The Role of Antegrade Techniques in Current Practice of Percutaneous Coronary Interventions for Chronic Total Occlusions
Tajti Péter1,2, Ungi Imre1
1Szegedi Tudományegyetem, Invazív Kardiológiai Részleg, II. Sz. Belgyógyászati Klinika és Kardiológiai Központ, Szeged
2Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, Egyesült Államok
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been rapidly evolving with high success and acceptable complication rates currently being achieved at dedicated high-volume centers. Successful CTO PCI in appropriately selected patients can provide significant clinical benefits, however crossing the occlusion with a guidewire can be challenging. The following techniques can be used for CTO crossing: antegrade wire escalation, antegrade dissection/re-entry and the retrograde approach. Antegrade wire escalation remains the most frequently used technique and is the most common final successful technique, especially in less complex CTOs. Antegrade dissection re-entry and the retrograde approach are more technically demanding, but are often necessary to achieve crossing, in complex CTOs. In this manuscript, we provide a comprehensive overview of antegrade wire crossing of coronary CTOs.