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Antegrade wire escalation in chronic total occlusions: State of the art review
Kara Denby1, Laura Young1, Stephen Ellis1
1Interventional Cardiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America.
Insights
Antegrade wire escalation (AWE) is the most common strategy for crossing coronary chronic total occlusions (CTO). This review details AWE techniques to improve safety and success for all interventional cardiologists.
Area of Science:
- Interventional Cardiology
- Cardiovascular Disease
- Medical Technology
Background:
- Coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) algorithms standardize crossing strategies for improved efficacy.
- Advanced CTO crossing techniques, while successful, carry higher major adverse cardiac event (MACE) rates compared to traditional methods.
Purpose of the Study:
- To outline techniques for maximizing the clinical utility of the antegrade wire escalation (AWE) crossing strategy in CTO PCI.
- To provide a framework for both novice and experienced operators to safely and effectively treat CTO lesions.
Main Methods:
- This is a state-of-the-art review.
- The review outlines specific techniques for the antegrade wire escalation (AWE) crossing strategy.
Main Results:
- AWE remains the most common CTO crossing strategy.
- Techniques discussed can enhance the safety and effectiveness of AWE for less experienced operators.
- Advanced operators can employ these techniques to improve technical success in complex CTO procedures.
Conclusions:
- Mastering AWE techniques can empower less experienced operators to treat more CTO patients without needing advanced operator referral.
- These AWE strategies can also enhance procedural success for experienced operators performing complex CTO interventions.
Abstract:
Coronary chronic total occlusion percutaneous coronary intervention treatment algorithms have helped to standardize crossing strategy sequence to improve efficacy and efficiency of CTO interventions based on angiographic criteria. Unfortunately, advanced crossing techniques such as a retrograde and subintimal guidewire tracking and reentry that have accelerated procedural success in more difficult lesions are associated with higher major adverse cardiac event rates as compared with traditional antegrade and intimal guidewire tracking. In this regard, antegrade wire escalation (AWE) remains the most common CTO crossing strategy. In this state of the art review, we outline the techniques employed to maximize the clinical utility of AWE crossing strategy for both novice operators as well as those experienced with the advanced crossing strategies. For the less experienced operator, these techniques may provide a framework to treat more patients safely and effectively without the need to refer to a more advanced operator. Whereas these same techniques may be employed by an advanced operator to improve the technical success in procedures requiring more advanced crossing strategies.
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