Abstract
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is considered relatively complex with low success rates and high complication rates. Treating a CTO with PCI using the hybrid algorithm increases success rates with acceptable complication rates. An essential part of the hybrid algorithm is antegrade dissection and reentry (ADR). In PCI of a non-CTO coronary lesion, the guidewire over which the stent is advanced and placed stays within the true lumen of the coronary artery. ADR techniques make it possible to cross the lesion through the wall of the coronary artery, the subintimal space, thus creating a small bypass within the architecture of the coronary artery and restoring antegrade blood flow. ADR increases success rates, especially in more difficult CTO procedures. In the last decade, new materials and techniques have been introduced in quick succession, which are summarised in this review. Consequently an updated ADR algorithm is presented, which can support the CTO operator during an ADR procedure.
Highlights
A coronary chronic total occlusion (CTO) is defined as the absence of antegrade transluminal flow (thrombolysis in myocardial infarction (TIMI) grade 0 flow) for an estimated duration of more than 3 months.Modern Percutaneous coronary intervention (PCI) for CTOHistorically, CTO-PCI success rates have been low, typically 70–80% [6]
Algorithms were developed, such as the hybrid approach [7] and the Asia Pacific algorithm [8], which increased success rates. These algorithms aid in teaching the knowledge needed to treat patients with CTO
The hybrid algorithm recommends a standardised approach for evaluating the CTO, to determine the initial approach and offers guidance on when to switch
Summary
A coronary chronic total occlusion (CTO) is defined as the absence of antegrade transluminal flow (thrombolysis in myocardial infarction (TIMI) grade 0 flow) for an estimated duration of more than 3 months. CTO-PCI success rates have been low, typically 70–80% [6]. Algorithms were developed, such as the hybrid approach [7] and the Asia Pacific algorithm [8], which increased success rates. These algorithms aid in teaching the knowledge needed to treat patients with CTO. The hybrid algorithm recommends a standardised approach for evaluating the CTO, to determine the initial approach (antegrade or retrograde) and offers guidance on when to switch
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