Manual of Chronic Total Occlusion Percutaneous Coronary Interventions

A Step-by-Step Approach

3rd Edition - February 7, 2023
Author: Emmanouil Brilakis
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 9 1 7 8 7 - 2
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 9 1 8 0 4 - 6

Manual of Chronic Total Occlusion Percutaneous Coronary Interventions: A Step-by-Step Approach, Third Edition is a practical reference for coronary chronic total occlusion… Read more

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Manual of Chronic Total Occlusion Percutaneous Coronary Interventions: A Step-by-Step Approach, Third Edition is a practical reference for coronary chronic total occlusion (CTO) percutaneous coronary interventions (PCI). Written by recognized national and international experts in the field, this reference compiles the steps necessary to preform, what pitfalls to watch out for, and how to troubleshoot tactics. Written to bring a practical approach, this book is perfect for interventional cardiologists, interventional and general cardiology fellows, cardiology researchers, physicians, cardiac catheterization laboratory personnel, technical staff, industry professionals and everyone else interested in understanding the cutting-edge and rapidly evolving field of CTO PCI.

In this new edition, new figures, images and algorithms have been developed to reflect the updates in CTO PCI during the past few years. In addition, this update links to approximately 200 CTO PCI cases that are accessible for free and hosted by the author on YouTube, with monthly updates on new cases. The structure of the book is completely revised to align it with the recently published Manual of Percutaneous Coronary Interventions (published in Oct 2020, also by Dr. Brilakis under the same imprint Academic Press).

Cover image
Title page
Table of Contents
Copyright
Dedication
List of contributors
Manual of CTO PCI cases
Manual of PCI cases
Prologue
Introduction
1 Chronic total occlusion definition
2 Prevalence of chronic total occlusions
3 Outline of the Manual of CTO PCI
Part A: The steps
Chapter 1. Planning
Abstract
1.1 Planning
1.2 Monitoring
1.3 Pharmacology
1.4 Access
1.5 Engagement
1.6 Angiography
1.7 Determine target lesion(s)
1.8 Lesion wiring
1.9 Lesion preparation
1.10 Stenting
1.11 Arterial closure
1.12 Physiology
1.13 Imaging
1.14 Hemodynamic support
References
Chapter 2. Monitoring
Abstract
2.1 Patient
2.2 Electrocardiogram
2.3 Pressure waveform
2.4 Oxygen saturation
2.5 Radiation dose—X-ray system and shield positioning
2.6 Contrast volume
2.7 Access site
2.8 Medication administration (anticoagulation—ACT, sedation, other medications)
2.9 Operator and team performance
2.10 Cath lab environment
2.11 Sterile field and equipment
2.12 Equipment position within the body
References
Chapter 3. Medications
3.1 Sedatives and analgesics
3.2 Vasodilators
3.3 Contrast media
3.4 Anticoagulants
3.5 Antiplatelet agents
3.6 Vasopressors and inotropes
3.7 Antiarrhythmics
References
Chapter 4. Access
Abstract
4.1 Dual (or triple) arterial access
4.2 Femoral versus radial access
4.3 Femoral access
4.4 Radial access
References
Chapter 5. Coronary and graft engagement
Abstract
Reference
Chapter 6. Coronary angiography and coronary computed tomography angiography
Abstract
6.1 Dual injection
6.2 Studying the lesion
6.3 Chronic total occlusion percutaneous coronary intervention angiographic scores
6.4 Use of coronary computed tomography angiography
References
Chapter 7. Selecting target lesion(s)
Abstract
7.1 Stable angina
7.2 Acute coronary syndromes (Fig. 7.7)
7.3 Percutaneous coronary intervention timing
7.4 Percutaneous coronary intervention lesion sequence selection
References
Chapter 8. Wiring
Abstract
Section 8.1. CTO Wiring classification/definitions
8.1.1 CTO crossing strategies definitions
8.1.2 CTO crossing strategies classification and terminology
Section 8.2. Antegrade wiring
8.2.1 Antegrade wiring: when?
8.2.2 Antegrade wiring: how?
Section 8.3. Antegrade dissection and reentry (ADR)
8.3.1 Antegrade dissection/reentry (ADR) nomenclature
8.3.2 Antegrade dissection/reentry: when?
8.3.3 Antegrade dissection/reentry: preparation
8.3.4 Antegrade dissection
8.3.5 Antegrade reentry
Section 8.4. Retrograde
8.4.1 Historical perspective
8.4.2 Advantages of the retrograde approach
8.4.3 Special equipment
8.4.4 Step-by-step description of the procedure
8.4.5 Contemporary role of the retrograde approach
Section 8.5. Crossing algorithms
8.5.1 Historical perspectives
8.5.2 Steps of the global CTO crossing algorithm
Chapter 9. Lesion preparation
Abstract
9.1 Goal
9.2 When is lesion preparation needed?
9.3 How to prepare a chronic total occlusion
References
Chapter 10. Stenting
Abstract
10.1 When to stent?
10.2 How to stent
10.3 Long-term outcomes after stenting for CTO PCI
References
Chapter 11. Access closure
Abstract
References
Chapter 12. Coronary physiology
Abstract
12.1 When to do coronary physiology during chronic total occlusion percutaneous coronary intervention?
References
Chapter 13. Intravascular imaging for CTO PCI
Abstract
13.1 Intravascular imaging modality selection
13.2 Intravascular imaging for CTO crossing
13.3 Intravascular imaging for PCI optimization
13.4 Frequency of intravascular imaging for CTO PCI
References
Chapter 14. Hemodynamic support for chronic total occlusion percutaneous coronary intervention
Abstract
14.1 Hemodynamic support: when and what device
14.2 Hemodynamic support devices
References
Part B: Complex subgroups
Chapter 15. Ostial chronic total occlusions
Abstract
15.1 Aorto-ostial chronic total occlusions
15.2 Branch ostial chronic total occlusions
References
Chapter 16. Bifurcations and CTOs
Abstract
16.1 Proximal cap ambiguity
16.2 Ostial circumflex and ostial left anterior descending artery CTOs
16.3 Bifurcation at the proximal cap
16.4 Bifurcation in the CTO body
16.5 Bifurcation at the distal cap
References
Chapter 17. Left main chronic total occlusions
Abstract
17.1 Aorto-ostial left main chronic total occlusions
17.2 Treatment of the bifurcation
17.3 Risk of hemodynamic collapse
References
Chapter 18. CTO PCI in the prior CABG patient
Abstract
18.1 Challenges of CTO PCI in prior CABG patients
18.2 Selecting the target vessel in prior CABG patients
18.3 Retrograde approach through saphenous vein grafts
18.4 Retrograde approach through internal mammary grafts
18.5 Saphenous vein graft CTOs
18.6 Saphenous vein graft aneurysms
18.7 Coronary perforation in prior CABG patients
References
Chapter 19. CTO PCI in heavily calcified vessels
Abstract
19.1 Difficulty crossing the proximal or distal CTO cap (wire impenetrable cap)
19.2 Crossing the occlusion
19.3 Reentry into the distal true lumen
19.4 Equipment delivery
19.5 Stent expansion
References
Chapter 20. Chronic total occlusion percutaneous coronary intervention in patients presenting with acute coronary syndromes
Abstract
References
Chapter 21. Multiple chronic total occlusions—Prior chronic total occlusion percutaneous coronary intervention failure
Abstract
21.1 Multiple chronic total occlusions
21.2 Prior chronic total occlusion percutaneous coronary intervention failure
References
Chapter 22. Percutaneous coronary intervention of in-stent chronic total occlusions
Abstract
22.1 Approach to in-stent chronic total occlusions
22.2 Challenges associated with percutaneous coronary intervention of in-stent chronic total occlusions
References
Chapter 23. Balloon uncrossable and balloon undilatable CTOs
Abstract
23.1 Balloon uncrossable lesions
23.2 Balloon undilatable CTOs
References
Chapter 24. Complex patient subgroups
Abstract
24.1 Prior transcatheter aortic valve replacement (TAVR) patients
24.2 Heart failure patients
References
Part C: Complications
Chapter 25. Acute vessel closure
Abstract
25.1 Maintain guidewire position
25.2 Determine the cause of acute vessel closure and treat accordingly
25.3 Hemodynamic support
References
Chapter 26. Perforation
Abstract
26.1 Perforation classification
26.2 General treatment of perforations
26.3 Large vessel perforation
26.4 Distal vessel perforation
26.5 Collateral vessel perforation
26.6 Perforation in patients with prior coronary artery bypass graft surgery carries very high risk
References
Chapter 27. Equipment loss and entrapment
Abstract
27.1 Stent loss or entrapment
27.2 Guidewire entrapment and fracture
27.3 Balloon entrapment or shaft fracture
27.4 Microcatheter entrapment or fracture
27.5 Rotablator burr entrapment
References
Chapter 28. Other complications: hypotension, radiation skin injury, contrast-induced acute kidney injury
Abstract
28.1 Hypotension
28.2 Radiation skin injury
28.3 Contrast-induced acute kidney injury (CI-AKI)
References
Chapter 29. Vascular access complications
Abstract
Reference
Part D: Equipment
Chapter 30. Equipment
Abstract
Introduction
30.1 Sheaths
30.2 Catheters
30.3 Guide catheter extensions
30.4 Support catheters
30.5 Y-connectors with hemostatic valves
30.6 Microcatheters
30.7 Guidewires
30.8 Embolic protection devices
30.9 Balloons
30.10 Atherectomy
30.11 Laser
30.12 Thrombectomy devices
30.13 Aorto-ostial lesion equipment
30.14 Stents
30.15 Vascular closure devices
30.16 CTO PCI dissection/re-entry equipment
30.17 Intravascular imaging
30.18 Complication management
30.19 Radiation protection
30.20 Hemodynamic support devices
30.21 Contrast management
30.22 Brachytherapy
30.23 The “CTO—CHIP cart”
References
Part E: How to develop a CTO PCI program
Chapter 31. How to build a successful chronic total occlusion program
Abstract
31.1 Operator
31.2 Team
31.3 Administration
31.4 Referring physicians and patients: increasing awareness of your CTO program
31.5 Why CTO PCI will make you a better interventionalist? (this section is reproduced with permission from the CTO Corner of Cardiology Today Interventions)
References
Part F: Appendices
Appendix 1
Appendix 2
Index

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Emmanouil Brilakis