Equipment requirement for chronic total occlusion percutaneous coronary intervention

The equipment necessary for performing chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be grouped into ten categories: sheaths, guide catheters, microcatheters, guidewires, dissection/reentry equipment, guide catheter extensions, snares, equipment for "balloon uncrossable" and "balloon undilatable" lesions, intravascular imaging, and equipment for managing complications. Use of the appropriate equipment and carefully selected guidewires based on the characteristics of the occlusion is of the utmost importance. The following steps will help you navigate through the vast compendium of available tools. 1. Have at least one item that fulfills each of the required steps in CTO-PCI (e.g., obtaining access, engaging the coronary artery, assessing the coronary artery, wiring, preparing the lesion, stenting the lesion, hemodynamic support, etc.) 2. Be familiar with each piece of equipment, understand its strengths and limitations, and be willing to use it when required (otherwise it will expire on the shelf). 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.