Further advancement in the percutaneous revascularization of coronary chronic total occlusions: the redefined "Minimalistic Hybrid Approach" algorithm.

Further advancement in the percutaneous revascularization of coronary chronic total occlusions: the redefined "Minimalistic Hybrid Approach" algorithm. Minerva Cardioangiol. 2020 Oct 15;: Authors: Vescovo GM, Zivelonghi C, Scott B, Agostoni P Abstract A careful angiographic assessment of a chronic total occlusion (CTO) is essential for optimal procedural planning. In the classic Hybrid Approach, the insertion of two guiding catheters at the beginning of the intervention is recommended. This is fundamental to perform simultaneous double injection, to achieve complete visualization of the coronary circulation and to choose the best starting strategy between antegrade wire escalation (AWE), antegrade dissection and re-entry (ADR) and the retrograde techniques (retrograde wire escalation [RWE] and retrograde dissection and re-entry [RDR]). In the Hybrid Algorithm the set-up is the same, regardless of the chosen first strategy, and therefore routinely uses double access. Because revascularizations of CTOs commonly require large bore catheters (7-8 French) to ensure high back up support, the femoral arterial access is preferred by most of the operators. However, the use of a double access, large introducer sheaths and femoral approach are associated with a greater risk of access-related complications and even the occurrence of major adverse cardiovascular events. We have previously proposed an algorithm, called "Minimalistic Hybrid Approac...
Source: Minerva Cardioangiologica - Category: Cardiology Tags: Minerva Cardioangiol Source Type: research