Global Consensus Recommendations on Improving the Safety of Chronic Total Occlusion Interventions - 18/07/24

Doi : 10.1016/j.hlc.2023.11.030

Eugene B. Wu, MD ^a,^{^{1
Equal First authors.},}^⁎ , Arun Kalyanasundaram, MD ^b,^{^{1
Equal First authors.}}, Emmanouil S. Brilakis, MD, PhD ^c, Kambis Mashayekhi, MD ^d, Etsuo Tsuchikane, MD, PhD ^e
and the
CTO Global Consensus Group^²
CTO Global Consensus Group Contributors listed at end of article.
Nidal Abi Rafeh ^f, Pierfrancesco Agostoni ^g, Khaldoon Alaswad ^h, Mario Araya ⁱ, Alexandre Avran ^j, Mohamed Ayoub ^k, Lorenzo Azzalini ^l, Avtandil M. Babunashvili ^m, Baktash Bayani ⁿ, Michael Behnes ^o, Ravinay Bhindi ^p, Nicolas Boudou ^q, Marouane Boukhris ^r, Nenad Z. Bozinovic ^s, Leszek Bryniarski ^t, Alexander Bufe ^u, Christopher E. Buller ^v, M. Nicholas Burke ^w, Heinz Joachim Buettner ^x, Pedro Cardoso ^y, Mauro Carlino ^z, Chi-Kin Chan ^aa, Jiyan Chen ^bb, Evald Hoej Christiansen ^cc, Antonio Colombo ^dd, Kevin Croce ^ee, Felix Damas de los Santos ^ff, Tony de Martini ^gg, Joseph Dens ^hh, Carlo di Mario ⁱⁱ, Darshan Doshi ^jj, Kefei Dou ^kk, Mohaned Egred ^ll, Basem Elbarouni ^mm, Ahmed M. ElGuindy ⁿⁿ, Javier Escaned ^oo, Sergey Furkalo ^pp, Andrea Gagnor ^qq, Alfredo R. Galassi ^rr, Roberto Garbo ^ss, Gabriele L.Gasparini ^tt, Junbo Ge ^uu, Lei Ge ^vv, Pravin Kumar Goel ^ww, Omer Goktekin ^xx, Nieves Gonzalo ^yy, Sevket Gorgulu ^zz, Luca Grancini ^aaa, Allison B. Hall ^bbb, Colm Hanratty ^ccc, Stefan Harb ^ddd, Scott A. Harding ^eee, Raja Hatem ^ggg, Farrel Hellig ^hhh, Jose P.S. Henriques ⁱⁱⁱ, David Hildick-Smith ^jjj, Jonathan M. Hill ^kkk, Angela Hoye ^lll, Wissam Jaber ^mmm, Farouc A. Jaffer ⁿⁿⁿ, Yangsoo Jang ^ooo, Risto Jussila ^ppp, Artis Kalnins ^qqq, Sanjog Kalra ^rrr, David E. Kandzari ^sss, Hsien-Li Kao ^ttt, Dimitri Karmpaliotis ^uuu, Hussien Heshmat Kassem ^vvv, Kathleen E. Kearney ^www, Jimmy Kerrigan ^xxx, Jaikirshan Khatri ^yyy, Dmitri Khelimskii ^zzz, Ajay J. Kirtane ^aaaa, Paul Knaapen ^bbbb, Ran Kornowski ^cccc, Oleg Krestyaninov ^dddd, V. Ganesh Kumar ^eeee, Prathap Kumar ^ffff, Pablo Manuel Lamelas ^gggg, Seung-Whan Lee ^hhhh, Thierry Lefevre ⁱⁱⁱⁱ, Gregor Leibundgut ^jjjj, Raymond Leung ^kkkk, Sum-Kin Leung ^llll, Yu Li ^mmmm, Yue Li ⁿⁿⁿⁿ, Soo-Teik Lim ^oooo, Sidney Lo ^pppp, William Lombardi ^qqqq, Anbukarasi Maran ^rrrr, Margaret McEntegart ^ssss, Jeffrey Moses ^tttt, Muhammad Munawar ^uuuu, Wataru Nagamatsu ^vvvv, Andres Navarro ^wwww, Hung M. Ngo ^xxxx, William Nicholson ^yyyy, Anja Oksnes ^zzzz, Goran K. Olivecrona ^aaaaa, Lucio Padilla ^bbbbb, Mitul Patel ^ccccc, Ashish Pershad ^ddddd, Marin Postu ^eeeee, Stylianos Pyxaras ^fffff, Jie Qian ^ggggg, Alexandre Quadros ^hhhhh, Franklin Leonardo Hanna Quesada ⁱⁱⁱⁱⁱ, Truls Råmunddal ^jjjjj, Vithala Suryaprakasa Rao ^kkkkk, Sudhir Rathore ^lllll, Nicolaus Reifart ^mmmmm, Robert F. Riley ⁿⁿⁿⁿⁿ, Stephane Rinfret ^ooooo, Meruzhan Saghatelyan ^ppppp, Ricardo Santiago ^qqqqq, Ashok Seth ^rrrrr, Georgios Sianos ^sssss, Elliot Smith ^ttttt, Anthony Spaedy ^uuuuu, James Spratt ^vvvvv, Gregg W. Stone ^wwwww, Julian W. Strange ^xxxxx, Khalid O. Tammam ^yyyyy, Craig A. Thompson ^zzzzz, Aurel Toma ^aaaaaa, Jennifer A. Tremmel ^bbbbbb, Imre Ungi ^cccccc, Giuseppe Vadalà ^dddddd, Minh Vo ^eeeeee, Vu Hoang Vu ^ffffff, Simon Walsh ^gggggg, Daniel Weilenmann ^hhhhhh, Gerald S. Werner ⁱⁱⁱⁱⁱⁱ, Jaroslaw Wojcik ^jjjjjj, Jason Wollmuth ^kkkkkk, Chiung-Jen Wu ^llllll, Bo Xu ^mmmmmm, Masahisa Yamane ⁿⁿⁿⁿⁿⁿ, Luiz F. Ybarra ^oooooo, Robert W. Yeh ^pppppp, Chris Zambakides ^qqqqqq, Qi Zhang ^rrrrrr
^f St. George Hospital University Medical Center, Beirut, Lebanon; NorthOaks Health System, Hammond, LA, USA
^g HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
^h Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Henry Ford Health System, Wayne State University, MI, USA
ⁱ Clinica Alemana and Hospital Militar de Santiago, Chile
^j Centre Hospitalier de Valenciennes, Valenciennes, France
^k University Heartcenter NRW, Bad Oeynhausen, Germany
^l Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
^m Moscow State Medical [Sechenov’s] University, Moscow, Russia
ⁿ Cardiology Department, Mehr Hospital, Mashhad, Iran
^o First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Germany
^p Royal North Shore Hospital and University of Sydney, Sydney, NSW, Australia
^q Interventional Cardiology Clinique Saint Augustin Bordeaux France
^r Cardiology Department, CHU Dupuytren, Limoges, France
^s University Clinical Center of Nis. Serbia
^t Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College; Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
^u Heart Center Krefeld, University Witten/Herdecke, Witten, Germany
^v Teleflex Inc. and St. Michael’s Hospital, Toronto, Canada
^w Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
^x Department of Cardiology and Angiology, II University Heart Center Freiburg Bad Krozingen, Germany
^y Cardiology and Vascular Department, Santa Maria University Hospital [CHULN], Lisbon Academic Medical Centre [CAML]; Centro Cardiovascular da Universidade de Lisboa [CCUL], Portugal
^z Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department IRCCS San Raffaele Scientific Institute, Milan, Italy
^aa Premier Medical Centre, Hong Kong
^bb Guangdong Provincial People's Hospital, Guangdong, China
^cc Department of Cardiology, Aarhus University Hospital, Denmark
^dd Department of Biomedical Sciences, Humanitas University, Pieve Emauele-Milan, Italy; Humanitas Clinical and Research Center, IRCCS, Rozzano-Milan, Italy
^ee Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
^ff Instituto Nacional de Cardiologia; Ignacio Chávez and Centro Medico ABC, Mexico City, Mexico
^gg Springfield Memorial Hospital, Springfield, IL; Midwest Cardiovascular Institute, Naperville, IL, USA
^hh Hospital Oost-Limburg, Genk, Belgium
ⁱⁱ Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
^jj Massachusetts General Hospital, Boston, MA, USA
^kk Research Center for Coronary Heart Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical, China
^ll Freeman Hospital & Newcastle University, Newcastle upon Tyne, UK
^mm St. Boniface Hospital & University of Manitoba, Winnipeg, MB, Canada
ⁿⁿ Department of Cardiology, Aswan Heart Centre - Magdi Yacoub Foundation, Egypt
^oo Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
^pp National Institute of Surgery and Transplantology NAMS, Kiev, Ukraine
^qq Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy
^rr Department of PROMISE University of Palermo, Italy
^ss Maria Pia Hospital, GVM Care & Research Turin, Italy
^tt Department of Biomedical Sciences, Humanitas University, Pieve Emauele-Milan, Italy; Humanitas Clinical and Research Center, IRCCS, Rozzano-Milan, Italy
^uu Zhongshan Hospital, Fudan University, Shanghai, China
^vv Zhongshan Hospital, Fudan University, Shanghai, China
^ww Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
^xx Memorial Hospital, Istanbul, Turkey
^yy Interventional Cardiology, Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
^zz Acibadem University Cardiology Department, Istanbul/Turkey
^aaa Centro Cardiologico Monzino, IRCCS, Milan, Italy
^bbb Eastern Health/Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
^ccc Mater Private Hospital, Dublin, Ireland
^ddd Medical University of Graz, Department of Cardiology, University Heart Center, Graz, Austria
^eee Wellington Hospital, Capital and Coast District Health Board, New Zealand
^ggg Hôpital du Sacré-Coeur de Montréal Université de Montréal, Canada
^hhh Sunninghill Hospital, Johannesburg; Division of Cardiology, University of Cape Town, Cape Town, South Africa
ⁱⁱⁱ Amsterdam UMC location, University of Amsterdam, Department, Amsterdam, The Netherlands
^jjj Sussex Cardiac Centre, Brighton, UK
^kkk Royal Brompton Hospital, London, UK
^lll Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, UK
^mmm Emory University, Atlanta, GA, USA
ⁿⁿⁿ Massachusetts General Hospital, Boston, MA, USA
^ooo CHA Bundang Medical Center, CHA University College of Medicine, South Korea
^ppp Interventional Cardiology, Helsinki Heart Hospital, Finland
^qqq Clinic of Cardiovascular Diseases Riga EAST Clinical University Hospital, Riga, Latvia
^rrr Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada
^sss Piedmont Heart Institute and Cardiovascular Services, Atlanta, GA, USA
^ttt Department of Internal Medicine, Cardiology Division, Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
^uuu Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
^vvv Kasr Alainy Medical School, Cairo University, Egypt; Fujairah Hospital, Ministry of Health, UAE
^www University of Washington Medical Centre, Seattle, WA, USA
^xxx Ascension Saint Thomas Heart, Nashville, TN, USA
^yyy Cleveland Clinic, Cleveland, OH, USA
^zzz Natsional'nyy Meditsinskiy Issledovatel'skiy Tsentr Imeni Akademika Ye.n. Meshalkina - Novosibirsk, Russian Federation
^aaaa Columbia University Irving Medical Center, New York, NY, USA
^bbbb Heart Center of the Amsterdam University Medical Centers, Amsterdam, Netherlands
^cccc Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
^dddd E.Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation
^eeee Department of Cardiology, Dr LH Hiranandani Hospital, Mumbai, India
^ffff Meditrina Hospitals Kerala, India
^gggg Cardiovascular de Buenos Aires, Argentina; Health Research Methods, Evidence, and Impact, McMaster University, Canada
^hhhh Department of Cardiology Asan Medical Center, University of Ulsan College of Medicine Seoul, Republic of Korea
ⁱⁱⁱⁱ Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
^jjjj Department of Cardiology Medizinische Universitätsklinik Kantonsspital Baselland, Liestal, Switzerland
^kkkk CK Hui Heart Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada
^llll Keen Heart, Hong Kong
^mmmm Beijing Anzhen Hospital, Capital Medical University, China
ⁿⁿⁿⁿ Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, China
^oooo National Heart Centre of Singapore, Singapore
^pppp Department of Cardiology, Liverpool Hospital; The University of New South Wales, Sydney, Australia
^qqqq University of Washington, Seattle, WA, USA
^rrrr Medical University of South Carolina Ralph H Johnson VA Medical Center, Charleston, SC, USA
^ssss Columbia University Irving Medical Center, New York, NY, USA
^tttt Columbia University Irving Medical Center, New York; St Francis Heart Center, Roslyn, New York, NY, USA
^uuuu Binawaluya Cardiac Center and Department of Cardiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Cardiology, Faculty of Medicine, Universitas Gadjahmada, Yogyakarta, Indonesia
^vvvv Hokusetsu General Hospital, Osaka, Japan
^wwww QRA Medicina Especilizada, Hospital de los Valles, Universidad San Francisco de Quito, Ecuador
^xxxx Choray University Hospital, Ho Chi Minh City, Vietnam
^yyyy Emory University, Atlanta, GA, USA
^zzzz Heart Department, Haukeland University Hospital, Norway
^aaaaa Department of Cardiology SUS-Lund, Lund University, Lund, Sweden
^bbbbb Department of Interventional Cardiology and Endovascular Therapeutics, ICBA, Instituto Cardiovascular, Buenos Aires, Argentina
^ccccc Division of Cardiovascular Medicine UC San Diego School of Medicine, San Diego, CA, USA
^ddddd Chandler Regional Medical Center, Chandler, AZ, USA
^eeeee Cardiology Department, University of Medicine and Pharmacy “Carol Davila,” Institute of Cardiovascular Diseases “Prof. Dr. C.C. Iliescu,” Bucharest, Romania
^fffff Medizinische Klinik I, Klinikum Fürth, Fürth, Germany
^ggggg Beijing Fuwai Hospital, Beijing, China
^hhhhh Interventional Cardiology Division and Post Graduate Course of Cardiology, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
ⁱⁱⁱⁱⁱ The "Clinica Comfamiliar" Pereira, Colombia
^jjjjj Dept of Cardiology Sahlgrenska University Hospital, Gothenburg, Sweden
^kkkkk Hod Cardiology, Care Hospitals Banjara, Hyderabad, Telangana, India
^lllll Frimley Health NHS Foundation Trust, Frimley, UK
^mmmmm Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany
ⁿⁿⁿⁿⁿ Overlake Medical Center & Clinics, Bellevue, WA, USA
^ooooo McGill University Health Centre, Montreal, Quebec, Canada
^ppppp Nork Marash MC; Erebouni MC, Yerevan, Armenia
^qqqqq PCI Cardiology Group, Bayamon Heart and Lung Institute, Puerto Rico
^rrrrr Fortis Escorts Heart Institute, New Delhi, India
^sssss HEPA University Hospital, Thessaloniki, Greece
^ttttt Department of Cardiology, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
^uuuuu Boone Hospital Center, Columbia, MO, USA
^vvvvv St George's University Hospital NHS Foundation Trust, London, UK
^wwwww The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
^xxxxx Bristol Royal Infirmary, University Hospital Bristol NHS Trust, Bristol, UK
^yyyyy Department at the International Medical Center, Jeddah, Kingdom of Saudi Arabia
^zzzzz Hartford Healthcare Hartford, CT, USA
^aaaaaa Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
^bbbbbb Stanford University Medical Centre, Stanford, CA, USA
^cccccc University of Szeged, Department of Invasive Cardiology, Hungary
^dddddd Division of Cardiology, University Hospital, Paolo Giaccone, Palermo, Italy
^eeeeee Royal Columbian Hospital, Vancouver, BC, Canada
^ffffff University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
^gggggg Belfast Health and Social Care Trust, Belfast, UK; Boston Scientific, UK
^hhhhhh Department of Cardiology, Kantonsspital St. Gallen, Sankt Gallen, Switzerland
ⁱⁱⁱⁱⁱⁱ Medizinische Klinik I Klinikum, Darmstadt GmbH, Germany
^jjjjjj Hospital of Invasive Cardiology IKARDIA, Nałęczów/Lublin, Poland
^kkkkkk Providence Heart and Vascular Institute, Portland, OR, USA
^llllll Chang Chung Memorial Hospital, Taiwan
^mmmmmm Massachusetts General Hospital Boston, MA, USA
ⁿⁿⁿⁿⁿⁿ Saitama-Sekishinkai Hospital, Saitama, Japan
^oooooo London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
^pppppp Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, USA
^qqqqqq Department of Cardiology, Chris-Hani Baragwanath Hospital, Johannesburg, South Africa
^rrrrrr Shanghai East Hospital, Tongji University, Shanghai, China

^a Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong
^b Promed Hospital, Chennai, India
^c Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
^d Department of Cardiology and Angiology, II University Heart Center, Freiburg Bad Krozingen, Germany
^e Toyohashi Heart Center, Aichi, Japan

^∗Corresponding author at: Dr Eugene Brian WU, 9/F, Division of Cardiology, Department of Medicine & Therapeutics, Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong9/FDivision of CardiologyDepartment of Medicine & TherapeuticsClinical Sciences BuildingPrince of Wales HospitalShatinN.T.Hong Kong

Abstract

Safety is of critical importance to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). This global consensus statement provides guidance on how to optimise the safety of CTO) PCI, addressing the following 12 areas: 1. Set-up for safe CTO PCI; 2. Guide catheter-–associated vessel injuries; 3. Hydraulic dissection, extraplaque haematoma expansion, and aortic dissections; 4. Haemodynamic collapse during CTO PCI; 5. Side branch occlusion; 6. Perforations; 7. Equipment entrapment; 8. Vascular access considerations; 9. Contrast-induced acute kidney injury; 10. Radiation injury; 11 When to stop; and, 12. Proctorship. This statement complements the global CTO crossing algorithm; by advising how to prevent and deal with complications, this statement aims to facilitate clinical practice, research, and education relating to CTO PCI.

El texto completo de este artículo está disponible en PDF.

Keywords : Chronic total occlusion, Percutaneous coronary intervention, Consensus document, Global, Safety

Esquema

Introduction

Set-Up for Safe CTO PCI

Guide Catheter–Associated Vessel Injury

Air and Thrombus Embolism

Guide-Induced Dissection

Donor Vessel Injury and Treatment

Hydraulic Dissection, Extraplaque Haematoma Expansion, and Aortic Dissection

Mechanism

Hydraulic Dissection

Haematoma Expansion

Haemodynamic Collapse During CTO PCI

Access Site Bleeding /Retroperitoneal Haematoma

Aortic Insufficiency

Ischaemia

Donor Vessel Lesions

Donor Vessel Ischaemia

Perforations

Anaphylaxis

Side Branch Occlusion

Large Vessel Perforation

Distal Vessel Perforation

Collateral Perforations

Collateral Wire Injury

Persistent Staining

Intact Pericardium

Prevention and Management

Equipment Entrapment

Vascular Access Considerations

Contrast-Induced Acute Kidney Injury

Radiation Injury

Radiation Injury in CTO PCI

The CTO Global Consensus Group Authors

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Vol 33 - N° 7

P. 915-931 - juillet 2024 Regresar al número

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Global Consensus Recommendations on Improving the Safety of Chronic Total Occlusion Interventions - 18/07/24

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