Percutaneous coronary intervention in chronic total occlusions: single centre experience with hybrid approach

    Authors

    Keywords

    chronic total occlusion, percutaneous coronary intervention, hybrid approach

    DOI

    https://doi.org/10.15836/ccar2018.391

    Full Text

    Introduction: Percutaneous coronary intervention (PCI) in chronic total occlusions (CTO) is almost the only growing area of ​​coronary interventional cardiology, where the key to success is true indication and knowledge of all available techniques and materials. Recently, the hybrid approach to CTO interventions proved to be an optimal strategy with the best ratio of success and complications. ( 1 ) Here, we present experience in University Hospital Dubrava with hybrid PCI approach to CTO. Patients and Methods: Procedures before and after the routine adoption of a hybrid approach to CTO interventions were analyzed. Hybrid approach to CTO is based on routine dual catheter contrast injection in each CTO lesion indicated for PCI, and only depending on the angiographic assessment of the proximal cap, collateral circulation visualization, and the appearance of the distal target by collateral circulation, one of the following strategies is selected: anterograde CTO wire escalation (AWE), anterograde dissection and re-entry with dedicated materials (“Crossboss and Stingray”) (ADR), retrograde CTO wire escalation (RWE), or reverse CART (retrograde dissection and re-entry into true lumen). Results: After the process of hybrid approach adoption to CTO interventions during 2016, the number of redo procedures in our center decreased considerably, whereas the success rate increased. In the period after the full adoption of the hybrid approach between July 2017 and July 2018, 52 CTO interventions were indicated, of which 34 on the right coronary artery. Proportions of final PCI strategies were: AWE 46/52, ADR 2/52, RWE 2/52, and reverse CART 2/52. Total success rate was 84.6%. Repeated procedure was indicated in 4/52 patients. Periprocedural complications were rare: 1 coronary perforation needing cardiac surgery and 1 coronary perforation treated in Cath lab without need for cardiac surgery. No periprocedural mortality was recorded. Conclusion: The hybrid approach to CTO PCI proved to be a safe, efficient, and economical method, and should be adopted as a routine approach to CTO intervention.

    Cardiologia Croatica
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    Percutaneous coronary intervention in chronic total occlusions: single centre experience with hybrid approach

    Extended Abstract
    Issue11-12
    Published
    Pages391
    PDF via DOIhttps://doi.org/10.15836/ccar2018.391
    chronic total occlusion
    percutaneous coronary intervention
    hybrid approach

    Authors

    Irzal Hadžibegović*ORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Mario SičajaORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Ognjen ČančarevićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Aleksandar BlivajsORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Tomo SvagušaORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Boris StarčevićORCIDUniversity Hospital Dubrava, Zagreb, Croatia

    Full Text

    Introduction: Percutaneous coronary intervention (PCI) in chronic total occlusions (CTO) is almost the only growing area of ​​coronary interventional cardiology, where the key to success is true indication and knowledge of all available techniques and materials. Recently, the hybrid approach to CTO interventions proved to be an optimal strategy with the best ratio of success and complications. ( 1 ) Here, we present experience in University Hospital Dubrava with hybrid PCI approach to CTO. Patients and Methods: Procedures before and after the routine adoption of a hybrid approach to CTO interventions were analyzed. Hybrid approach to CTO is based on routine dual catheter contrast injection in each CTO lesion indicated for PCI, and only depending on the angiographic assessment of the proximal cap, collateral circulation visualization, and the appearance of the distal target by collateral circulation, one of the following strategies is selected: anterograde CTO wire escalation (AWE), anterograde dissection and re-entry with dedicated materials (“Crossboss and Stingray”) (ADR), retrograde CTO wire escalation (RWE), or reverse CART (retrograde dissection and re-entry into true lumen). Results: After the process of hybrid approach adoption to CTO interventions during 2016, the number of redo procedures in our center decreased considerably, whereas the success rate increased. In the period after the full adoption of the hybrid approach between July 2017 and July 2018, 52 CTO interventions were indicated, of which 34 on the right coronary artery. Proportions of final PCI strategies were: AWE 46/52, ADR 2/52, RWE 2/52, and reverse CART 2/52. Total success rate was 84.6%. Repeated procedure was indicated in 4/52 patients. Periprocedural complications were rare: 1 coronary perforation needing cardiac surgery and 1 coronary perforation treated in Cath lab without need for cardiac surgery. No periprocedural mortality was recorded. Conclusion: The hybrid approach to CTO PCI proved to be a safe, efficient, and economical method, and should be adopted as a routine approach to CTO intervention.