Chronic Total Occlusions

Ron Waksman, MD, is Director of Clinical Research and Advanced Education and Associate Director of the Cardiology Division at MedStar Heart Institute, as well as Clinical Professor of Medicine (Cardiology) at Georgetown University, Washington, DC., USA. He is editor-in-chief of the journal Cardiovascular Revascularization Medicine and has published hundreds of articles on interventional cardiology. Shigeru Saito, MD, is Director of the Cardiology and Catheterization Laboratories and Vice Director at Shonan Kamakura General Hospital, Kamakura, Japan. He sits on the editorial boards of numerous journals and has published extensively on interventional cardiology.

List of Contributors vii

Foreword x

Preface xii

Part I Pathology, Indications, and Review of Clinical Trials

1 The Pathobiology of CTO 3
Gabby Elbaz-Greener & Bradley H. Strauss

2 Pathology of Chronic Total Occlusions: Implications for Revascularization 10
Takao Konishi, Ji Eun Park, Diljon S. Chahal & Aloke V. Finn

3 Indications and Guidelines of PCI for CTO 19
Ilan Merdler, Gabriel Maluenda & Ron Waksman

Part II Imaging

4 CT Angiography: Application in Chronic Total Occlusions 29
Hidehiko Hara, John R. Lesser, Nicholas Burke & Robert S. Schwartz

5 IVUS-Guided Recanalization of CTO 35
Etsuo Tsuchikane

6 Optical Coherence Tomography to Guide the Treatment of Chronic Total Occlusions 39
Francesca Maria Di Muro, Giulia Nardi, Niccolò Ciardetti, Selcuk Kucukseymen, Alessio Mattesini & Carlo Di Mario

Part III Wires Technology

7 New Coronary Guidewire Technology in Chronic Total Occlusion Percutaneous CoronaryInterventions 49
Salman Allana & Emmanouil S. Brilakis

8 Tornus Catheter 64
Hideaki Kaneda

9 Microcatheters: Characteristics and Use 69
John D. Hung & James C. Spratt

Part IV Wires Technique

10 CTO Wires: Engineering 101 and Principles of Wire Manipulation 83
Rahul Kurup & Luiz Fernando Ybarra

11 Use of Two Wires in the Treatment of CTO 101
Thierry Lefèvre & Thomas Hovasse

12 Parallel-Wire Techniques 109
Sudhir Rathore & Takahiko Suzuki

13 Transradial Approach for CTO Lesions 115
Yutaka Tanaka & Shigeru Saito

14 Subintimal Angioplasty in Coronary CTO 121
Negar Salehi, Philippe Généreux & George D. Dangas

15 Antegrade Dissection and Re-Entry Techniques 129
Anbukarasi Maran, Carson Keck & Matthew C. Evans

16 3D Wiring Methods in CTO PCI 135
Atsunori Okamura

17 Antegrade Fenestration and Re-Entry: An Alternative Approach to Antegrade Dissection and Re-Entry 156
Lorenzo Azzalini & Mauro Carlino

18 Retrograde CTO PCI: Step by Step 166
Michael Megaly & Ashish Pershad

19 Retrograde CTO Intervention via Vein Grafts 172
Pavan Reddy & Nelson L. Bernardo

20 Tips and Tricks of the CART and Reverse CART Technique 177
Arber Kodra, Chad Kliger, Apurva Patel, Craig Basman, Tak Kwan & Michael Kim

21 Debulking of CTO 181
Etsuo Tsuchikane

22 Laser Revascularization in Coronary CTO 186
On Topaz

23 How to Handle Subintimal Dissections 203
Pratik B. Sandesara & William J. Nicholson

24 CTO: How to Minimize Contrast-Associated Acute Kidney Injury 218
Luis Gruberg

25 Mechanical Support for CTO 232
Khaldoon Alaswad, Asaad Nakhle, Ankur Gupta, Katherine J. Kunkel & Mir Babar Basir

26 Stent Grafts to Seal Coronary Perforation 246
Jasleen Tiwana & Kathleen E. Kearney

27 Complications During Retrograde Approach for CTO 250
Yutaka Tanaka & Shigeru Saito

Part V Interesting Cases

28 Interesting Cases I–V 257
Yutaka Tanaka & Shigeru Saito

Index 263