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Hybrid algorithm for chronic total occlusion percutaneous coronary intervention

S Gallagher & EJ Smith

The field of percutaneous intervention for chronic total occlusion (CTO) has enjoyed a rich period of innovation in recent years. The advent of novel techniques and technologies is revolutionizing the field, such that intervention can be considered for a greater number of patients with increasing anatomical complexity. However, uptake of these novel techniques into routine clinical practice has been sporadic. In addition, the key advances, including the retrograde approach and dissection re-entry techniques, have evolved in parallel, such that the applicability of any one novel skill set may be uncertain in clinical practice. Thus, there has been a need not only for technical innovation, but also for innovation in our approach to CTO percutaneous coronary intervention (PCI) itself. The hybrid algorithm for CTO PCI represents that key step. Guided by detailed angiographic assessment, it provides a framework that integrates the available techniques to achieve reproducible procedural success in routine clinical practice. In this article, we describe the key innovations that are enhancing success rates, and the rationale for and application of the hybrid algorithm for CTO PCI.