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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Complications during chronic total occlusion percutaneous coronary intervention: a sign- and symptom-based approach

Francesco Moroni1,2, Ricardo Santiago3, Riccardo DI Pietro4

  • 1Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.

Minerva Cardiology and Angiology
|August 2, 2021
PubMed

Insights

Coronary chronic total occlusions (CTO) are complex interventions. This review details CTO percutaneous coronary interventions (PCIs) complications and offers an approach for early recognition and management.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Medicine

Background:

  • Coronary chronic total occlusions (CTOs) are common findings during coronary angiography.
  • Despite their prevalence and indication for revascularization, CTO recanalization is infrequently performed due to complexity and perceived risks.
  • CTO percutaneous coronary interventions (PCIs) are among the most challenging procedures in interventional cardiology.

Purpose of the Study:

  • To review potential complications associated with CTO percutaneous coronary intervention (PCI).
  • To present an algorithmic, sign- and symptom-based approach for managing CTO PCI complications.
  • To encourage more operators to undertake complex CTO interventions by demystifying complication management.

Main Methods:

  • Literature review of CTO percutaneous coronary intervention (PCI) complications.
  • Development of a structured, algorithmic approach to complication recognition and management.
  • Emphasis on early identification of signs and symptoms related to procedural adverse events.

Main Results:

  • CTO interventions carry a higher risk of procedural complications compared to non-CTO interventions.
  • Specific complications associated with CTO PCI include dissection, perforation, tamponade, and distal embolization.
  • The proposed algorithmic approach facilitates timely diagnosis and effective management strategies.

Conclusions:

  • Understanding and anticipating CTO PCI complications is crucial for successful outcomes.
  • An algorithmic approach aids in the early recognition and management of complications.
  • This strategy can help mitigate risks and encourage broader adoption of CTO PCI procedures.

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