Article thumbnail

Percutaneous Recanalization of Coronary Chronic Total Occlusions: Current Devices and Specialized Wire Crossing Techniques

By Hee-Yeol Kim


Treatment of coronary chronic total occlusions (CTOs) remains a challenging obstacle, posing a considerable barrier to achieving successful complete revascularization. By nature of their complexity, percutaneous CTO interventions are associated with lower rates of procedural success, higher complication rates, greater radiation exposure and longer procedure times compared with non-CTO interventions. In the last few years, development in guidewires, devices and the emergence of new techniques from Japanese centers resulted in higher success rates in the hands of experienced operators. The impact of drug eluting stents on restenosis has improved long-term outcomes after successful recanalization. Successful revascularization is associated with improved long-term survival, reduced symptoms, improved left ventricular function and reduced need for coronary bypass surgery. This paper reviews the current devices and specialized crossing techniques of percutaneous intervention to relieve CTOs

Topics: Review
Publisher: The Korean Society of Cardiology
OAI identifier:
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. (2009). A comparison of the transradial and the transfemoral approach in chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv
  2. A contemporary overview of percutaneous coronary interventions: the American College of Cardiology-National Cardiovascular Data Registry (ACCNCDR).
  3. Agiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions.
  4. Anchoring technique to improve guiding catheter support in coronary angioplasty of chronic total occlusions. Catheter Cardiovasc Interv 2006;67:366-71. 15) Rathore
  5. (2003). Angioplasty for chronic total occlusion by using tapered-tip guidewires. Catheter Cardiovasc Interv
  6. Clinical, electrocardiographic, and procedural characteristics of patients with coronary chronic total occlusions.
  7. Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions.
  8. (2008). CTO recanalization by intraocclusion injection of contrast: the microchannel technique. Catheter Cardiovasc Interv
  9. (1993). Determinants of success of coronary angioplasty in patients with a chronic total occlusion: a multiple logistic regression model to improve selection of patients.
  10. Effect of chronic total coronary occlusion on treatment strategy.
  11. Immediate results and oneyear clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE).
  12. (1998). Improvement in left ventricular ejection fraction and wall motion after successful recanalization of chronic coronary occlusions.
  13. IVUS-guided wiring technique: promising approach for the chronic total occlusion. Catheter Cardiovasc Interv 2004;61:381-6. 26) Rathore
  14. (2000). Percutaneous coronary intervention in the current era compared with 1985-1986: the National Heart, Lung, and Blood Institute Registries. Circulation
  15. Percutaneous revascularization of chronic total occlusion of left anterior descending artery using contralateral injection via isolated conus artery.
  16. (2002). Procedural and in-hospital outcomes after percutaneous coronary intervention for chronic total occlusions of coronary arteries
  17. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience.
  18. (1996). Prospective, randomized trial of prolonged intracoronary urokinase infusion for chronic total occlusions in native coronary arteries.
  19. Recanalization strategy for chronic total occlusions with tapered and stiff-tip guidewire.
  20. Regression of collateral function after recanalization of chronic total coronary occlusions: a serial assessment by intracoronary pressure and Doppler recordings.
  21. Retrograde percutaneous recanalization of chronic total occlusion of the coronary arteries: procedural outcomes and predictors of success in contemporary practice.
  22. The efficacy of a bilateral approach for treating lesions with chronic total occlusions the CART (controlled antegrade and retrograde subintimal tracking) registry.
  23. The experience of transradial coronary intervention for chronic total occlusion.
  24. (1997). The histopathology of angiographic chronic total coronary artery occlusions N changes in neovascular pattern and intimal plaque composition associated with progressive occlusion duration.
  25. (1999). Utility of bilateral coronary injections during complex coronary angioplasty.
  26. (1997). Vessel reconstruction in total coronary occlusions with a long subintimal wire pathway: use of muiltiple stents under guidance of intravascular ultrasound. Cathet Cardiovasc Diagn
  27. Wire control handling technique.