In usual PCI setting 6F Guiding Catheter (GC) is enough to obtain a complete procedural success in the vast majority of cases. The four angiographic parameters of this score are: (1) proximal cap location and morphology, with a clearly defined and вЂњtaperedвЂќ proximal cap favoring antegrade approach (2) lesion length, with a value > 20 mm clearly more challenging to cross (3) calcification (4) bending > 45В° within CTO lesions, which lower procedural success.Д¬an complex PCI and CTO procedures fit transradial approach? Patients with higher J-CTO score have significantly lower success rate. However, regarding CTO procedures, many scores have been proposed, but the most commonly used for its simplicity in identifying main characteristics that may impact procedural success is the вЂњJ-CTOвЂќ score. A complete evaluation of CTO lesion characteristic before the procedure is the key for the success.ДЄ first extensive evaluation of anatomic predictors of PCI success was reported in AHA/ACC Guidelines for Percutaneous Interventions. In this context, dual injection angiography should be performed in all cases except in the complete absence of contralateral collaterals. Planning the procedure: weigh the pros and consДЄccurate angiographic review with complete quantification of possible hazard during the procedure remains a cornerstone of successful CTO PCI. Hence, in this review, we focus the attention on specific insights on CTO devices and techniques, which could enhance interventional cardiologist capability to overcome many challenges and complications encountered during daily PCI.

Moreover, operators involved in such courses and on-site CTO programs could improve their learning curve even in complex percutaneous coronary interventions (PCI), bringing their experience about CTO devices and techniques to everyday practice. Hence, it is now advisable for the interventional cardiologist to follow specific training programs and to consider on site proctoring before starting to perform CTO procedures. Following technical advancement and procedural increased success, interventional cardiologists have been recently more involved in CTO procedures. However, observational reports still showed that CTO procedural success rate is lower in less skilled hands, reaching in some cases only 70%. ДЄbove all these clinical and prognostic considerations, only in the last few years, the developing of new techniques and new devices and guidewires has raised the procedural success to near 90% in experienced centers. However, when looking to recent randomized clinical trials, there are still some concerns about effective clinical impact of CTO revascuarization, showing conflicting results. Some recent observational studies have shed a new light about CTO procedures demonstrating a clinical benefit in term of reduced angina symptoms, improved left ventricular ejection fraction and improved long term survival. They show a high prevalence between patients referred for coronary angiography in various real-world registries, with an incidence increasing with age. Д¬TO represent the most technically challenging procedure subset for the interventional cardiologists. Chronic total occlusion (CTO) lesions are defined as a coronary lesion with Thrombolysis In Myocardial Infarction grade 0 flow distal to the occluded segment and, although often difficult to determine, clinical evidence of occlusion duration more than 3 months.

Guideliner catheter video