Chronic total coronary occlusion

Gerald S. Werner, Emmanouil S. Brilakis

Research output: Chapter in Book/Report/Conference proceedingChapter


Coronary chronic total occlusions (CTO) make up 18% of all significant coronary lesions observed during diagnostic angiography, as demonstrated recently in a cohort study of 14, 400 angiographies from three Canadian centers. Sometimes, CTOs are detected when other coronary lesions progress and lead to unstable angina. For the left coronary artery (LCA), the guide catheter has to be selected according to the length of the left main artery, and the angle of take off of the occluded artery. Guidewire selection incorporates a great deal of personal preference and operator experience. Antegrade dissection can be achieved using a “knuckled” guidewire, but the reliability of the wire re-entry is not controllable. The retrograde approach proceeds by means of very structured steps, but it requires in all cases, except for an ostial occlusion, the positioning of an antegrade wire into the body of the occlusion. New types of complications occur through the application of the retrograde wire technique.

Original languageEnglish (US)
Title of host publicationInterventional Cardiology
Subtitle of host publicationPrinciples and Practice
Number of pages11
ISBN (Electronic)9781118983652
ISBN (Print)9781118976036
StatePublished - Nov 21 2016


  • Antegrade dissection
  • Coronary chronic total occlusions
  • Coronary lesions
  • Diagnostic angiography
  • Guide catheter
  • Guidewire selection
  • Left coronary artery
  • Ostial occlusion
  • Retrograde wire technique

ASJC Scopus subject areas

  • Medicine(all)


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