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Global Chronic Total Occlusion Crossing Algorithm

2021; Elsevier BV; Volume: 78; Issue: 8 Linguagem: Inglês

10.1016/j.jacc.2021.05.055

1558-3597

Eugene B. Wu, Emmanouil S. Brilakis, Kambis Mashayekhi, Etsuo Tsuchikane, Khaldoon Alaswad, Mario Araya, Alexandre Avran, Lorenzo Azzalini, А. М. Бабунашвили, Baktash Bayani, Michael Behnes, Ravinay Bhindi, Nicolas Boudou, Marouane Boukhris, Nenad Božinović, Leszek Bryniarski, Alexander Bufe, Christopher E. Buller, M. Nicholas Burke, Achim Buttner, Pedro Cardoso, Mauro Carlino, Ji-yan Chen, Evald Høj Christiansen, Antonio Colombo, Kevin Croce, Félix Damas de los Santos, Tony De Martini, Joseph Dens, Carlo Di Mario, Kefei Dou, Mohaned Egred, Basem Elbarouni, Ahmed ElGuindy, Javier Escaned, Sergey Furkalo, Andrea Gagnor, Alfredo R. Galassi, Roberto Garbo, Gabriele Gasparini, Junbo Ge, Lei Ge, Pravin K. Goel, Ömer Göktekín, Nieves Gonzalo, Luca Grancini, Allison B. Hall, Franklin Leonardo Hanna Quesada, Colm G. Hanratty, Stefan Harb, Scott A. Harding, Raja Hatem, José P.S. Henriques, David Hildick‐Smith, Jonathan Hill, Angela Hoye, Wissam Jaber, Farouc A. Jaffer, Yangsoo Jang, Risto Jussila, Artis Kalniņš, Arun Kalyanasundaram, David E. Kandzari, Hsien‐Li Kao, Dimitri Karmpaliotis, Hussien Heshmat Kassem, Jaikirshan Khatri, Paul Knaapen, Ran Kornowski, Oleg Krestyaninov, Ashish Kumar, Pablo Lamelas, Seung‐Whan Lee, Thierry Lefévre, Raymond Leung, Yu Li, Yue Li, Soo-Teik Lim, S. Lo, William Lombardi, Anbukarasi Maran, Margaret McEntegart, Jeffrey W. Moses, Muhammad Munawar, Andrés Navarro, Hung Manh Ngo, William Nicholson, Anja Øksnes, Göran Olivecrona, Lucio Padilla, Mitul Patel, Ashish Pershad, Marin Postu, Jie Qian, Alexandre Schaan de Quadros, Nidal Abi Rafeh, Truls Råmunddal, Vithala Surya Prakasa Rao, Nicolaus Reifart, Robert F. Riley, Stéphane Rinfret, Meruzhan Saghatelyan, George Sianos, Elliot J. Smith, Anthony Spaedy, James C. Spratt, Gregg W. Stone, Julian Strange, Khalid Tammam, Craig A. Thompson, Aurel Toma, Jennifer A. Tremmel, Ricardo Santiago Trinidad, Imre Ungi, Minh Vo, Vũ Hoàng Vũ, Simon Walsh, Gerald Werner, Jarosław Wójcik, Jason Wollmuth, Bo Xu, Masahisa Yamane, Luiz F. Ybarra, Robert W. Yeh, Qi Zhang,

Vascular Procedures and Complications

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.