TCT 2015: Hybrid Approach to CTO PCI Increases Success Rates

October 14, 2015

On Tuesday evening, October 13, at the session on CHIP or Complex, High-Risk and Indicated PCI, Dr. Aaron Grantham of St. Luke’s Hospital, Kansas City, Missouri discussed thevCTO-PCI) in his talk entitled “The Hybrid Approach to CTO PCI: What it is, and How It Has Changed CTO PCI.”

Dr. Grantham stated the hybrid approach was invented by Craig Thompson and published in JACC Cardiovas Interv (5:367-79) in 2012 by Brilakis et al. in a paper entitled “A percutaneous treatment algorithm for crossing coronary chronic total occlusions”.

Historically, CTO has had low success rates. The goal of the hybrid approach is to increase success rates of angioplasty when CTO is present.

The hybrid approach uses antegrade and/or retrograde ways to increase the success rates of PCI when CTO is present. Dr. Grantham is an expert in this approach and reviewed the four main characteristics that help determine the approach:

  1. The CTO cap is defined or ambiguous
  2. Presence or absence of collaterals and determination if they are useful for retrograde re-entry
  3. Occlusion length
  4. Quality of the distal vessel

A summary of this approach was written by Kim Dalton and posted on TCTMD in July 2014 with the title “‘Hybrid Approach Boosts PCI Success for In-Stent CTOs”.

The hybrid approach to CTO angioplasty will be the focus of a new clinical study called Open CTO. The goal is to assess CTO in 1000 patients. Dr. Grantham is the principal investigator.

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