title: Fundamental wire technique and current standard strategy of percutaneous intervention for chronic total occlusion with histopathological insights.
abstract: Currently, successful treatment of chronic total occlusion (CTO) seems markedly improved, due to several new techniques and dedicated device developments. However, this improved success rate is often limited to procedures performed by skilled, highly experienced operators. To improve the overall success rate of percutaneous coronary intervention of CTO from a worldwide perspective, a deeper understanding of CTO histopathology might offer insights into the development of new techniques and procedural strategies. In this review, CTO histopathology and wire techniques are discussed on the basis of the fundamental concepts of antegrade and retrograde approaches. Although details pertaining to wire manipulation are very difficult to explain objectively, we tried to describe this as best as possible in this article. Finally, a systematic review of the current standard CTO strategy is provided. Hopefully, this article will enhance the understanding of this complex procedure and, consequently, promote safe and effective CTO-percutaneous coronary intervention for patients who present with this challenging lesion subset.
authors.affiliation: Nozaki Tokushukai Hospital, Nagoya Tokushukai General Hospital and Osaka University, Osaka, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Sumitsuji
authors.forename: Katsumi
authors.initials: K
authors.lastname: Inoue
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ochiai
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Ikeno
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D000818:Animals; D057785:Catheters; D002908:Chronic Disease; D002983:Clinical Competence; D054059:Coronary Occlusion / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D004867:Equipment Design; D006801:Humans; D009048:Motor Skills; D061214:Patient Safety; D016896:Treatment Outcome