Interventional treatment strategy for CTO lesions, three key steps must be mastered!

Model:2D PCI model(PCI-21)

Chronic Total Occlusion (CTO) lesions refer to coronary artery lesions with complete vascular occlusion, positive TIMI blood flow of 0 and occlusion time of more than 3 months, or the presence of ipsilateral collateral vessels. Even if the TIMI blood flow of the occluded distal vessel is greater than 0, it is still considered a CTO lesion. Compared with other lesions, CTO lesions have a lower surgical success rate and a higher complication rate. Therefore, the choice of interventional treatment strategy is very important.

Step 1 Detailed preoperative evaluation

Whether to perform PCI treatment on CTO lesions requires weighing the benefits of opening and potential short-term and long-term risks. Short-term risks include emergency bypass, coronary artery perforation, perioperative myocardial infarction, acute renal failure, vascular access-related complications and stroke. Long-term risks include in-stent restenosis, stent thrombosis, skin damage caused by prolonged radiation exposure, etc. Only when the benefits outweigh the risks is it necessary to open the CTO.

Step 2: Formulation of initial strategy

There are three main types of initial strategies for CTO lesions: forward interventional treatment strategy, forward dissection re-entry (ADR) strategy, and reverse interventional treatment strategy.

Step 3: Adjustment of intraoperative strategy

~ If the forward guidewire fails to successfully pass through the occluded segment, ADR technology or parallel guidewire technology can be considered.

~ To improve the success rate of parallel guidewire technology, the use of double-lumen microcatheter-mediated parallel guidewire technology can be considered.

~ However, if there are severe diffuse lesions in the blood vessels beyond the occluded segment, the success rates of parallel guidewire technology and ADR technology are often not high. If there are available collateral vessels after the failure of ADR technology and parallel guidewire, it is recommended to start the reverse opening strategy early;

~ For complex CTO lesions, simple forward and simple reverse strategies are sometimes difficult to succeed. It is recommended to start the reverse technology early after the forward attempt fails, or directly perform reverse interventional treatment, which can be combined with ADR technology.

The 2D PCI model can be used for simulating coronary intervention through radial artery and femoral artery. The model includes radial artery,

aortic arch, left coronary artery, diagonal branch, LAD, LCX and femoral artery as well as other major relevant arteries. It can be also used for Simulating CTO, coronary embolism and PCI training, etc.