Algorithmic solutions to common problems encountered during chronic total occlusion angioplasty: The algorithms within the algorithm

• Published in: Catheterization and cardiovascular interventions Vol. 93; no. 2; pp. 286 - 297
• Main Authors: Riley, Robert F., Walsh, Simon J., Kirtane, Ajay J., Michael Wyman, R., Nicholson, William J., Azzalini, Lorenzo, Spratt, James C., Kalra, Sanjog, Hanratty, Colm G., Pershad, Ashish, DeMartini, Tony, Karmpaliotis, Dimitri, Lombardi, William L., Aaron Grantham, J.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-02-2019; Wiley Subscription Services, Inc
• Subjects: Algorithms; Angioplasty; Chronic Disease; Clinical Decision-Making; Codification; Consensus; Coronary Angiography; Coronary Occlusion - diagnostic imaging; Coronary Occlusion - therapy; Critical Pathways; Humans; Lesions; Occlusion; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; solutions; Treatment Outcome; consensus; percutaneous coronary intervention; solutions
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.27987

Improved technical equipment, dissemination of best practices, and the importance of complete coronary revascularization have led to a renewed interest in coronary chronic total occlusion (CTO) PCI. In particular, the hybrid algorithm has been associated with increasing procedural success rates in the US. However, the hybrid algorithm only covers overarching strategies in the overall approach to these lesions. Several technical challenges can occur during execution of these approaches, each of which has several potential solutions. A systematic or algorithmic approach to dealing with these challenges could contribute to improved procedural efficiency and higher procedural success. While there have been isolated attempts in the past to codify approaches to each of these situations, there has not been a contemporary, comprehensive review of the potential solutions to these problems. We present 10 common problems encountered during CTO PCI and a consensus hierarchical approach to them.