Chronic Total Occlusions by Ron Waksman, Shigeru Saito

By Ron Waksman, Shigeru Saito

Persistent overall occlusions (CTO) are universal, and located in nearly one 3rd of sufferers with major coronary artery ailment who endure angiography. during the last twenty years, CTO lesions have represented the main tough anatomy for remedy — with reduce luck premiums and better difficulty rates.Chronic overall Occlusions offers interventionalists perception into the area of CTOs with introductory chapters that describe the pathology and symptoms of CTOs in addition to a overview of medical trials. Imaging modalities together with CT angiography, magnetic navigation cord, and IVUS guided recanalization of CTO also are brought, including details on new wires know-how and units for CTOs.With quite a few illustrations of those units, applied sciences, and methods to enhance the CTO luck cost, this scientific advisor, headed up through Ron Waksman, will end up to be the precise spouse for interventional cardiologists and cardiac surgeons who're required to accomplish angioplasty and coronary stenting.

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Since the first generation of MSCT scanners were introduced in 2000, CT imaging has been made rapid advances. Modern scanners obtain 64 or more slices in one gantry rotation, and the temporal resolution has significantly decreased. Evidence for the utility of CT in coronary artery disease has accumulated over the years, and recent studies show its high quantitative and qualitative diagnostic accuracy when compared against quantitative coronary angiography [2]. It also has the potential for coronary plaque characterization in the proximal coronary system, perhaps comparable to intravascular ultrasound [9].

1). Coronary artery bypass grafting A series of 44 patients with attempted CTO angioplasty had a 59% success rate. 04) whose CTO could not be recanalized underwent CABG by 31-month follow-up [2]. 0001) [8]. Among 100 CTO in patients with Canadian Cardiovascular Society (CCS) angina class III or IV despite medical therapy, 47 were successfully recanalized, and only 7 (15%) of these patients went on to undergo CABG. Among the 45 patients who had unsuccessful, uncomplicated procedures, 16 (36%) surgeries were required and among the 8 patients with complicated procedures, 3 (38%) required CABG [7].

J Am Coll Cardiol 2003; 41: 1672–1678. 8 Höher M, Wöhrle J, Grebe OC et al. A randomized trial of elective stenting after balloon recanalization of chronic total occlusions. J Am Coll Cardiol 1999; 34: 722–729. 9 Rubartelli P, Verna E, Niccoli L et al. Coronary stent implantation is superior to balloon angioplasty for chronic coronary occlusions: six-year clinical follow-up of the GISSOC trial. J Am Coll Cardiol 2003; 41: 1488–1492. 10 Buller CE, Dzavik V, Carere RG et al. Primary stenting versus balloon angioplasty in occluded coronary arteries: the Total Occlusion Study of Canada (TOSCA).

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