Intro
Foreword
Acknowledgments
Contents
Contributors
List of Columns
1: Mitsudo's PCI Techniques for CTO
1.1 Approach (Puncture Site)
1.1.1 Selection of the Approach
1.1.1.1 Guiding Catheter Size
1.1.1.2 Fluoroscopic Angles for Biplane Cineangiography and Puncture Sites
1.1.1.3 Influence of Severe Tortuosity and/or Stenosis
1.2 Sheath
1.3 Guiding Catheter
1.3.1 Selection of the Guiding Catheter
1.3.1.1 Amplatz-Type Catheter for the RCA
1.3.1.2 Tips When Using an Amplatz Left-Type Guiding Catheter for the RCA

Shape of the Catheter Tip
1.3.1.3 Short-Tipped Judkins Catheter or Extra Backup Catheter for the LCA
1.3.1.4 Size of the Catheter Tip Curve
1.3.2 Anchoring Technique
1.3.2.1 Size and Inflation Pressure of the Anchoring Balloon
1.3.2.2 If No Side Branch Is Available for Anchoring
1.4 Anticoagulation Strategy
1.4.1 Administration of Heparin
1.4.2 Blood Sample Collection for ACT Measurement
1.4.3 Precautions When Collecting Blood via the Guiding Catheter
1.5 Fluoroscopy and Imaging Strategies
1.5.1 Video Imaging Equipment and Fluoroscopy Angles

1.5.1.1 Is Biplane Imaging Essential?
1.5.1.2 Direction of the Longitudinal Axis of the Target Vessel in the Region of Interest for Guidewire Advancement
1.5.1.3 Selecting Two Orthogonal Projections
1.5.1.4 Isocenter
1.5.2 Bilateral Angiography and Collateral Flow Angiography (Contralateral Imaging, etc.)
1.6 Antegrade Approach
1.6.1 Mechanism of CTO Formation and Changes After Occlusion
1.6.1.1 Occlusion Resulting from Tight Stenosis (Fig. 1.42)
1.6.1.2 Acute Thrombotic Occlusion (Fig. 1.46)
1.6.1.3 Occlusions with Complex Etiologies

1.6.2 Histological Features Before and After Occlusion
1.6.3 Guidewire Crossing Based on the Presumed Mechanism of CTO Formation and Changes After Occlusion
1.6.4 Guidewire Strategies
1.6.4.1 Tip Load and Penetration Force: Why a Crossing Guidewire Is Needed to Perform Antegrade PCI for CTO
1.6.4.2 Curve of the Guidewire Tip
1.6.4.3 Fixed Point Guidewire Rotation
1.6.4.4 Guidewire Trapping and Inflection
1.6.4.5 Does a Stiff Guidewire Only Advance Toward the Larger Curvature in a Curved Vessel?
1.6.4.6 Straightening of the Guidewire Tip

1.6.4.7 Basic Techniques for Manipulating a CTO Guidewire
1.6.4.8 Selection and Manipulation of Guidewires in Various Situations
Role of the First Guidewire
1.6.4.9 Setting a Landmark
1.6.4.10 Parallel Wire Technique
Choice of the Second Guidewire (Figs. 1.109, 1.110, 1.111, 1.112, 1.113, and 1.114)
1.6.4.11 Correcting the Guidewire Route by Using a Landmark
1.6.4.12 IVUS-Guided Wiring: Side Branch Technique
1.6.4.13 IVUS-Guided Wiring: False Lumen Technique
1.6.4.14 Confirmation of Crossing the True Lumen and Points to Be Considered After Crossing