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Zivelonghi et al. Vessel Plus 2019;3:30 Vessel Plus
DOI: 10.20517/2574-1209.2019.06

Review Open Access

The hybrid algorithm for chronic total occlusions

Carlo Zivelonghi, Simone Budassi, Pierfrancesco Agostoni

Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp 2020, Belgium.

Correspondence to: Dr. Pierfrancesco Agostoni, Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp
2020, Belgium. Email: agostonipf@gmail.com
How to cite this article: Zivelonghi C, Budassi S, Agostoni P. The hybrid algorithm for chronic total occlusions. Vessel Plus
2019;3:30. http://dx.doi.org/10.20517/2574-1209.2019.06
Received: 4 Feb 2019 First Decision: 21 Jun 2019 Revised: 22 Jun 2019 Accepted: 31 Jul 2019 Published: 14 Aug 2019

Science Editor: Mario F. L. Gaudino Copy Editor: Jia-Jia Meng Production Editor: Jing Yu

Abstract

In the last years procedural success rate of chronic total occlusions (CTOs) percutaneous coronary intervention
has improved primarily for two reasons: the evolution in materials and the new techniques and skills acquired by
Received: First Decision: Revised: Accepted: Published: x dedicated CTOs operators. In the last decade a lot of complex and advanced CTO techniques have been introduced.
The hybrid algorithm allows to standardize the experience shared by CTO operators. The aim of the algorithm is
Science Editor: Copy Editor: Production Editor: Jing Yu
to help the operators to choose the best strategy for the single case, in order to improve procedural success rate,
to fasten the procedure, shortening failure modes, and to reduce X ray exposure and contrast load. The aim of our
review is to highlight the most recent scientific evidence about the use of the hybrid algorithm for the treatment of
CTO.

Keywords: Chronic total occlusion, percutaneous coronary intervention, interventional cardiology, coronary artery
disease, hybrid algorithm

INTRODUCTION
In the last years the success rate of chronic total occlusions (CTOs) percutaneous coronary interventions
(PCI) has rapidly improved, not only because of the evolution in materials (e.g., microcatheters, dedicated
guidewires) but also thanks to the development of dedicated programs and shared strategies for
operators approaching these very complex procedures. In addition, a major role has been played by the
introduction of new complex techniques, including retrograde approaches and sub-intimal strategies. In
details, dissection/re-entry techniques consist in gaining the sub-intimal space before/inside the CTO
and re-entering in the true-lumen of the native vessel once the occlusion segment is overtaken. This can

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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