Chronic Total Occlusions: A Guide to Recanalization

307 Pages·2013·9.882 MB·English

Chronic Total
Occlusions
Chronic Total
Occlusions
A Guide to
Recanalization
Second Edition
EDITED BY
Ron Waksman,
MD, FACC
Division of Cardiology
MedStar Washington Hospital Center
Washington, DC
USA
Shigeru Saito,
MD, FACC, FSCAI, FJCC
Cardiology & Catheterization Laboratories
Shonan Kamakura General Hospital
Kamakura
Japan
A John Wiley & Sons, Ltd., Publication
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Library of Congress Cataloging-in-Publication Data
Chronic total occlusions : a guide to recanalization / edited by Ron Waksman, Shigeru Saito. – 2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-470-65854-3 (hardback : alk. paper)
I. Waksman, Ron. II. Saito, Shigeru, 1950, Feb. 15–
[DNLM: 1. Chronic Disease. 2. Coronary Occlusion. 3. Angioplasty, Balloon, Coronary–
methods. 4. Arterial Occlusive Diseases. 5. Coronary Angiography–methods. WG 300]
617.4′13–dc23
2012032888
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may
not be available in electronic books.
Cover image: Courtesy of the editors
Cover design by Meaden Creative
Set in 9/11.5pt Minion by SPi Publisher Services, Pondicherry, India
1 2013
Contents
List of Contributors, vii 10 IVUS evaluation of CTO, 78
Akiko Maehara, Masahiko Ochiai &
Foreword, xi
Gary S. Mintz
Preface, xii
11 Magnetic navigation wire, 85
Steve Ramcharitar & Patrick Serruys
Part I Pathology, Indications, and
Review of Clinical Trials
Part III Wires Technology
1 The pathobiology of CTO, 3
12 Deflecting wire systems, 93
Sergey Yalonetsky, Azriel B. Osherov &
Bradley H. Strauss Mirko Schiemann
13 Asahi wires, 97
2 Collateral circulation in CTO, 9
Shigeru Saito
Alfredo R. Galassi, S.D. Tomasello & Hazem Khamis
14 IVUS-guided recanalization of
3 CTO: review of trials, 18
CTO, 105
Tina L. Pinto Slottow & Ron Waksman
Etsuo Tsuchikane
4 CTO-percutaneous coronary intervention:
15 Frontrunner CTO technology, 109
what is the evidence?, 26
Chad Kliger, Steven P. Sedlis &
Gabriel Maluenda, Tina L. Pinto Slottow &
Jeffrey D. Lorin
Ron Waksman
16 Channel dilator: Corsair, 113
5 Case selection and long-term benefits, 33 Masashi Kimura
Imran N. Ahmad, Kamran I. Muhammad &
Patrick L. Whitlow
Part IV Wires Technique
Part II Imaging 17 Tornus catheter, 121
Hideaki Kaneda
6 CT angiography: application in chronic
total occlusions, 45 18 Antegrade approach: step by step, 126
Hidehiko Hara, John R. Lesser, Nicholas Burke & Nicolaus Reifart
Robert S. Schwartz
19 Use of two wires in the treatment of CTO, 134
Yves Louvard, Thierry Lefèvre &
7 Co-registration CTO and CT angiography, 51
Marie-Claude Morice
Gary M. Idelchik & Ariel Roguin
20 Parallel-wire techniques, 143
8 Optical coherence tomography to guide
Sudhir Rathore & Takahiko Suzuki
the treatment of chronic total occlusions, 60
Nicola Viceconte, Rodrigo Teijeiro-Mestre, 21 Guidewire handling techniques for CTO
Nicolas Foin, Alistair C. Lindsay and lesions, 147
Carlo Di Mario. Shigeru Saito
9 IVUS-guided CTO-PCI, 67 22 Subintimal angioplasty in coronary CTO, 155
Masashi Kimura & Yasushi Asakura Philippe Généreux & George D. Dangas
v
vi Contents
23 Antegrade device assisted re-entry 34 Treatment of chronic total coronary occlusions
techniques, 162 with drug-eluting stents: overview of
Nicolaus Reifart angiographic and clinical outcomes, 240
David E. Kandzari
24 The microchannel technique, 166
Mauro Carlino, Gill L. Buchanan & 35 Laser for CTO recanalization, 251
Cosmo Godino On Topaz
25 The STAR technique, 172 36 The ENABLER-P: a novel CTO crossing
Cosmo Godino, Mauro Carlino & cystem, 257
Antonio Colombo Maurice Buchbinder
26 Attempting CTO after first failed attempt, 178 37 Collagenase plaque digestion for facilitating
Sudhir Rathore & Takahiko Suzuki guidewire crossing, 262
Azriel B. Osherov & Bradley H. Strauss
27 Transradial approach for CTO lesions
and tapered-tip guidewires, 184 38 The BridgePoint re-entry system, 268
Shigeru Saito Imran N. Ahmad, Kamran I. Muhammad &
Patrick L. Whitlow
28 Bilateral approach, 191
Osamu Katoh
Part VI Complications
29 Tips and tricks of the CART technique, 198
Osamu Katoh 39 Complications during the retrograde approach
for CTO, 275
Shigeru Saito
Part V Devices Technology
40 CTO: how to minimize contrast nephropathy, 279
30 Recanalizing total occlusion in the periphery:
Travis J. Bench & Luis Gruberg
utilization of radio frequency and other
technology, 209
Shishir Murarka & Richard Heuser Part VII Interesting Cases
31 High-frequency mechanical 41 Interesting cases I–VI, 291
revascularization, 226 Shigeru Saito
Eberhard Grube & Lutz Buellesfeld
Index, 301
32 Debulking of CTO, 230
Etsuo Tsuchikane
33 Vibrational angioplasty, 235
Lampros K. Michalis
List of Contributors
Imran N. Ahmad, MD Director, Cardiac Cath Lab and Interventional
Interventional Cardiovascular Medicine Fellow Cardiology Unit
Cleveland Clinic Foundation San Raffaele Scientific Institute
Cleveland, OH Milan
USA Italy
Yasushi Asakura, MD Mauro Carlino, MD
Interventional Cardiology Unit
Toyohashi Heart Center
San Raffaele Scientific Institute
Toyohashi
Milan
Japan
Italy
Travis J. Bench, MD George D. Dangas, MD, PhD
Division of Cardiology Professor of Medicine
Stony Brook University Medical Center Director, Cardiovascular Research Foundation;
Stony Brook, NY Mount Sinai Medical Center
USA New York, NY
USA
Gill L. Buchanan, MBChB
Interventional Cardiology Unit Carlo Di Mario, MD, PhD, FESC, FACC,
San Raffaele Scientific Institute FRCP
Milan Royal Brompton Hospital
Italy London
UK
Maurice Buchbinder, MDCM
Professor of Clinical Medicine Nicolas Foin, PhD
Foundation for Cardiovascular Medicine Royal Brompton Hospital
Stanford University London
Stanford, CA UK
USA
Alfredo R. Galassi, MD, FACC, FESC, FSCAI
Lutz Buellesfeld, MD Associate Professor of Cardiology
Department of Medical Sciences and Pediatrics
Department of Cardiology & Angiology
University of Catania;
HELIOS Heart Center
Director of the Catheterization Laboratory and
Siegburg
Cardiovascular Interventional Unit
Germany
Cannizzaro Hospital
Catania, Italy
Nicholas Burke, MD
Minneapolis Heart Institute and Foundation Philippe Généreux, MD
Minneapolis, MN Columbia University Medical Center;
USA Cardiovascular Research Foundation
New York, NY
Antonio Colombo, MD USA
Visiting Professor of Medicine
Columbia University Medical Center Cosmo Godino, MD
New York, NY Interventional Cardiology Unit
USA; San Raffaele Scientific Institute;
Director, Cardiac Cath Lab EMO-GVM Centro Cuore Columbus
EMO GVM Centro Cuore Columbus; Milan
Italy
vii
viii List of Contributors
Eberhard Grube, MD Department of Cardiology
Department of Cardiology & Angiology Toyohashi Heart Center
HELIOS Heart Center Toyohashi
Siegburg Japan
Germany
Chad Kliger, MD
Luis Gruberg, MD, FACC New York University School of Medicine;
Professor of Medicine New York Harbor Healthcare System
Division of Cardiology New York, NY
Stony Brook University Medical Center USA
Stony Brook, NY
USA
Thierry Lefèvre, MD, FESC, FSCAI
Institut Cardiovasculaire Paris Sud
Hidehiko Hara, MD
Massy
Minneapolis Heart Institute and Foundation
France
Minneapolis, MN
USA
John R. Lesser, MD
Richard Heuser, MD, FACC, FACP, FESC, Minneapolis Heart Institute and Foundation
Minneapolis, MN
FSCAI
USA
St. Luke’s Medical Center;
University of Arizona College of Medicine
Phoenix, AZ Alistair C. Lindsay, MBChB, MRCP,
USA MBA, DPhiL
Royal Brompton Hospital
Gary M. Idelchik, MD London
Interventional Cardiology UK
Trinity Clinic Cardiology
Tyler, TX
USA Jeffrey D. Lorin, MD, FACC
New York University School of Medicine;
New York Harbor Healthcare System
David E. Kandzari, MD, FACC, FSCAI
New York, NY
Director, Interventional Cardiology and
USA
Chief Scientific Officer
Piedmont Heart Institute
Atlanta, GA Yves Louvard, MD, FSCAI
USA Institut Cardiovasculaire Paris Sud
Massy
Hideaki Kaneda, MD, PhD France
Cardiology and Catheterization Laboratories
Shonan Kamakura General Hospital Akiko Maehara, MD
Kanagawa Director, Intravascular Imaging Core Laboratory
Japan Cardiovascular Research Foundation;
Assistant Professor
Osamu Katoh, MD Columbia University Medical Center
Toyohashi Heart Center New York, NY
Toyohashi USA
Japan
Hazem Khamis, MD, FACC Gabriel Maluenda, MD
Division of Cardiology
Professor of Cardiology and Head of Cathlab Department
MedStar Washington Hospital Center
Wadi Elnile Hospital
Washington, DC
October 6th University
USA
Cairo
Egypt
Lampros K. Michalis, MD, MRCP, FESC
Masashi Kimura, MD, PhD Medical School
Cardiovascular Research Foundation; University of Ioannina
Columbia University Medical Center Ioannina
New York, NY Greece
USA;
List of Contributors ix
Gary S. Mintz, MD Ariel Roguin, MD, PhD
Chief Medical Officer Director, Division of Interventional Cardiology
Cardiovascular Research Foundation Rambam Medical Center;
New York, NY Bruce Rappaport Faculty of Medicine
USA Technion - Israel Institute of Technology
Haifa, Israel
Marie-Claude Morice, MD,
FACC, FESC Shigeru Saito, MD, FACC, FSCAI, FJCC
Institut Cardiovasculaire Paris Sud Cardiology & Catheterization Laboratories
Massy Shonan Kamakura General Hospital
France Kamakura
Japan
Kamran I. Muhammad, MD
Interventional Cardiovascular Medicine Fellow Mirko Schiemann, MD
Cleveland Clinic Foundation University Hospital Frankfurt
Cleveland, OH Frankfurt
USA Germany
Shishir Murarka, MD Robert S. Schwartz, MD
St. Luke’s Medical Center;
Minneapolis Heart Institute and Foundation
University of Arizona College of Medicine
Minneapolis, MN
Phoenix, AZ
USA
USA
Steven P. Sedlis, MD, FACC, FSCAI
Masahiko Ochiai, MD
New York University School of Medicine
Professor
New York, NY
Showa University Northern Yokohama Hospital
USA
Yokohama
Japan
Patrick Serruys, MD, PHD
Azriel B. Osherov, MD The Thoraxcenter
Schulich Heart Centre Erasmus Medical Center
Sunnybrook Health Sciences Centre Rotterdam
University of Toronto The Netherlands
Toronto, ON
Canada Tina L. Pinto Slottow, MD
Division of Cardiology
Steve Ramcharitar, BMBCh, DPhil MedStar Washington Hospital Center
The Thoraxcenter Washington, DC
Erasmus Medical Center USA
Rotterdam
The Netherlands
Bradley H. Strauss, MD, PhD
Schulich Heart Centre
Sudhir Rathore, MD Sunnybrook Health Sciences Centre
St George’s Hospital NHS Trust University of Toronto
London Toronto, ON
UK Canada;
The Heart Institute
Nicolaus Reifart, MD, PhD, FESC, FACC, Chaim Sheba Medical Center
Tel Hashomer
RANS
Israel
Main Taunus Kliniken
Bad Soden;
Professor of Medicine Takahiko Suzuki, MD
Johann Wolfgang Goethe University Toyohashi Heart Center
Frankfurt Toyohashi
Germany Japan
x List of Contributors
Rodrigo Teijeiro-Mestre, MD Department of Cardiology
Royal Brompton Hospital Toyohashi Heart Center
London Toyohashi
UK Japan
Ron Waksman, MD, FACC
S.D. Tomasello, MD
Division of Cardiology
Department of Medical Sciences and Pediatrics MedStar Washington Hospital Center
Catheterization Laboratory and Washington, DC
Cardiovascular Interventional Unit USA
Cannizzaro Hospital
Catania
Patrick L. Whitlow, MD
Italy
Interventional Cardiovascular Medicine Staff
Cleveland Clinic Foundation
On Topaz, MD Cleveland, OH
Professor of Medicine USA
Charles George Veterans Affairs Medical Center
Asheville, NC; Nicola Viceconte, PhD
Duke University School of Medicine
Royal Brompton Hospital
Durham, NC
London
USA
UK
Etsuo Tsuchikane, MD, PhD Sergey Yalonetsky, MD
Cardiovascular Research Foundation; Schulich Heart Centre
Columbia University Medical Center Sunnybrook Health Sciences Centre
New York, NY University of Toronto
USA; Toronto, ON
Canada
Foreword
Many years ago I was chairing a symposium at the percutaneous coronary intervention and is a primary
American Heart Association annual Scientific reason for surgical referral of these patients.
Sessions during which a paper on chronic total occlu- The first edition of Chronic Total Occlusion: A
sions was presented by colleagues from Japan, some of Guide to Recanalization brought together an impres-
whom are authors of this book. The audience was sive group of “thinkers and tinkerers” from around
stunned by the report that 90% of attempted chronic the world to address this challenging condition.
total occlusions were actually recanalized by this Now, four years later, Drs. Waksman and Saito, and
group. The reaction could be best described as incred- the highly experienced authors they have recruited,
ulous. I confess that my reaction must not have been have brought the knowledge base of this technology
very different since my colleague, John Douglas, and I up to date. The advances have necessitated a signifi-
had been working alongside our partner, Andreas cant increase in the number of chapters to now
Gruentzig – who was a pretty competent interven- include the radial artery approach and several novel
tionalist – and our success rate was just over two- techniques.
thirds of CTOs attempted. Perhaps in response to the As the limitations of percutaneous coronary inter-
perceived reaction of the audience, these Japanese col- vention using current technology become clear from
leagues invited me to a small live case demonstration the SYNTAX trial and other observations, it is even
course in Japan. As I recall, 10 cases of chronic total more interesting to contemplate the future of the less
occlusion were attempted and nine were successful, invasive approach. The solutions to chronic total
convincing me that a 90% success rate was not unat- occlusion, not only in the hands of expert operators,
tainable. Since then, chronic total occlusion revascu- but widely applied will be pivotal in charting the
larization has developed into what borders on a direction of coronary intervention in the years to
specialty unto itself. Some operators have taken on come. This second edition will be of great value to
these cases as a special interest, even while many those who strive to influence that course.
interventionalists around the world continue to avoid
Spencer B. King, III, MD, MACC, FESC
dealing with this difficult subset. The debate over the
Emeritus Professor of Medicine
clinical relevance of chronic total occlusions has
Emory University School of Medicine;
evolved from an attitude of indifference to one of
President
recognition that many of these patients are highly
Saint Joseph’s Heart & Vascular Institute
ischemic and restoration of perfusion is beneficial.
Atlanta, GA
Indeed chronic total occlusion is the main feature
USA
that  results in incomplete revascularization with
xi