Complex Chronic Total Occlusion:Hybrid approach how to do it?

Abstract

Chronic Total Occlusion (CTO) is defined as complete obstruction in a coronary artery with TIMI flow grade 0 of at least 3 months duration(1). CTO are diagnosed in 15-20% of patients undergoing coronary angiography(2). Percutaneous Coronary Intervention (PCI) involving CTO is challenging, complex, involves large volume of contrast, accessories and may yield suboptimal results.
The main reason for PCI failure in CTO procedure in inability to cross the lesion by a guide wire (3). There have been several technical refinements techniques like antegrade wiring, antegrade dissection and its re-entry, retrograde and antegrade dissection and reentry with improved outcomes (4,5,6). The report will describe step by step use of different crossing strategies and the rationale for the hybrid approach. The emphasis will be on how to proceed further in case of an initial failure. We report a case of multivessel coronary artery disease (CAD) where complex CTO of right coronary artery (RCA) was treated using a hybrid approach along with PCI to other
vessels.