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Chronic total coronary occlusion recanalization: Current techniques and new devices
Jan-Erik Gülker1, Lars Bansemir1, Heinrich G Klues1
1Heart Centre Niederrhein, Department of Cardiology, HELIOS Clinics Krefeld, Krefeld, aGermany; Institute for Heart and Circulation Research, University of Cologne, Kerpener Straße 62 50937, Cologne, aGermany.
Insights
Percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO) is challenging but advancing. New techniques and tools improve success rates, offering benefits like angina relief and better heart function.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Chronic total coronary occlusion (CTO) affects up to 30% of patients undergoing coronary angiography.
- Despite advancements, CTO recanalization remains technically demanding, with fewer than 10% of cases attempted.
- Successful CTO recanalization offers significant clinical benefits, including symptom relief and improved cardiac function.
Purpose of the Study:
- To review and describe the latest developments in CTO recanalization strategies.
- To highlight advancements in interventional techniques and tools for CTO PCI.
Main Methods:
- Review of recent literature on CTO PCI techniques and technologies.
- Emphasis on the impact of new interventional tools and retrograde techniques.
- Inclusion of imaging modalities like intravascular ultrasound (IVUS) and multislice computed tomography (MSCT).
Main Results:
- Success rates for CTO PCI have improved significantly, reaching approximately 90% in experienced centers.
- The introduction of the retrograde technique has been a major advancement.
- New microcatheters, specialized wires, and advanced imaging improve lesion crossing and success.
Conclusions:
- CTO PCI procedures are evolving rapidly with improved success rates.
- Advanced techniques and tools are crucial for successful CTO recanalization.
- CTO PCI should be considered standard therapy in invasive cardiac centers.
Abstract:
Percutaneous coronary intervention (PCI) of total chronic coronary occlusion (CTO) still remains a major challenge. The prevalence of a CTO has been reported to be up to 30% among patients with a clinical indication for coronary angiography. Progress has been made with further advanced interventional techniques and continuously sophisticated interventional tools. Nevertheless the number of interventions carried out to recanalize a CTO is less than 10% of all procedures. Benefits of a successful CTO recanalization include relief of angina pectoris and ischemia-related dyspnea, substantial improvement in left ventricular function and, avoidance of surgery treatment. A vast variety of new CTO PCI techniques and materials has been introduced into clinical practise and pushed success rates of reopening a CTO up to around 90% in experienced hands. Particulary the introduction of the retrograde technique was a milestone. New developed microcatheters and special polymer coated wires allow to recanalize via small collaterals and vessels. Other tools such as intravascular ultrasound (IVUS) and multislice computertomography (MSCT) help to identify the anatomy and the characteristic of the lesions. Any invasive cardiac center should adopt CTO PCI procedures as standard therapy.
Objective:
This review wants to assess and describe the latest development in CTO recanalization strategies.