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Updating the Hybrid Algorithm: The Continual Evolution of Chronic Total Occlusion Percutaneous Coronary Intervention
Madeleine Barker1, Anja Oksnes2, Margaret McEntegart3
1Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
None:
The hybrid algorithm had a substantial impact on improving chronic total occlusion (CTO) percutaneous coronary intervention (PCI) success rates. Over the last decade, techniques and technologies have continued to evolve. We describe some of these novel approaches including dual lumen microcatheter-facilitated parallel wiring and re-entry, intravascular ultrasound-guided wiring and re-entry, and investment procedures. In addition, we discuss the redeployment of some established techniques including subintimal tracking and re-entry, the Carlino technique, and controlled antegrade retrograde tracking. Incorporating the continuing evolution in CTO PCI practice, we propose an updated hybrid algorithm.
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