tailieunhanh - Ebook Manual of coronary chronic total occlusion interventions: Part 2

(BQ) Part 2 book "Manual of coronary chronic total occlusion interventions" presentation of content: The retrograde approach, radiation management during CTO PCI, stenting of CTO lesions, complications, how to build a successful CTO program,. | 6 The Retrograde Approach Historical Perspective The retrograde technique differs from the standard antegrade approach in that the occlusion is approached from the distal vessel advancing a wire against the original direction of blood flow, ., The guidewire is advanced into the artery distal to the occlusion through either a bypass graft or a collateral channel. This approach differs from the antegrade approach, in which all equipment is inserted only proximal to the occlusion and travels in the same direction as the original arterial flow, ., antegrade. The retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) technique was first described in 1990 by Kahn and Hartzler, who performed balloon angioplasty of a left anterior descending artery (LAD) CTO via a saphenous vein graft (SVG).3 In 1996, Silvestri et al. reported retrograde stenting of the left main artery via a In 2006, Surmely et al. reported for the first time retrograde crossing via septal collaterals,5 starting the modern era of the retrograde techniques through septal5À10 and epicardial11 collaterals and arterial bypass The introduction of specialized equipment and further refinements of the technique started in Japan12,13 with rapid adoption both in Europe14À16 and in the United Advantages of the Retrograde Approach Crossing in the retrograde direction can sometimes be easier than antegrade crossing because the distal cap: a. Is easier to enter than the proximal cap, as it is more frequently tapered. b. Is often softer than the proximal cap, likely because of exposure to lower filling pressure. c. Is less frequently anatomically ambiguous. Moreover, the antegrade approach may not be feasible in some CTOs, ., ostial and stumpless CTOs, CTOs with ambiguous proximal cap, or long and tortuous CTOs. Special Equipment In addition to the standard equipment needed for the antegrade approach, the retrograde .