DESCRIPTION:
Chronic total occlusions (CTO) are common, and found in approximately one third of patients with significant coronary artery disease who undergo angiography. CTO constitute one of the main criteria when selecting between angioplasty and bypass surgery. Angioplasty for CTO is intricate and requires excellent operator skill, but even when performed under the best circumstances, it is plagued by lower success rates when compared to non-total occlusions. The main difficulty with CTO lies not with choosing which stent to use, but rather occurs during earlier steps of crossing the lesion and advancing the wire into the true lumen of the distal vessel. Having accomplished this, the rates of restenosis are prohibitively high. Mehran, Dangas and an international team of experienced operators offer the reader sound advice on the evaluation and management of CTO in both the coronary and peripheral vascular systems. Their practical guidance should aid all those working with this difficult subset of patients.
CONTENTS:
1 Patient selection and general approach to CTO revascularization
2 Guidewire techniques and technologies: hydrophilic versus stiff wire selection
3 Advanced techniques for antegrade advancement of wires
4 Retrograde and bilateral techniques
5 Subintimal tracking and reentry: the STAR technique
6 Technical options for uncrossable lesions
7 Rotational atherectomy
8 Role of the CROSSER Catheter
9 The role of fibrinolytic therapy in the management of chronic total occlusions
10 Drug-eluting stents for chronic total occlusions: the European experience
11 Drug-eluting stents for chronic total occlusions: the North American and Asian experience
12 Prevention of complications: when to stop-retry-redirect to other therapy
13 Complications related to radiation and contrast media exposure
14 Procedural and technical complications
15 Peripheral CTO recanalization and revascularization techniques
16 Role of excimer laser
17 Role of antegrade blunt dissection for coronary and peripheral chronic total occlusions
18 Role of an optical reflectometry and radiofrequency ablation device: coronary chronic total occlusions
19 Role of an optical reflectometry and radiofrequency ablation device: peripheral chronic total occlusions
20 Tackling chronic total occlusions: training standards and recommendations
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