Histopathology and Related Problems of Percutaneous Revascularization of Chronic Total Occlusions: Why the Venture™ Steering Catheter Can Offer a Solution? 

Of more than seven million coronary diagnostic procedures performed every year world wide, thirty percent of those demonstrate a chronic total occlusion (CTO), and usually 200,000 percutaneous revascularization procedures are attempted in those patients for clinically driven ischemia. The revascularization success rate is around 70-80% on average. However, especially in old lesions and long occlusions, revascularization of the CTO is frequently characterized by an inability to cross or dilate the lesion, and a high incidence of reocclusion or restenosis. Understanding the histopathology of these lesions may help not only to understand the reasons for these problems, but also to develop new revascularization strategies. A comprehensive evaluation of CTO was undertaken by Srivatsa and colleagues. The typical CTO results from a thrombotic occlusion followed by thrombus organization and chronic aging of this tissue. Little to no relation exists between histopathologic lumen stenosis and lesion age, or plaque composition. The typical CTO may be classified as “soft”, “hard”, or a mixture of these. Soft plaque includes cholesterol and foam cell-laden cells and loose fibrous tissue, more frequent in younger lesions...continua a leggere