The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe

Abstract

High procedure and patient success rates, combined with a low event rate and improved procedural characteristics, support further use of the hybrid algorithm for a broad community of appropriately trained CTO operators.

Intravascular Ultrasound Analysis of Intraplaque Versus Subintimal Tracking in Percutaneous Intervention for Coronary Chronic Total Occlusions and Association With Procedural Outcomes

“…The observed higher event rates in the subintimal wire tracking group should be taken in the context of a low overall adverse event rate (5.0%, 11 of 219 patients met the primary endpoint) with an overall high success rates (89.5% of CTO interventions in the overall cohort were successful) comparable to recent hybrid studies from Europe and the United States (24,25). Although patient characteristics between subintimal and intraplaque groups were similar, the subintimal group had significantly higher J-CTO scores, which may partially explain the trend toward higher event rates in this group; however, after adjustment for important covariates (including components of the J-CTO score), both subintimal wire location and dissection re-entry were independently associated with a higher rate of the secondary composite endpoint of dye staining/extravasation, branch occlusion, or PMI.…”

2018 ESC/EACTS Guidelines on myocardial revascularization

“…Recent developments in catheter and wire technology, and increasing operator expertise with both antegrade and retrograde approaches as well as wire escalation and dissection/re-entry techniques, have translated into increasing success rates of CTO-PCI with low rates of MACE. [631][632][633] Success rates are strongly dependent on operator skills, depending on experience with specific procedural techniques, and the availability of dedicated equipment, and vary from 60-70% to >90%.…”

Impact of ultra‐thin struts on restenosis after chronic total occlusion recanalization: Insights from the randomized PRISON IV trial

“…Procedural success rates in percutaneous treatment of coronary chronic total occlusions (CTOs) have certainly improved in the last years, with continuous benefits deriving from developments in materials, devices, and techniques. The clinical advantages of a full coronary revascularization by means of CTO recanalization, as shown in some reports, may lead to improved long‐term survival in patients presenting with both stable coronary artery disease (CAD) and acute coronary syndrome (ACS) .…”