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Wu EB, Brilakis ES, Mashayekhi K, et al. Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;78(8):840-853doi: 10.1016/j.jacc.2021.05.055.
Wu, E. B., Brilakis, E. S., Mashayekhi, K., Tsuchikane, E., Alaswad, K., Araya, M., Avran, A., Azzalini, L., Babunashvili, A. M., Bayani, B., Behnes, M., Bhindi, R., Boudou, N., Boukhris, M., Bozinovic, N. Z., Bryniarski, L., Bufe, A., Buller, C. E., Burke, M. N., Buttner, A., Cardoso, P., Carlino, M., Chen, J. Y., Christiansen, E. H., Colombo, A., Croce, K., de Los Santos, F. D., de Martini, T., Dens, J., di Mario, C., Dou, K., Egred, M., Elbarouni, B., ElGuindy, A. M., Escaned, J., Furkalo, S., Gagnor, A., Galassi, A. R., Garbo, R., Gasparini, G., Ge, J., Ge, L., Goel, P. K., Goktekin, O., Gonzalo, N., Grancini, L., Hall, A., Hanna Quesada, F. L., Hanratty, C., Harb, S., Harding, S. A., Hatem, R., Henriques, J. P. S., Hildick-Smith, D., Hill, J. M., Hoye, A., Jaber, W., Jaffer, F. A., Jang, Y., Jussila, R., Kalnins, A., Kalyanasundaram, A., Kandzari, D. E., Kao, H. L., Karmpaliotis, D., Kassem, H. H., Khatri, J., Knaapen, P., Kornowski, R., Krestyaninov, O., Kumar, A. V. G., Lamelas, P. M., Lee, S. W., Lefevre, T., Leung, R., Li, Y., Li, Y., Lim, S. T., Lo, S., Lombardi, W., Maran, A., McEntegart, M., Moses, J., Munawar, M., Navarro, A., Ngo, H. M., Nicholson, W., Oksnes, A., Olivecrona, G. K., Padilla, L., Patel, M., Pershad, A., Postu, M., Qian, J., Quadros, A., Rafeh, N. A., Råmunddal, T., Prakasa Rao, V. S., Reifart, N., Riley, R. F., Rinfret, S., Saghatelyan, M., Sianos, G., Smith, E., Spaedy, A., Spratt, J., Stone, G., Strange, J. W., Tammam, K. O., Thompson, C. A., Toma, A., Tremmel, J. A., Trinidad, R. S., Ungi, I., Vo, M., Vu, V. H., Walsh, S., Werner, G., Wojcik, J., Wollmuth, J., Xu, B., Yamane, M., Ybarra, L. F., Yeh, R. W., & Zhang, Q. (2021). Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 78(8), 840-853. https://doi.org/10.1016/j.jacc.2021.05.055
Wu, Eugene B, et al. "Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review." Journal of the American College of Cardiology vol. 78,8 (2021): 840-853. doi: https://doi.org/10.1016/j.jacc.2021.05.055
Wu EB, Brilakis ES, Mashayekhi K, Tsuchikane E, Alaswad K, Araya M, Avran A, Azzalini L, Babunashvili AM, Bayani B, Behnes M, Bhindi R, Boudou N, Boukhris M, Bozinovic NZ, Bryniarski L, Bufe A, Buller CE, Burke MN, Buttner A, Cardoso P, Carlino M, Chen JY, Christiansen EH, Colombo A, Croce K, de Los Santos FD, de Martini T, Dens J, di Mario C, Dou K, Egred M, Elbarouni B, ElGuindy AM, Escaned J, Furkalo S, Gagnor A, Galassi AR, Garbo R, Gasparini G, Ge J, Ge L, Goel PK, Goktekin O, Gonzalo N, Grancini L, Hall A, Hanna Quesada FL, Hanratty C, Harb S, Harding SA, Hatem R, Henriques JPS, Hildick-Smith D, Hill JM, Hoye A, Jaber W, Jaffer FA, Jang Y, Jussila R, Kalnins A, Kalyanasundaram A, Kandzari DE, Kao HL, Karmpaliotis D, Kassem HH, Khatri J, Knaapen P, Kornowski R, Krestyaninov O, Kumar AVG, Lamelas PM, Lee SW, Lefevre T, Leung R, Li Y, Li Y, Lim ST, Lo S, Lombardi W, Maran A, McEntegart M, Moses J, Munawar M, Navarro A, Ngo HM, Nicholson W, Oksnes A, Olivecrona GK, Padilla L, Patel M, Pershad A, Postu M, Qian J, Quadros A, Rafeh NA, Råmunddal T, Prakasa Rao VS, Reifart N, Riley RF, Rinfret S, Saghatelyan M, Sianos G, Smith E, Spaedy A, Spratt J, Stone G, Strange JW, Tammam KO, Thompson CA, Toma A, Tremmel JA, Trinidad RS, Ungi I, Vo M, Vu VH, Walsh S, Werner G, Wojcik J, Wollmuth J, Xu B, Yamane M, Ybarra LF, Yeh RW, Zhang Q. Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021 Aug 24;78(8):840-853. doi: 10.1016/j.jacc.2021.05.055. PMID: 34412818.
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J Am Coll Cardiol. 2021 Aug 24;78(8):840-853. doi: 10.1016/j.jacc.2021.05.055.

Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review.

Journal of the American College of Cardiology

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

Affiliations

  1. Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong. Electronic address: [email protected].
  2. Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
  3. Department of Cardiology and Angiology, II University Heart Center Freiburg, Bad Krozingen, Germany.
  4. Toyohashi Heart Center, Aichi, Japan.
  5. Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Henry Ford Health System, Wayne State University, Detroit, Michigan, USA.
  6. Clinica Alemana, Hospital Militar de Santiago, Santiago, Chile.
  7. Pasteur Clinic Essey-lès-Nancy, Essey-lès-Nancy, France.
  8. Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
  9. Center of Endosurgery, Moscow, Russia.
  10. Cardiology Department, Mehr Hospital, Mashhad, Iran.
  11. First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany.
  12. Royal North Shore Hospital, University of Sydney, Sydney, Australia.
  13. Interventional Cardiology, Clinique Saint Augustin, Bordeaux, France.
  14. Cardiology Department, Abderrahment Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  15. University Clinical Niš, Niš, Serbia.
  16. II Department of Cardiology and Cardiovascular Interventions, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
  17. Heart Center Krefeld, University Witten/Herdecke, Witten, Germany.
  18. Teleflex, Markham, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada.
  19. St. Michael's Hospital, Toronto, Ontario, Canada.
  20. Santa Maria University Hospital, Lisbon Academic Medical Centre and Centro Cardiovascular da Universidade de Lisboa, Lisbon, Portugal.
  21. Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS, San Raffaele Scientific Institute, Milan, Italy.
  22. Guangdong General Hospital, Guangdong, China.
  23. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
  24. Cardiology, Humanitas University, Humanitas IRCCS, Rozzano, Milan, Italy.
  25. Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  26. Instituto Nacional de Cardiologia, Ignacio Chávez and Centro Medico ABC, Mexico City, Mexico.
  27. Advocate Heart Institute, Downers Grove, Illinois, USA.
  28. Hospital Oost-Limburg, Genk, Belgium.
  29. Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy.
  30. Research Center for Coronary Heart Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
  31. Freeman Hospital & Newcastle University, Newcastle upon Tyne, UK.
  32. St. Boniface Hospital & University of Manitoba, Winnipeg, Manitoba, Canada.
  33. Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt.
  34. Hospital Clinico San Carlos, IdISSC, Complutense University of Madrid, Madrid, Spain.
  35. National Institute of Surgery and Transplantology NAMS, Kiev, Ukraine.
  36. Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy.
  37. Cardiovascular Medicine Department of PROMISE University of Palermo, Palermo, Italy.
  38. Maria Pia Hospital, GVM Care & Research, Turin, Italy.
  39. Department of Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.
  40. Zhongshan Hospital, Fudan University, Shanghai, China.
  41. Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
  42. Memorial Hospital, Istanbul, Turkey.
  43. Interventional Cardiology, Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain.
  44. Centro Cardiologico Monzino, IRCCS, Milan, Italy.
  45. Eastern Health/Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
  46. "Clinica Comfamiliar," Pereira, Colombia.
  47. Belfast Health and Social Care Trust, Belfast, UK.
  48. Medical University of Graz, University Heart Center, Graz, Austria.
  49. Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand.
  50. Hôpital du Sacré-Coeur de Montréal Université de Montréal, Montréal, Québec, Canada.
  51. University of Amsterdam, Amsterdam, the Netherlands.
  52. Sussex Cardiac Centre, Brighton, UK.
  53. King's College Hospital, London, UK.
  54. Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK.
  55. Emory University, Atlanta, Georgia, USA.
  56. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  57. Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
  58. Interventional Cardiology, Helsinki Heart Hospital, Helsinki, Finland.
  59. Clinic of Cardiovascular Diseases, Riga East Clinical University Hospital, Riga, Latvia.
  60. Promed Hospital, Chennai, India.
  61. Piedmont Heart Institute and Cardiovascular Services, Atlanta, Georgia, USA.
  62. Department of Internal Medicine, Cardiology Division, Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
  63. Columbia University, New York, New York, USA.
  64. Kasr Alainy Medical School, Cairo University, Cairo, Egypt, and Fujairah Hospital, Ministry of Health, Fujairah, United Arab Emirates.
  65. Cleveland Clinic, Cleveland, Ohio, USA.
  66. Heart Center of the Amsterdam University Medical Centers, Amsterdam, the Netherlands.
  67. Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  68. Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia.
  69. Department of Cardiology, Dr. L.H. Hiranandani Hospital, Mumbai, India.
  70. Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina, and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
  71. Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
  72. Institut Cardiovasculaire Paris Sud, Hôpital Prive Jacques Cartier, Massy, France.
  73. C.K. Hui Heart Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
  74. Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  75. Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
  76. National Heart Centre of Singapore, Singapore.
  77. Department of Cardiology, Liverpool Hospital and The University of New South Wales, Sydney, Australia.
  78. University of Washington, Seattle, Washington, USA.
  79. Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA.
  80. Golden Jubilee National Hospital, Glasgow, UK.
  81. NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
  82. Binawaluya Cardiac Center and Department of Cardiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, and Department of Cardiology, Faculty of Medicine, Universitas Gadjahmada, Yogyakarta, Indonesia.
  83. Hospital de los Valles, Hospital de Especialidades Eugenio Espejo, Universidad San Francisco de Quito, Quito, Ecuador.
  84. Choray University Hospital, Hochiminh City, Vietnam.
  85. Emory Healthcare, Atlanta, Georgia, USA.
  86. Heart Department, Haukeland University Hospital, Bergen, Norway.
  87. Department of Cardiology SUS-Lund, Lund University, Lund, Sweden.
  88. Department of Interventional Cardiology and Endovascular Therapeutics, ICBA, Instituto Cardiovascular, Buenos Aires, Argentina.
  89. Division of Cardiovascular Medicine, University of California, San Diego, School of Medicine, San Diego, California, USA.
  90. Chandler Regional Medical Center, Chandler, Arizona, USA.
  91. Cardiology Department, University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases "Prof Dr C.C. Iliescu," Bucharest, Romania.
  92. Beijing Fuwai Hospital, Beijing, China.
  93. Interventional Cardiology Division and Post Graduate Course of Cardiology, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil.
  94. St. George Hospital University Medical Center, Beirut, Lebanon, and North Oaks Healthcare System, Hammond, Louisiana, USA.
  95. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
  96. Care Hospitals, Hyderabad, India.
  97. Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany.
  98. The Christ Hospital Health Network, Cincinnati, Ohio, USA.
  99. McGill University Health Centre, Montréal, Québec, Canada.
  100. Nork Marash MC, Erebouni MC, Yerevan, Armenia.
  101. AHEPA University Hospital, Thessaloniki, Greece.
  102. Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
  103. Boone Hospital Center, Columbia, Missouri, USA.
  104. St. George's University Hospital NHS Foundation Trust, London, UK.
  105. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
  106. Bristol Royal Infirmary, University Hospital Bristol NHS Trust, Bristol, UK.
  107. Department at the International Medical Center, Jeddah, Saudi Arabia.
  108. NYU Langone Medical Center, New York, New York, USA.
  109. Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
  110. Stanford University Medical Centre, Stanford, California, USA.
  111. PCI Cardiology Group, Bayamon, Puerto Rico, USA.
  112. University of Szeged, Department of Invasive Cardiology, Szeged, Hungary.
  113. Royal Columbian Hospital, Vancouver, British Columbia, Canada.
  114. Heart Center University Medical Center, Ho Chi Minh City, Vietnam.
  115. Medizinische Klinik I Klinikum Darmstadt, Darmstadt, Germany.
  116. Hospital of Invasive Cardiology IKARDIA, Na??czów/Lublin, Poland.
  117. Providence Heart and Vascular Institute, Portland, Oregon, USA.
  118. Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
  119. Saitima St. Luke's International Hospital, Tokyo, Japan.
  120. London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
  121. Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  122. Shanghai East Hospital, Tongji University, Shanghai, China.

PMID: 34412818 DOI: 10.1016/j.jacc.2021.05.055

Abstract

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.

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Keywords: chronic total occlusion; global; percutaneous coronary intervention; treatment algorithm

Conflict of interest statement

Funding Support and Author Disclosures Dr Wu has received research funding from Abiomed, OrbusNeich, Asahi Intecc; has received consulting honoraria from Boston Scientific and Abbott Vascular; is a me

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