Interventional Management of “Balloon-Uncrossable” Coronary Chronic Total Occlusion: Is There Any Way Out?

Dash, Debabrata

doi:10.4070/kcj.2017.0345

Cited by 14 publications

(9 citation statements)

References 14 publications

(15 reference statements)

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“…Anchor balloon technique involves negotiation of a wire into a side branch (Figure 1) followed by a little in latable (1.5-2.0 mm) expansion at 6-8 atm and thus facilitates advancement of a wire, balloon or microcatheters. However, there may be a risk of injury or ischemia to the side branch supplying a large myocardial territory [24].…”

Section: Antegrade Approachesmentioning

confidence: 99%

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Tips and Tricks for PCI of Chronic Total Occlusions – A Review

Rohit¹

2021

RIJCCM

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Chronic total occlusion recanalization still represents the final frontier in percutaneous coronary intervention. Retrograde recanalization is one of the greatest amendments of this technique. At present, it has become an integral complement to the traditional antegrade approach. Despite being most frequently used in complex patients, it has the highest success rate with the lowest incidence of complications. Since its inception, significant iterations have occurred that made this technique safer, faster, and even more successful.

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Section: Antegrade Approachesmentioning

confidence: 99%

“…is advanced so that it enters the true distal lumen (Figure 5 and Figure 6). As dedicated microcatheter are available, this CART technique is now superseded by the newer technique that is reverse CART [4,24].…”

Section: Navigation Through Co Llateral Channelmentioning

confidence: 99%

Tips and Tricks for PCI of Chronic Total Occlusions – A Review

Rohit¹

2021

RIJCCM

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“…Intentional balloon assisted microdissection should be used as a last resort measure whether other strategies have failed or not available. 19…”

Section: Intentional Balloon Assisted Microdissectionmentioning

confidence: 99%

Contemporary treatment options for surmounting the conundrum of calcified coronaries

Dash¹,

Ahmed²,

Rohit³

2020

J Transcat Intervent

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Since the advent of balloon angioplasty in 1977, countless tools and techniques have been introduced and broadened the application of percutaneous coronary intervention in unprecedented anatomic settings. Heavily calcified coronary lesions traditionally continue to pose a challenge for percutaneous coronary intervention, since they are difficult to dilate adequately and/or there is inability to deliver and deploy drug eluting stents appropriately. Poor stent deployment is associated with increased procedural complications and suboptimal long-term outcomes. Thanks to the introduction of dedicated percutaneous coronary intervention tools, like cutting-and scoring balloons, atherectomy devices, and the novel intravascular lithotripsy technology, the treatment of such lesions has become increasingly feasible, safe and predictable. In this focused review, the author provides a summary of the principles, technique and contemporary evidence for various plaque modification strategies, with main objective of optimizing drug eluting stents delivery and deployment, translating into improved patient outcome.

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“…This often occurs because of severe calcification and/or tortuosity at the occlusion site. 2 Data from the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) showed that balloon-uncrossable lesions accounted for 9% of all CTOs and were associated with significantly lower technical and procedural success compared with balloon-crossable lesions. 3 Balloon-uncrossable lesions are primarily treated by increasing guiding catheter support and implementing plaque modification.…”

Section: Introductionmentioning

confidence: 99%

“…However, this can lead to vessel perforation or dissection and resultant problematic removal of the ruptured balloon. 2 The mechanism of the BAM technique involves modification of the plaque by rupture of the balloon; thus, the BAM balloon should be pushed against the CTO lesion as deeply as possible. The Sapphire V R II 1.0-mm balloon (OrbusNeich, Hong Kong) is the smallest balloon for PCI and might be more easily inserted into a CTO lesion.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of balloon-assisted microdissection with Sapphire® II 1.0-mm balloon in balloon-uncrossable chronic total occlusion lesions

Zhao

Du³

et al. 2020

J Int Med Res

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Objective Earlier studies have shown that the balloon-assisted microdissection (BAM) technique is feasible using a 1.2- to 1.5-mm small balloon in balloon-uncrossable chronic total occlusion (CTO) lesions. This study was performed to assess the efficacy and safety of the BAM technique with a Sapphire® II 1.0-mm balloon. Methods In this retrospective study, patients undergoing percutaneous coronary intervention for CTO were consecutively screened for balloon-uncrossable CTO lesions using BAM with the Sapphire® II 1.0-mm balloon. The patients’ clinical and angiographic characteristics and procedural outcomes were collected for analyses. Results Twenty-four balloon-uncrossable CTO lesions were identified. Most of the CTO lesions were located in the right coronary artery, followed by the left anterior descending artery and left circumflex artery. The mean Japanese Multicenter CTO Registry (J-CTO) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) scores were 1.96 and 1.38, respectively. The total technical success rates were 91.6% (22/24) and 75.00% (18/24) for the lesions that were successfully treated with BAM. No patients developed major complications with the exception of one patient who developed a femoral hematoma. Conclusion BAM with the Sapphire® II 1.0-mm balloon may be an effective and safe technique for balloon-uncrossable CTO lesions.

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Interventional Management of “Balloon-Uncrossable” Coronary Chronic Total Occlusion: Is There Any Way Out?

Cited by 14 publications

References 14 publications

Tips and Tricks for PCI of Chronic Total Occlusions – A Review

Tips and Tricks for PCI of Chronic Total Occlusions – A Review

Contemporary treatment options for surmounting the conundrum of calcified coronaries

Efficacy and safety of balloon-assisted microdissection with Sapphire® II 1.0-mm balloon in balloon-uncrossable chronic total occlusion lesions

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