Global Chronic Total Occlusion Crossing Algorithm

• Published in: Journal of the American College of Cardiology Vol. 78; no. 8; pp. 840 - 853
• Main Authors: Wu, Eugene B., Mashayekhi, Kambis, Tsuchikane, Etsuo, Alaswad, Khaldoon, Araya, Mario, Avran, Alexandre, Azzalini, Lorenzo, Babunashvili, Avtandil M., Bayani, Baktash, Behnes, Michael, Bhindi, Ravinay, Boudou, Nicolas, Boukhris, Marouane, Bryniarski, Leszek, Buller, Christopher E., Burke, M. Nicholas, Cardoso, Pedro, Carlino, Mauro, Chen, Ji-Yan, Christiansen, Evald Hoej, Colombo, Antonio, Croce, Kevin, de los Santos, Felix Damas, de Martini, Tony, Dens, Joseph, di Mario, Carlo, Dou, Kefei, Egred, Mohaned, Furkalo, Sergey, Galassi, Alfredo R., Garbo, Roberto, Gasparini, Gabriele, Ge, Junbo, Ge, Lei, Goel, Pravin Kumar, Grancini, Luca, Hanna Quesada, Franklin Leonardo, Hanratty, Colm, Harb, Stefan, Harding, Scott A., Hatem, Raja, Henriques, Jose P.S., Hildick-Smith, David, Hill, Jonathan M., Hoye, Angela, Jaber, Wissam, Jaffer, Farouc A., Jussila, Risto, Kalnins, Artis, Kalyanasundaram, Arun, Kandzari, David E., Kao, Hsien-Li, Karmpaliotis, Dimitri, Khatri, Jaikirshan, Knaapen, Paul, Krestyaninov, Oleg, Kumar, A.V. Ganesh, Lamelas, Pablo Manuel, Lee, Seung-Whan, Lefevre, Thierry, Leung, Raymond, Li, Yu, Li, Yue, Lim, Soo-Teik, Lo, Sidney, Maran, Anbukarasi, Moses, Jeffrey, Navarro, Andres, Ngo, Hung M., Nicholson, William, Oksnes, Anja, Olivecrona, Goran K., Patel, Mitul, Pershad, Ashish, Postu, Marin, Qian, Jie, Quadros, Alexandre, Rafeh, Nidal Abi, Råmunddal, Truls, Prakasa Rao, Vithala Surya, Reifart, Nicolaus, Saghatelyan, Meruzhan, Sianos, George, Smith, Elliot, Spaedy, Anthony, Spratt, James, Strange, Julian W., Tammam, Khalid O., Thompson, Craig A., Toma, Aurel, Ungi, Imre, Vo, Minh, Vu, Vu Hoang, Walsh, Simon, Werner, Gerald, Xu, Bo, Yamane, Masahisa, Ybarra, Luiz F., Yeh, Robert W., Zhang, Qi
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 24.08.2021; Elsevier BV
• Subjects: Algorithms; Cardiovascular; Chronic total occlusion; chronic total occlusion; global; percutaneous coronary intervention; treatment algorithm; Coronary Angiography; Algorithms; Coronary Angiography; Coronary Occlusion; Coronary Occlusion / diagnostic imaging; Coronary Occlusion / surgery; Global; Humans; percutaneous coronary intervention; treatment algorithm; treatment algorithm; percutaneous coronary intervention; APCTO; PCI; IVUS; chronic total occlusion; global; ADR; CTO; intravascular ultrasound; Asia Pacific CTO Club; antegrade dissection and re-entry
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2021.05.055

The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration. [Display omitted] •Several regional crossing algorithms for chronic total coronary artery occlusive lesions (CTO) have been published.•The authors of these regional algorithms from 50 countries have collaborated in developing a global CTO crossing algorithm.•This algorithm can encourage discussion, promote research collaboration, facilitate training and improve outcomes of percutaneous revascularization for patients with CTO.