Chronic Total Occlusion.
Enviado por augustin_60 • 8 de Febrero de 2017 • Síntesis • 4.961 Palabras (20 Páginas) • 152 Visitas
Training of Acrostak
number the figures (Fig.1)
[pic 2]
This is for private use only[1].
Table of contents
Table of contents 2
I. What is a CTO 4
A. Types of CTO 5
True total occlusion / Functional total occlusion 5
Old / young CTO 5
B. Formation of a CTO 5
II. Who can have a CTO 7
III. How to treat a CTO 7
A. Who can do a CTO 7
B. Factors for the success of a CTO recanalization 7
C. Steps for CTO recanalization 9
D. Which products to use? 11
The guiding catheter 11
The guidewire 13
E. Stent implantation 15
F. Dual antiplatelet therapy 15
IV. Techniques of revascularization 16
A. Antegrade approach 16
The parallel wire technique 17
The see-saw technique 18
The STAR technique 18
The Microchannel technique 18
B. Retrograde approach 19
The kissing wire technique 21
The landmark retrograde technique 21
The Knuckle technique 22
The CART (Controlled Antegrade and Retrograde subintimal Tracking) technique 22
The reverse CART technique 22
V. Benefits of a CTO revascularization 23
A. Treatment of CTOs 23
B. Benefits of the treatment 24
VI. To go further 26
VII. FAQ 26
A. General objections 26
B. Acrostak product objection 28
Across CTO ST 28
Across HP 29
What is a CTO
CTO stands for Chronic Total Occlusion and it refers to the arteries.
Chronic total occlusion means a total or almost total occlusion of the artery by atherosclerosis, a progressive disease characterized by the accumulation of lipids and fibrous elements in the large arteries.
It is usually defined by more than 3-month-old obstruction of a native[2] coronary artery. The picture below shows a Chronic Total Occlusion seen on an angiography.
[pic 3]
Image: Incathlab
CTOs are often considered as the most complicated lesion because of the inability to cross or dilate it and to its high incidence of restenosis and reocclusion after the treatment.” It is hard to enter in these lesions because the concentration of fibrous tissue is higher at the proximal and distal part of the lesion. This blocks the entry or progression of the wire, and can deflect it in the artery’s wall.
Without any blood passing through the artery, the occluded artery can’t be seen during the angiography –unless using dual injection views -. It is then difficult for the operator to visualize where the artery goes.
Types of CTO
We can differentiate CTO depending on their nature:
True total occlusion / Functional total occlusion
True total occlusion is when the artery is totally blocked and no blood flow pass.
Functional total occlusion is an occlusion with still blood flow penetrating but considered as minimal.
Or we can differentiate them depending on their age:
Old / young CTO
The composition of a CTO depends on how long ago it was formed.
Occlusion formed more than a year are considered old occlusions. They have a high concentration of hard material like fibrocalcific (fibrous tissue + calcification) material, which makes it hard to cross.
Occlusion formed less than year are softer and easier to cross and are considered young occlusions.
Formation of a CTO
There are two types of formation of CTO:
- Development of acute occlusion due to a plaque rupture with a large accumulation of old thrombus.
[pic 4]
Image: http://whatcardiologyis.com/
- Progression of a high degree stenosis and sometimes layers of thrombi.
[pic 5]
Image: http://whatcardiologyis.com/
Who can have a CTO
The real prevalence of a CTO in the population is unknown. It is difficult to evaluate because there is a certain proportion of patients with CTO never undergoing any diagnostic because they are asymptomatic or with very few symptoms. The prevalence to have a CTO is however increasing with advancing patient age.
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