z-logo
Premium
An algorithmic approach for the management of ostial right coronary artery chronic total occlusions
Author(s) -
Avran Alexandre,
Boukhris Marouane,
Drogoul Laurent,
Brilakis Emanouil S
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27603
Subject(s) - medicine , ostium , catheter , dissection (medical) , surgery , lumen (anatomy) , right coronary artery , radiology , cardiology , coronary angiography , myocardial infarction
Treatment of ostial chronic total occlusions (CTOs) of the right coronary artery (RCA) can be challenging. We present an algorithmic approach to the management of such lesions that incorporates all contemporary equipment and techniques. If the RCA ostium can be engaged with a guide catheter then antegrade crossing attempts should be performed. If the antegrade guidewire enters the subintimal space, re‐entry into the distal true lumen is performed provided that the antegrade guide catheter provides enough support. If re‐entry cannot be achieved, the antegrade wire is left in place to facilitate retrograde recanalization attempts (usually performed using the reverse controlled antegrade and retrograde tracking and dissection—reverse CART—technique). If the RCA ostium cannot be engaged with a guide catheter (for example in flush ostial occlusions) or if the guide catheter does not provide sufficient support, a primary retrograde approach is required, aiming for retrograde guidewire puncture into the aorta, followed by snaring and externalization. Retrograde guidewire puncture can be challenging, requiring use of stiff, highly penetrating guidewires or occasionally use of the Carlino technique. The aforementioned algorithm can facilitate crossing of ostial RCA CTOs.

This content is not available in your region!

Continue researching here.

Having issues? You can contact us here