Percutaneous Interventional Strategies in the Treatment of Chronic Total Coronary Occlusions

KW Lau, ZP Ding, U Sigwart, L Lam
Correspondence: A/Prof K W Lau

ABSTRACT
Chronic total coronary occlusions which make up 10% to 20% of all interventional procedures in high-volume centres remain a vexing problem for invasive cardiologists for 2 main reasons. First, they are only successfully recanalised in about 60% of attempts with most failures resulting from an inability to cross the lesions. Laser guidewire appears to be a promising innovation in overcoming this obstacle. Second, after initially successful recanalisation with conventional balloon angioplasty (PTCA), a high restenosis rate (range, 45% to 75%) is observed. Stent placement, by conferring maximal luminal expansion, appears to have resolved this problem to a large extent; both observational and randomised studies indicate that after stent placement, restenosis rate is at least halved that of PTCA.

Keywords: Chronic total occlusion, balloon angioplasty, stents, restenosis
Singapore Med J 2000; 41(9): 468-470