Lithoplasty-Facilitated Proximal Cap Penetration of a Calcified Chronic Total Occlusion Coronary Lesion

Side-Branch Intravascular Lithotripsy for an Uncrossable Chronic Total Occlusion

This case describes percutaneous coronary intervention of a chronic total occlusion of the right coronary artery at the RV marginal bifurcation that was wire-uncrossable until plaque modification with side branch intravascular lithotripsy into the right ventricular marginal allowed crossing.

Role of pre-procedure CCTA in predicting failed percutaneous coronary intervention for chronic total occlusions

Purpose

This study aimed to identify major lesion characteristics of chronic total occlusions (CTOs) that predict failed percutaneous coronary intervention (PCI) using pre-procedure coronary computed tomography angiography (CCTA) in combination with conventional coronary angiography (CCA).

Methods

Consecutive patients with at least one CTO of the native coronary arteries received CCTA and CCA-guided PCI, with computed tomography performed before or during PCI.

Results

A total of 76 patients with CTO were included in this study. 76 patients were divided into successful and failed PCI groups based on their PCI outcome. There were 62 (81.58 %) patients in the successful PCI group and 14 (18.42 %) in the failed PCI group. The occlusion length ≥20 mm, ostial or bifurcation lesions, negative remodeling, microchannels, and good collateral vessels were the CCTA morphologic parameters associated with PCI outcome (P<0.05). In addition, the blunt stump, occlusion length ≥20 mm, and ostial or bifurcation lesions, were the CCA morphologic parameters associated with PCI outcome (P<0.05). The multivariate regression model showed that the three independent negative predictors: blunt stump on CCA (OR: 0.63; 95 % CI: 0.23-0.98; p =0.048), occlusion length ≥20 mm on CCTA (OR: 0.37; 95 % CI: 0.32-0.71; p <0.001) and negative remodeling on CCTA (OR: 0.26; 95 % CI: 0.28-0.44; p <0.001).

Conclusion

Our study demonstrated that combining CCTA and CCA morphologic characteristics could improve PCI outcome prediction in patients with CTO compared to CCTA morphologic features alone.

Recanalisation of coronary chronic total occlusions

Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators in this demanding, rapidly evolving field of interventional cardiology.