Table of Contents


List of Contributors


1. CTO Interventions: Definition, Prevalence, Indications, Guidelines

1.1 CTO Definition

1.2 Prevalence of CTOs

1.3 Indications and Potential Clinical Benefits of CTO PCI

1.4 Guidelines for CTO PCI

1.5 Appropriateness Use Criteria in CTO PCI

1.6 Contraindications to CTO PCI

1.7 Summary and Conclusions


2. Equipment

2.1 Sheaths

2.2 Guide Catheters

2.3 Microcatheters

2.4 Guidewires

2.5 Dissection/Re-Entry Equipment

2.6 Snares

2.7 “Uncrossable-Undilatable” Lesion Equipment

2.8 Intravascular Ultrasound

2.9 Complication Management Equipment

2.10 Radiation Protection

2.11 The “CTO cart”


3. The Basics: Timing, Dual Injection, Studying the Lesion, Access, Anticoagulation, Guide Support, Trapping

3.1 Timing

3.2 Dual Injection

3.3 Studying the Lesion

3.4 Vascular Access

3.5 Anticoagulation

3.6 Techniques to Increase Guide Catheter Support (Large Bore Guide, Active Guide Support, Guide Catheter Extensions, Anchor Techniques

3.7 Trapping


4. Antegrade Wire Escalation: The Foundation of CTO PCI

4.1 Special Situations


5. Antegrade Dissection/Re-entry

5.1 Knuckle Wire

5.2 CrossBoss

5.3 Stingray-Based Re-entry

5.4 Wire-Based Re-entry


6. The Retrograde Approach

6.1 Historical Perspective

6.2 Advantages of the Retrograde Approach

6.3 Special Equipment

6.4 Step-by-Step Description of the Procedure

6.5 Retrograde True Lumen Puncture

6.6 Retrograde Dissection/Re-entry

6.7 Antegrade Crossing

6.8 Special Retrograde CTO PCI Scenarios


7. Putting


No. of pages:
© 2014
Academic Press
eBook ISBN:
Print ISBN:

About the author

Emmanouil Brilakis

Emmanouil S. Brilakis, MD, PhD, FACC, FAHA, FESC, FSCAI Dr. Brilakis is Director of the Cardiac Catheterization Laboratories at VA North Texas Healthcare System and an Associate Professor of Medicine at University of Texas Southwestern Medical School. After graduating from Lycee Leonin de Patissia, Dr. Brilakis received his medical degree from the National Kapodistrian University of Athens, Greece. He trained in Internal Medicine, Cardiovascular Diseases and Interventional Cardiology at the Mayo Clinic. He also completed a Masters in Clinical Research at the Mayo Clinic and a PhD in Clinical Research at the National Kapodistrian University of Athens, Greece. Dr. Brilakis is leading a very active clinical trial team that investigates the percutaneous treatment of chronic total occlusions, prevention and treatment of saphenous vein graft disease, intracoronary imaging, and antiplatelet treatment optimization post coronary stenting. He has authored or co-authored over 230 manuscripts and receives funding from the National Institutes of Health, the Department of Veterans Affairs and industry. He is a reviewer for several journals and grant agencies and is lecturing and proctoring at several institutions in the United States and abroad.

Affiliations and Expertise

Director, Cardiac Catheterization Laboratories, VA North Texas Healthcare System; Associate Professor of Medicine, University of Texas Southwestern Medical School


BMA Medical Book Awards 2014 - Highly Commended, Cardiology, British Medical Association


"In addition to its comprehensive and up-to-date coverage of all aspects of CTO intervention, this easy-to-read, practical book serves as a valuable manual that helps novices learn CTO intervention techniques, and allows experienced operators to hone their skills."  Rating: 5, April 4, 2014
"Interventional cardiologists explain a new algorithmic approach to chronic total occlusion (CTO) intervention. Rather than reviewing angiograms and deciding whether a patient should get revascularization, the cardiologist will look at the ischemic burden and the patient's symptoms and use the angioram to determine how best to achieve revascularization. Among the topics are equipment, the retrograde approach, "balloon undilatable" CTOs, stenting CTO lesions…", January 2014