Utility of Guiding Catheter Extensions for Recanalization of Chronic Total Occlusions: A EuroCTO Club Expert Panel
Roberto Garbo1, Mario Iannaccone2, Gerald S Werner3
1Maria Pia Hospital, GVM Care & Research, Turin, Italy.
Insights
Guiding catheter extensions (GCEs) are vital for complex percutaneous coronary intervention (PCI), especially for chronic total occlusions (CTO). This guide details GCE use in various CTO recanalization techniques for improved procedural success.
Area of Science:
- Interventional Cardiology
- Vascular Devices
- Cardiac Procedures
Background:
- Guiding catheter extensions (GCEs) are crucial in modern percutaneous coronary intervention (PCI).
- Their utility is particularly pronounced in complex cases like chronic total occlusions (CTOs), offering essential support.
- GCEs facilitate both conventional and advanced techniques for CTO recanalization.
Purpose of the Study:
- To provide a consensus document from EuroCTO on the application of GCEs in CTO recanalization.
- To offer a practical guide to specific anatomies and techniques where GCEs are beneficial.
- To detail the features and delivery techniques of commonly used GCE devices.
Main Methods:
- Review and consensus of expert opinions on GCE utilization in CTO PCI.
- Description of GCE features and standard delivery techniques.
- Detailed discussion of GCE applications in antegrade and retrograde CTO PCI strategies.
Main Results:
- GCEs enhance support in standard PCI and complex CTO interventions.
- Specific indications for GCEs in antegrade CTO PCI include support and dissection/re-entry techniques.
- In retrograde CTO PCI, GCEs improve support for gear delivery and facilitate complex approaches like bifurcation treatment and ipsilateral externalization.
Conclusions:
- GCEs are indispensable tools for complex PCI, particularly CTO recanalization.
- The document outlines practical applications and techniques for GCE use in both antegrade and retrograde CTO PCI.
- Understanding GCEs' role, limitations, and potential complications is key for interventional cardiologists.
Abstract:
Guiding catheter extensions (GCEs) have become indispensable tools in the modern approach to percutaneous coronary intervention (PCI). The support offered during complex PCI of uncrossable, or tortuous lesions is particularly valuable in the setting of chronic total occlusions (CTO), both for conventional anterograde wire escalation and for anterograde or retrograde dissection and re-entry techniques. This EuroCTO consensus document describes the use of GCE during CTO recanalization and provides a practical guide to anatomies and techniques in which these devices are applicable. We describe the peculiar features of the most-used device and the practical technique for GCE delivery in standard PCI; further specific indications for antegrade and retrograde CTO PCI are discussed in a specific section. In the antegrade approach, the GCEs may be useful to increase support or facilitate antegrade dissection and re-entry techniques, while in the retrograde approach for reverse controlled antegrade and retrograde tracking, to increase retrograde support for gear delivery, for treatment of CTO in bifurcation and ipsilateral externalization with a single guide catheter. The last section of the paper describes GCE-related complications, challenges, limitations, and future perspectives.
