Current Cardiology Reviews

Jian'an Wang
School of Medicine Zhejiang University
Hangzhou
China

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Adjunctive Strategies in the Management of Resistant, ‘Undilatable’ Coronary Lesions After Successfully Crossing a CTO with a Guidewire

Author(s): Sara L. Fairley, James C. Spratt, Omar Rana, Suneel Talwar, Colm Hanratty, Simon Walsh.

Abstract:

Successful revascularisation of chronic total occlusions (CTOs) remains one of the greatest challenges in the era of contemporary percutaneous coronary intervention (PCI). Such lesions are encountered with increasing frequency in current clinical practice. A predictable increase in the future burden of CTO management can be anticipated given the ageing population, increased rates of renal failure, graft failure and diabetes mellitus. Given recent advances and developments in CTO PCI management, successful recanalisation can be anticipated in the majority of procedures undertaken at high-volume centres when performed by expert operators. Despite advances in device technology, the management of resistant, calcific lesions remains one of the greatest challenges in successful CTO intervention. Established techniques to modify calcific lesions include the use of high-pressure non-compliant balloon dilation, cutting-balloons, anchor balloons and high speed rotational atherectomy (HSRA). Novel approaches have proven to be safe and technically feasible where standard approaches have failed. A step-wise progression of strategies is demonstrated, from well-recognised techniques to techniques that should only be considered when standard manoeuvres have proven unsuccessful. These methods will be described in the setting of clinical examples and include use of very high-pressure non-compliant balloon dilation, intentional balloon rupture with vessel dissection or balloon assisted micro-dissection (BAM), excimer coronary laser atherectomy (ECLA) and use of HSRA in various ‘offlabel’ settings.

Keywords: Chronic total occlusions, dissection re-entry techniques, excimer coronary laser atherectomy, high speed rotational atherectomy, novel revascularisation techniques.

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Article Details

VOLUME: 10
ISSUE: 2
Year: 2014
Page: [145 - 157]
Pages: 13
DOI: 10.2174/1573403X10666140331124954
Price: $58