The Clinical Significance and Management Implications of Chronic Total Occlusion Associated With Surgical Coronary Artery Revascularization Lorenzo Azzalini,

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Presentation transcript:

The Clinical Significance and Management Implications of Chronic Total Occlusion Associated With Surgical Coronary Artery Revascularization Lorenzo Azzalini, MD, PhD, MSc Canadian Journal of Cardiology Volume 32, Issue 11, Pages 1286-1289 (November 2016) DOI: 10.1016/j.cjca.2016.02.072 Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 1 Suggested algorithm to manage patients with chronic total occlusion (CTO). Percutaneous coronary intervention (PCI) should be performed with second-generation drug-eluting stents. ∗If hybrid revascularization cannot be performed (eg, lack of local expertise), consider conventional coronary artery bypass grafting (CABG). LV, left ventricular; SYNTAX, Synergy Between PCI with Taxus and Cardiac Surgery. Canadian Journal of Cardiology 2016 32, 1286-1289DOI: (10.1016/j.cjca.2016.02.072) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 2 Suggested approach to hybrid revascularization for patients with chronic total occlusion (CTO). In hybrid revascularization, minimally invasive direct coronary artery bypass (MIDCAB) with a left internal mammary artery–to–left anterior descending artery (LIMA-to-LAD) graft is performed, and percutaneous coronary intervention (PCI) is used to treat the circumflex artery or right coronary artery (RCA), or both. An extensive dissertation on hybrid revascularization can be found elsewhere.16 ∗Dual antiplatelet therapy should be given for at least 6 months after successful PCI (unless clinically contraindicated; eg, high bleeding risk), and MIDCAB should be performed thereafter. Canadian Journal of Cardiology 2016 32, 1286-1289DOI: (10.1016/j.cjca.2016.02.072) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions