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3 years ago
Significant advances have been made with new generation stents to further improve the results of percutaneous coronary intervention (PCI) and outcomes for patients. Drug-eluting stents introduced in the early 2000s, thinner strut stent platforms, and bioabsorbable polymers and stents are among these developments.1 Despite these advances, there remain some areas where optimal stenting continues to…
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3 years ago
Coronary chronic total occlusions (CTOs) remain one of the most challenging percutaneous challenges in interventional cardiology, with technical success rates of only ~50–70 %.1,2 This lesion subset often poses the greatest risk and often requires techniques and equipment not typically utilised for more acute coronary lesions. However, successful percutaneous CTO revascularisation is associated…
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3 years ago
Definition and Prevalence
Nowadays it is widely accepted to define chronic total occlusions (CTOs) of the coronary artery as lesions with thrombolysis in myocardial infarction 0 flow for more than three months (either angiographically proven or with high clinical likelihood).1 Occlusions of less than four weeks following an acute infarction are defined as acute or subacute and occlusions of…
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3 years ago
Carotid angioplasty and stenting (CAS) is becoming a frequent therapeutic strategy for approaching severe carotid obstructive disease and is now widely accepted as a less invasive technique that provides an attractive alternative for many patients, particularly those with significant co-morbidities.1–6 From a technical standpoint, the continuous evolution of carotid stent design increases the…
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3 years ago
There has been rapid development in the techniques used for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) over the past decade, with success rates in experienced centres now exceeding 90%.1 This is in part due to advances in devices and techniques for CTO crossing, but also an improved understanding of strategy. The development of the ‘hybrid algorithm’ has improved…
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3 years ago
Radial vs Femoral Access
In recent years several large registries and randomised controlled trials have demonstrated a mortality benefit for trans-radial over trans-femoral percutaneous coronary intervention (PCI), likely mediated by reduced bleeding complications.1–4 Building on the pioneering Japanese experience, the advent of the hybrid algorithim approach, coupled with innovative new…
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3 years ago
Section A
Techniques for Chronic Total Occlusions Revascularisation
Access Route, Guiding Catheter Selection and Contralateral Injection
The femoral approach is the preferred access route by most operators. However, the radial approach might be chosen because of severe peripheral vascular disease, operator’s preference or for contralateral injection. The guiding principle of access selection is…
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3 years ago
Abstract
The basic equipment involved in percutaneous coronary interventions - guiding catheters, guide wires and dilation catheters (balloons) - have undergone significant evolution which has allowed for improvements in procedural success and safety. The coronary interventionalist should possess a thorough working knowledge of the available equipment and the ability to select specific equipment…
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1 month ago
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2 years ago
