How to fix common problems encountered in CTO PCI: The expanded hybrid approach

James Sapontis, Steven P. Marso, William L. Lombardi, J. Aaron Grantham

Research output: Chapter in Book/Report/Conference proceedingChapter

2 Scopus citations


There remains a pressing need in the interventional cardiology community to narrow the existing gap in the success rates, safety, and effi ciency of chronic total occlusion percutaneous coronary intervention (CTO-PCI) relative to non CTO-PCI. Success rates for non CTOPCI are high (>98 %). The success rates of CTO-PCI at experienced CTO-PCI centers are catching up (>90 %) but are likely much lower (50-70 %) at the vast majority of other PCI centers. Complication rates appear to be equal between CTO and non-CTO procedures at experienced CTO centers but may not be at others. CTO-PCI is associated with higher procedural time, contrast use, radiation exposure and supply cost than non CTO PCI even at experienced CTO-PCI centers. Thus, a wide variability in the CTO-PCI cases being attempted persists in large part due to these gaps. This chapter provides an overview of the new expanded hybrid approach, commonly employed by successful CTO operators.

Original languageEnglish (US)
Title of host publicationPercutaneous Intervention for Coronary Chronic Total Occlusion
Subtitle of host publicationThe Hybrid Approach
PublisherSpringer International Publishing
Number of pages19
ISBN (Electronic)9783319215631
ISBN (Print)9783319215624
StatePublished - Jan 1 2016


  • Antegrade dissection reentry (ADR)
  • CTO cap
  • Dissection reentry (DR)
  • Guidewire escalation
  • Hybrid approach to CTO-PCI
  • Retrograde cap
  • Subintimal TRAnscatheter Withdrawal (STRAW) technique

ASJC Scopus subject areas

  • General Medicine


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