PCI) of Chronic Total Occlusions (CTO) represents the most challenging procedure in modern endovascular treatments. In recent years, the success rate of CTO PCI has substantially improved, owing to increasing operator expertise and advancements in CTO equipment and algorithms as well as the development of expert consensus documents. In this review, we summarize existing evidence for CTO PCI, its success/ risk prediction scoring tools, procedural principles and complications and provide an insight into the future role of CTO PCI.
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http://dx.doi.org/10.2174/1573403X17666210531143519 | DOI Listing |
JACC Case Rep
January 2025
Department of Interventional Cardiology, Vall d'Hebron Hospital, Barcelona, Spain.
Percutaneous coronary intervention (PCI) in pediatric patients is rare, especially in cases of chronic total occlusion (CTO) of the left main coronary artery (LMCA), with scarce evidence. These are associated with poorer prognostic outcomes, highlighting the need for timely intervention. In addition, its unique and entirely different pathophysiology compared to that well-studied in adults makes it a clinically challenging scenario for diagnosis, treatment, and follow-up.
View Article and Find Full Text PDFJACC Case Rep
January 2025
Section of Cardiovascular Diseases, White River Health, Batesville, Arkansas, USA.
Patients presenting with acute coronary syndrome with ST-segment elevation myocardial infarction require rapid and decisive interventions to restore blood flow to the affected myocardium, minimizing ischemic damage. This case report is particularly unique because it involves a patient presenting with ST-segment elevation myocardial infarction, where the culprit lesion was an occluded coronary artery graft with an extensive thrombus burden. The complexity of this case necessitated a strategic shift to revascularize the chronically occluded native vessel instead of the graft.
View Article and Find Full Text PDFBackground: The prevalence of coronary chronic total occlusion (CTO) in coronary angiography (CAG) has risen with ageing populations, along with the expansion of CTO percutaneous coronary interventions (CTO-PCI). However, CTO-PCI encounters challenges such as undersized stents, dissection risks, and limited access to intravascular imaging (IVI), particularly in regions with limited health budgets. This study introduces the 'GIVE IT TIME TO SOBER UP - GITSU strategy', a two-session CTO-PCI approach where Thrombolysis in Myocardial Infarction (TIMI-3) antegrade flow is achieved without stent placement in the first session.
View Article and Find Full Text PDFCatheter Cardiovasc Interv
January 2025
Department of Cardiology, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
We report the case of a 73-year-old male with a history of recurrent coronary interventions who presented with progressive angina and was diagnosed with a chronic total occlusion (CTO) of a heavily calcified and tortuous right coronary artery (RCA). Standard antegrade and retrograde techniques were attempted but failed due to the complexity of the lesion. A novel "Drag-Drill" technique was employed, utilizing a retrogradely externalized RG3 guidewire as a rotational atherectomy wire, enabling successful rotational atherectomy and percutaneous coronary intervention (PCI).
View Article and Find Full Text PDFSci Rep
January 2025
Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China.
In this research, we explored the relationship between the AIP and clinical outcomes in patients undergoing PCI. A total of 2533 consecutive patients who underwent PCI were included in this retrospective cohort study, and the data from 2098 patients were used. AIP is calculated based on the log (triglycerides/high-density lipoprotein-cholesterol).
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