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. 2005 Jun;91(Suppl 3):iii42–iii48. doi: 10.1136/hrt.2004.058495

Chronic total occlusions—a stiff challenge requiring a major breakthrough: is there light at the end of the tunnel?

S Aziz, D Ramsdale
PMCID: PMC1876352  PMID: 15919653

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Figure 1.

Figure 1

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 Microscopic section through a chronic total occlusion (CTO) with visible tiny microchannels. Courtesy of Dr John Gosney, Royal Liverpool University Hospital, Liverpool.

Figure 2.

Figure 2

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 Conquest Pro guidewire incorporating both a distal tapered tip design with a diameter of 0.009 inch and a hydrophilic coating. A polytetrafluoroethylene (PTFE) coating is present on the proximal section of the guidewire. Courtesy of Asahi Intecc Co, European Office, Amsterdam, Netherlands.

Figure 3.

Figure 3

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 (A). The new 0.014 inch Magnum wire has a 0.7 mm diameter, 1.2 mm long radiopaque olive tip, which has a smoother surface and edges (top) than the original (bottom). (B) The distal 3 cm is radiopaque with a hydrophilic coating.

Figure 4.

Figure 4

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 Angiogram of chronically occluded right coronary artery before and after PCI and stenting.

Figure 5.

Figure 5

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 Summary of PTCA versus stenting trials in CTOs. SICCO, stenting in chronic coronary occlusion; GISSOC, gruppo Italiano di studi sulla stent nelle occlusioni coronariche; SPACTO, stent vs. percutaneous angioplasty in chronic total occlusion; STOP, stents in total occlusion for restenosis prevention; TOSCA, total occlusion study of Canada.

Figure 6.

Figure 6

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 Frontrunner-XR catheter. The straight and hinged distal tip versions with bioptome-like jaws are shown. Courtesy of LuMend Inc, Redwood City, California.

Figure 7.

Figure 7

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 Use of optical coherence reflectometry to help distinguish between arterial wall and plaque with the SafeCross system. Courtesy of Intraluminal Therapeutics Inc, Carlsbad, California.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allemann Y., Kaufmann U. P., Meyer B. J., Gunnes P., Urban P., Mülhauser B., Dorsaz P. A., Meier B. Magnum wire for percutaneous coronary balloon angioplasty in 800 total chronic occlusions. Am J Cardiol. 1997 Sep 1;80(5):634–637. doi: 10.1016/s0002-9149(97)00438-4. [DOI] [PubMed] [Google Scholar]
  2. Buller C. E., Dzavik V., Carere R. G., Mancini G. B., Barbeau G., Lazzam C., Anderson T. J., Knudtson M. L., Marquis J. F., Suzuki T. Primary stenting versus balloon angioplasty in occluded coronary arteries: the Total Occlusion Study of Canada (TOSCA). Circulation. 1999 Jul 20;100(3):236–242. doi: 10.1161/01.cir.100.3.236. [DOI] [PubMed] [Google Scholar]
  3. Chung Chang-Min, Nakamura Shigeru, Tanaka Koji, Tanigawa Jun, Kitano Katsuya, Akiyama Tatsurou, Matoba Yoshiki, Katoh Osamu. Effect of recanalization of chronic total occlusions on global and regional left ventricular function in patients with or without previous myocardial infarction. Catheter Cardiovasc Interv. 2003 Nov;60(3):368–374. doi: 10.1002/ccd.10641. [DOI] [PubMed] [Google Scholar]
  4. Delacrétaz E., Meier B. Therapeutic strategy with total coronary artery occlusions. Am J Cardiol. 1997 Jan 15;79(2):185–187. doi: 10.1016/s0002-9149(96)00710-2. [DOI] [PubMed] [Google Scholar]
  5. Go A. S., Hylek E. M., Phillips K. A., Borowsky L. H., Henault L. E., Chang Y., Selby J. V., Singer D. E. Implications of stroke risk criteria on the anticoagulation decision in nonvalvular atrial fibrillation: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. Circulation. 2000 Jul 4;102(1):11–13. doi: 10.1161/01.cir.102.1.11. [DOI] [PubMed] [Google Scholar]
  6. Gruberg L., Mehran R., Dangas G., Hong M. K., Mintz G. S., Kornowski R., Lansky A. J., Kent K. M., Pichard A. D., Satler L. F. Effect of plaque debulking and stenting on short- and long-term outcomes after revascularization of chronic total occlusions. J Am Coll Cardiol. 2000 Jan;35(1):151–156. doi: 10.1016/s0735-1097(99)00491-x. [DOI] [PubMed] [Google Scholar]
  7. Hoye Angela, Tanabe Kengo, Lemos Pedro A., Aoki Jiro, Saia Francesco, Arampatzis Chourmouzios, Degertekin Muzaffer, Hofma Sjoerd H., Sianos Georgios, McFadden Eugene. Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions. J Am Coll Cardiol. 2004 Jun 2;43(11):1954–1958. doi: 10.1016/j.jacc.2004.01.045. [DOI] [PubMed] [Google Scholar]
  8. Höher M., Wöhrle J., Grebe O. C., Kochs M., Osterhues H. H., Hombach V., Buchwald A. B. A randomized trial of elective stenting after balloon recanalization of chronic total occlusions. J Am Coll Cardiol. 1999 Sep;34(3):722–729. doi: 10.1016/s0735-1097(99)00254-5. [DOI] [PubMed] [Google Scholar]
  9. Ivanhoe R. J., Weintraub W. S., Douglas J. S., Jr, Lembo N. J., Furman M., Gershony G., Cohen C. L., King S. B., 3rd Percutaneous transluminal coronary angioplasty of chronic total occlusions. Primary success, restenosis, and long-term clinical follow-up. Circulation. 1992 Jan;85(1):106–115. doi: 10.1161/01.cir.85.1.106. [DOI] [PubMed] [Google Scholar]
  10. Lotan C., Rozenman Y., Hendler A., Turgeman Y., Ayzenberg O., Beyar R., Krakover R., Rosenfeld T., Gotsman M. S. Stents in total occlusion for restenosis prevention. The multicentre randomized STOP study. The Israeli Working Group for Interventional Cardiology. Eur Heart J. 2000 Dec;21(23):1960–1966. doi: 10.1053/euhj.2000.2295. [DOI] [PubMed] [Google Scholar]
  11. Mori M., Kurogane H., Hayashi T., Yasaka Y., Ohta S., Kajiya T., Takarada A., Yoshida A., Matsuda Y., Nakagawa K. Comparison of results of intracoronary implantation of the Plamaz-Schatz stent with conventional balloon angioplasty in chronic total coronary arterial occlusion. Am J Cardiol. 1996 Nov 1;78(9):985–989. doi: 10.1016/s0002-9149(96)00521-8. [DOI] [PubMed] [Google Scholar]
  12. Moses Jeffrey W., Leon Martin B., Popma Jeffrey J., Fitzgerald Peter J., Holmes David R., O'Shaughnessy Charles, Caputo Ronald P., Kereiakes Dean J., Williams David O., Teirstein Paul S. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med. 2003 Oct 2;349(14):1315–1323. doi: 10.1056/NEJMoa035071. [DOI] [PubMed] [Google Scholar]
  13. Ng William, Chen Wai-Hong, Lee Pui-Yin, Lau Chu-Pak. Initial experience and safety in the treatment of chronic total coronary occlusions with a new optical coherent reflectometry-guided radiofrequency ablation guidewire. Am J Cardiol. 2003 Sep 15;92(6):732–734. doi: 10.1016/s0002-9149(03)00841-5. [DOI] [PubMed] [Google Scholar]
  14. Noguchi T., Miyazaki MD S., Morii I., Daikoku S., Goto Y., Nonogi H. Percutaneous transluminal coronary angioplasty of chronic total occlusions. Determinants of primary success and long-term clinical outcome. Catheter Cardiovasc Interv. 2000 Mar;49(3):258–264. doi: 10.1002/(sici)1522-726x(200003)49:3<258::aid-ccd7>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  15. Olivari Zoran, Rubartelli Paolo, Piscione Federico, Ettori Federica, Fontanelli Alessandro, Salemme Luigi, Giachero Corinna, Di Mario Carlo, Gabrielli Gabriele, Spedicato Leonardo. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE). J Am Coll Cardiol. 2003 May 21;41(10):1672–1678. doi: 10.1016/s0735-1097(03)00312-7. [DOI] [PubMed] [Google Scholar]
  16. Puma J. A., Sketch M. H., Jr, Tcheng J. E., Harrington R. A., Phillips H. R., Stack R. S., Califf R. M. Percutaneous revascularization of chronic coronary occlusions: an overview. J Am Coll Cardiol. 1995 Jul;26(1):1–11. doi: 10.1016/0735-1097(95)00156-t. [DOI] [PubMed] [Google Scholar]
  17. Rubartelli P., Niccoli L., Verna E., Giachero C., Zimarino M., Fontanelli A., Vassanelli C., Campolo L., Martuscelli E., Tommasini G. Stent implantation versus balloon angioplasty in chronic coronary occlusions: results from the GISSOC trial. Gruppo Italiano di Studio sullo Stent nelle Occlusioni Coronariche. J Am Coll Cardiol. 1998 Jul;32(1):90–96. doi: 10.1016/s0735-1097(98)00193-4. [DOI] [PubMed] [Google Scholar]
  18. Serruys P. W., Hamburger J. N., Koolen J. J., Fajadet J., Haude M., Klues H., Seabra-Gomes R., Corcos T., Hamm C., Pizzuli L. Total occlusion trial with angioplasty by using laser guidewire. The TOTAL trial. Eur Heart J. 2000 Nov;21(21):1797–1805. doi: 10.1053/euhj.2000.2263. [DOI] [PubMed] [Google Scholar]
  19. Serruys P. W., Umans V., Heyndrickx G. R., van den Brand M., de Feyter P. J., Wijns W., Jaski B., Hugenholtz P. G. Elective PTCA of totally occluded coronary arteries not associated with acute myocardial infarction; short-term and long-term results. Eur Heart J. 1985 Jan;6(1):2–12. doi: 10.1093/oxfordjournals.eurheartj.a061750. [DOI] [PubMed] [Google Scholar]
  20. Sheiban Imad, Moretti Claudio, Kumar Prathap, Gagnor Andrea, Leonardo Filippo, Montaldo Tiziana, Marra Walter Grosso, Omede Pierluigi, Trevi Gianpaolo. Immediate and medium-term outcomes following the treatment of very long (> or =50 mm) chronic total coronary artery occlusions. J Invasive Cardiol. 2004 Jan;16(1):5–9. [PubMed] [Google Scholar]
  21. Sirnes P. A., Golf S., Myreng Y., Mølstad P., Emanuelsson H., Albertsson P., Brekke M., Mangschau A., Endresen K., Kjekshus J. Stenting in Chronic Coronary Occlusion (SICCO): a randomized, controlled trial of adding stent implantation after successful angioplasty. J Am Coll Cardiol. 1996 Nov 15;28(6):1444–1451. doi: 10.1016/s0735-1097(96)00349-x. [DOI] [PubMed] [Google Scholar]
  22. Sirnes P. A., Myreng Y., Mølstad P., Bonarjee V., Golf S. Improvement in left ventricular ejection fraction and wall motion after successful recanalization of chronic coronary occlusions. Eur Heart J. 1998 Feb;19(2):273–281. doi: 10.1053/euhj.1997.0617. [DOI] [PubMed] [Google Scholar]
  23. Strauss Bradley H., Goldman Lorne, Qiang Beiping, Nili Nafiseh, Segev Amit, Butany Jagdish, Sparkes John D., Jackson Zane S., Eskandarian Mohammad R., Virmani Renu. Collagenase plaque digestion for facilitating guide wire crossing in chronic total occlusions. Circulation. 2003 Aug 25;108(10):1259–1262. doi: 10.1161/01.CIR.0000086320.24172.A1. [DOI] [PubMed] [Google Scholar]
  24. Suero J. A., Marso S. P., Jones P. G., Laster S. B., Huber K. C., Giorgi L. V., Johnson W. L., Rutherford B. D. 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. J Am Coll Cardiol. 2001 Aug;38(2):409–414. doi: 10.1016/s0735-1097(01)01349-3. [DOI] [PubMed] [Google Scholar]
  25. Tadros Peter. Successful revascularization of a long chronic total occlusion of the right coronary artery utilizing the frontrunner X39 CTO catheter system. J Invasive Cardiol. 2003 Nov;15(11):3–p.. [PubMed] [Google Scholar]

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