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Chronic Total Occlusions

A Guide to Recanalization

Third Edition

 

Ron Waksman

Section of Interventional Cardiology MedStar Washington Hospital Center Washington, DC, USA

Shigeru Saito

Heart Center, Cardiology & Catheterization Laboratories Shonan Kamakura General Hospital Kamakura City, Japan

Edition History

1e, 2006; 2e, 2011 by John Wiley & Sons Ltd

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.

The right of Ron Waksman and Shigeru Saito to be identified as the authors of the editorial material in this work has been asserted in accordance with law.

Registered Offices

John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.

Wiley also publishes its books in a variety of electronic formats and by print-on-demand. Some content that appears in standard print versions of this book may not be available in other formats.

Trademarks: Wiley and the Wiley logo are trademarks or registered trademarks of John Wiley & Sons, Inc. and/or its affiliates in the United States and other countries and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc. is not associated with any product or vendor mentioned in this book.

Limit of Liability/Disclaimer of Warranty

The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Library of Congress Cataloging-in-Publication Data

Names: Waksman, Ron, 1952 - editor. | Saito, Shigeru, 1950 - editor. Title: Chronic total occlusions : A Guide to Recanalization / edited by Ron Waksman, MedStar

Washington Hospital Center, Washington, DC, USA, Shigeru Saito, Shonan Kamakura General Hospital, Kamakura City, Japan.

Description: Third edition. | Hoboken, NJ : Wiley-Blackwell, 2024. | Includes bibliographical

references and index.

Identifiers: LCCN 2023021444 (print) | LCCN 2023021445 (ebook) | ISBN 9781119517276 (hardback) |

eng/20230605 LC record available at https://lccn.loc.gov/2023021444 LC ebook record available at https://lccn.loc.gov/2023021445

Cover Images: © AYImages/Getty Images; Daria Serdtseva/Shutterstock; anek.soowannaphoom/Shutterstock; Arctic-Images/Getty Images Cover Design: Wiley

Set in 9/11.5pt Minion by Integra Software Services Pvt. Ltd, Pondicherry, India

Contents

List of Contributors, vii

Foreword, x

Preface, xii

Part I Pathology, Indications, and Review of Clinical Trials

1 The Pathobiology of CTO, 3

Gabby Elbaz-Greener & Bradley H. Strauss

2 Pathology of Chronic Total Occlusions:

Implications for Revascularization, 10

Takao Konishi, Ji Eun Park, Diljon S. Chahal & Aloke V. Finn

3 Indications and Guidelines of PCI for CTO, 19

Ilan Merdler, Gabriel Maluenda & Ron Waksman

Part II Imaging

4 CT Angiography: Application in Chronic Total

Occlusions, 29

Hidehiko Hara, John R. Lesser, Nicholas Burke & Robert S. Schwartz

5 IVUS-Guided Recanalization of CTO, 35

Etsuo Tsuchikane

8 Tornus Catheter, 64

Hideaki Kaneda

9 Microcatheters: Characteristics and Use, 69

John D. Hung & James C. Spratt

Part IV Wires Technique

10 CTO Wires: Engineering 101 and Principles of

Wire Manipulation, 83

Rahul Kurup & Luiz Fernando Ybarra

11 Use of Two Wires in the Treatment of CTO, 101

Thierry Lefèvre & Thomas Hovasse

12 Parallel-Wire Techniques, 109

Sudhir Rathore & Takahiko Suzuki

13 Transradial Approach for CTO Lesions, 115

Yutaka Tanaka & Shigeru Saito

14 Subintimal Angioplasty in Coronary CTO, 121

Negar Salehi, Philippe Généreux & George D. Dangas

15 Antegrade Dissection and Re-Entry

Techniques, 129

Anbukarasi Maran, Carson Keck & Matthew C. Evans

6 Optical Coherence Tomography to Guide the

Treatment of Chronic Total Occlusions, 39

Francesca Maria Di Muro, Giulia Nardi, Niccolò Ciardetti, Selcuk Kucukseymen, Alessio Mattesini & Carlo Di Mario

Part III Wires Technology

7 New Coronary Guidewire Technology in Chronic

Total Occlusion Percutaneous Coronary Interventions, 49

Salman Allana & Emmanouil S. Brilakis

16 3D Wiring Methods in CTO PCI, 135

Atsunori Okamura

17 Antegrade Fenestration and Re-Entry: An

Alternative Approach to Antegrade Dissection and Re-Entry, 156

Lorenzo Azzalini & Mauro Carlino

18 Retrograde CTO PCI: Step by Step, 166

Michael Megaly & Ashish Pershad

19 Retrograde CTO Intervention via Vein Grafts, 172

Pavan Reddy & Nelson L. Bernardo

vi Contents

20 Tips and Tricks of the CART and Reverse

CART Technique, 177

Arber Kodra, Chad Kliger, Apurva Patel, Craig Basman, Tak Kwan & Michael Kim

21 Debulking of CTO, 181

Etsuo Tsuchikane

22 Laser Revascularization in Coronary CTO, 186

On Topaz

23 How to Handle Subintimal Dissections, 203

Pratik B. Sandesara & William J. Nicholson

24 CTO: How to Minimize Contrast-Associated

Acute Kidney Injury, 218

Luis Gruberg

25 Mechanical Support for CTO, 232

Khaldoon Alaswad, Asaad Nakhle, Ankur Gupta, Katherine J. Kunkel & Mir Babar Basir

26 Stent Grafts to Seal Coronary Perforation, 246

Jasleen Tiwana & Kathleen E. Kearney

27 Complications During Retrograde Approach

for CTO, 250

Yutaka Tanaka & Shigeru Saito

Part V Interesting Cases

28 Interesting Cases I–V, 257

Yutaka Tanaka & Shigeru Saito

Index, 263

List of Contributors

Khaldoon Alaswad, MD, FACC, FSCAI

Henry Ford Hospital & Health System, Detroit, MI, USA Wayne State University, Michigan, USA

Salman Allana, MD

Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis, MN, USA

Lorenzo Azzalini, MD, PhD, MSc

Division of Cardiology Department of Medicine, University of Washington Seattle, WA, USA

Mir Babar Basir, DO, FACC, FSCAI

Henry Ford Hospital Detroit, MI, USA

Craig Basman, MD

Department of Cardiology, Lenox Hill Hospital New York, NY, USA

Nelson L. Bernardo, MD

Section of Interventional Cardiology MedStar Washington Hospital Center Washington, DC, USA

Emmanouil S. Brilakis, MD, PhD

Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis, MN, USA

Nicholas Burke, MD

Minneapolis Heart Institute and Foundation Minneapolis, MN, USA

Mauro Carlino, MD, PhD, MSc

Division of Interventional Cardiology Cardio-Thoracic-Vascular Department San Raffaele Scientific Institute Milan, Italy

Niccolò Ciardetti, MD

Structural Interventional Cardiology Department of Clinical and Experimental Medicine Careggi University Hospital, Italy

George D. Dangas, MD, PhD

Mount Sinai Medical Center, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA

Gabby Elbaz-Greener, MD

Department of Cardiology, Hadassah Medical Center & The Faculty of Medicine, Hebrew University of Jerusalem Jerusalem, Israel

Matthew C. Evans, MD

Medical University of South Carolina Charleston, SC, USA

Aloke V. Finn, MD

CVPath Institute, Gaithersburg, MD, USA; University of Maryland School of Medicine Baltimore, MD, USA

Philippe Généreux, MD

Cardiovascular Research Foundation New York, NY, USA

Luis Gruberg, MD, FACC

Mather Hospital Donald and Barbara Zucker School of Medicine New York, NY, USA

Ankur Gupta, MD, PhD

Piedmont Heart Institute Atlanta, GA, USA

Hidehiko Hara, MD

Minneapolis Heart Institute and Foundation Minneapolis, MN, USA

Thomas Hovasse, MD

Institut Cardiovasculaire Paris Sud (ICPS) Massy, France

Diljon S. Chahal, MD

University of Maryland School of Medicine Baltimore, MD, USA

John D. Hung, MBChB, PhD, MRCP

Consultant Cardiologist, Liverpool Heart and Chest Hospital Liverpool University Foundation Trust, UK

vii

viii List of Contributors

Hideaki Kaneda, MD, PhD

Okinaka Memorial Institute for Medical Research Toky o, Ja pan

Kathleen E. Kearney, MD

University of Washington Medical Center Seattle, WA, USA

Carson Keck, MD

Medical University of South Carolina Charleston, SC, USA

Michael Kim, MD

Department of Cardiology, Lenox Hill Hospital New York, NY, USA

Chad Kliger, MD

Lenox Hill Hospital/Northwell Health Hofstra School of Medicine, New York, NY, USA

Arber Kodra, MD

Department of Cardiology, Lenox Hill Hospital New York, NY, USA

Takao Konishi, MD

CVPath Institute, Gaithersburg, MD, USA

Selcuk Kucukseymen, MD

Structural Interventional Cardiology Department of Clinical and Experimental Medicine Careggi University Hospital, Italy

Anbukarasi Maran, MD

Medical University of South Carolina Charleston, SC, USA

Carlo Di Mario, MD, PhD, FESC, FACC,

FSCAI, FRCP

Structural Interventional Cardiology, Department of Clinical and Experimental Medicine Careggi University Hospital, Italy

Francesca Maria Di Muro, MD

Structural Interventional Cardiology, Department of Clinical and Experimental Medicine Careggi University Hospital, Italy

Alessio Mattesini, MD

Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Italy

Michael Megaly, MD, MS

Willis Knighton Heart Institute, Shreveport, LA, USA

Ilan Merdler, MD, MHA

MedStar Washington Hospital Center Washington, DC, USA

Asaad Nakhle, MD

Henry Ford Hospital Detroit, MI, USA

Katherine J. Kunkel, MD

HonorHealth Scottsdale Shea Medical Center Scottsdale, AZ, USA

Rahul Kurup, MD, PhD

South West Sydney Local Health District (Campbelltown and Liverpool Hospitals) and Sydney Medical School University of Sydney, NSW, Australia

Tak Kwan, MD

Department of Cardiology, Lenox Hill Hospital New York, NY, USA

Thierry Lefèvre, MD, FESC, FSCAI

Institut Cardiovasculaire Paris Sud (ICPS) Massy, France

John R. Lesser, MD

Minneapolis Heart Institute and Foundation Minneapolis, MN, USA

Gabriel Maluenda, MD

MedStar Washington Hospital Center Washington, DC, USA

Giulia Nardi, MD

Structural Interventional Cardiology Department of Clinical and Experimental Medicine Careggi University Hospital, Florence, Italy

William J. Nicholson, MD

Emory Heart and Vascular Center, Division of Cardiology Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

Atsunori Okamura, MD

Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan

Ji Eun Park, MD

University of Maryland School of Medicine Baltimore, MD, USA

Apurva Patel, MD

Department of Cardiology, Lenox Hill Hospital New York, NY, USA

Ashish Pershad, MD, MS

Department of Interventional Cardiology Chandler Regional Medical Center, Gilbert, AZ, USA

List of Contributors ix

Sudhir Rathore, MD

Frimley Health NHS Foundation Trust Surrey, UK

Pavan Reddy, MD

Section of Interventional Cardiology MedStar Washington Hospital Center Washington, DC, USA

Shigeru Saito, MD, FACC, FSCAI, FJCC

Heart Center, Cardiology & Catheterization Laboratories Shonan Kamakura General Hospital Kamakura city, Japan

Negar Salehi, MD

Mount Sinai Medical Center New York, NY, USA

Pratik B. Sandesara, MD

Emory Heart and Vascular Center, Division of Cardiology Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

Robert S. Schwartz, MD

Minneapolis Heart Institute and Foundation Minneapolis, MN, USA

James C. Spratt, MD, PhD

Consultant Cardiologist, Professor of Interventional Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK

Bradley H. Strauss, MD, PhD

Schulich Heart Centre, Sunnybrook Health Sciences Centre University of Toronto, Toronto, ON, Canada

Takahiko Suzuki, MD

Toyohashi Heart Centre, Toyohashi, Japan

Yutaka Tanaka, MD, PhD

Shonan Kamakura General Hospital, Kamakura City, Japan

Jasleen Tiwana, MD

University of Washington Medical Center Seattle, WA, USA

On Topaz, MD, FACC, FACP, FSCAI

Professor of Medicine, Duke University School of Medicine Durham, NC, USA

Etsuo Tsuchikane, MD, PhD

Toyohashi Heart Center, Toyohashi, Japan

Ron Waksman, MD, FACC

Section of Interventional Cardiology MedStar Washington Hospital Center Washington, DC, USA

Luiz Fernando Ybarra, MD

London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, ON Canada

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