![]() ![]() Guide catheter extensions (GuideLiner, Trapliner, Guidezilla, Guidion)Ĭorsair, Corsair Pro, and Caravel or Turnpike and Turnpike LP (150 cm for retrograde 135 cm for antegrade) or NHancer ProX (155 cm for retrograde 135 cm for antegrade)įinecross (150 cm for retrograde 135 cm for antegrade) or Micro 14 (155 cm) Y-connector with hemostatic valve (such as Co-pilot or Guardian) Table 2.1 shows a must-have and a good-to-have checklist for CTO PCI, classifying equipment into 12 categories.ħ French Slender sheaths for transradial approach In some cases, such as covered stents and coils, equipment expiration is to some extent expected given the low frequency of complications requiring their use ( Chapter 12 ). ![]() The operator should be familiar with the equipment, understand its strengths and limitations, and be willing to actually use it when required (otherwise it will expire on the shelf). Here are some criteria to use when deciding the must-haves for CTO PCI:Īt least one item that fulfills each of the requisite steps in CTO PCI (e.g., septal crossing, wire externalization, snaring, etc.) should be available. One of the most frequently asked questions about chronic total occlusion (CTO) percutaneous coronary intervention (PCI), especially from programs early in the learning curve, is, “what equipment do I really need?”Īlthough many operators would like to have everything available, the reality is that equipment cost and space limitations require prioritization. Hemodynamic support devices should be considered prophylactically in selected high-risk cases or used if a patient develops hemodynamic compromise during the procedure. ![]() Long, noncompliant balloons are often needed for lesion preparation after crossing and second-generation drug-eluting stents are used in CTO PCI to minimize the risk for restenosis. Radiation scatter shields can minimize operator radiation exposure. Intravascular ultrasonography and/or optical coherence tomography can assist with CTO crossing and stenting optimization, whereas covered stents and coils with appropriate delivery microcatheters are necessary for treating perforations, which is the most common complication of CTO PCI. Small balloons, various microcatheters, laser, atherectomy, and scoring balloons are often needed for balloon-uncrossable and balloon-undilatable lesions. Guide catheter extensions can increase support and also facilitate retrograde CTO PCI. ![]() Specialized equipment can facilitate dissection/reentry, and snares may be needed for retrograde guidewire externalization. CTO crossing should always be performed by advancing a guidewire through a microcatheter (preferred) or over-the-wire balloon, with careful selection of guidewires based on the lesion characteristics. CTO PCI equipment can be grouped into 12 categories: (1) sheaths, (2) guide catheters and guide catheter extensions, (3) microcatheters and support catheters, (4) guidewires, (5) dissection/reentry equipment, (6) snares, (7) equipment for balloon-uncrossable and balloon-undilatable lesions, (8) intravascular imaging, (9) equipment for managing complications, (10) equipment for minimizing operator radiation exposure, (11) balloons/stents, and (12) hemodynamic support devices. Availability of dedicated equipment and familiarity with its use are critical for successfully and safely performing chronic total occlusion (CTO) percutaneous coronary interventions (PCIs). ![]()
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