Introduction: Percutaneous coronary intervention (PCI) in chronic total occlusions (CTO) is almost the only growing area of ​​coronary interventional cardiology, where the key to success is true indication and knowledge of all available techniques and materials. Recently, the hybrid approach to CTO interventions proved to be an optimal strategy with the best ratio of success and complications. (1) Here, we present experience in University Hospital Dubrava with hybrid PCI approach to CTO.

Patients and Methods: Procedures before and after the routine adoption of a hybrid approach to CTO interventions were analyzed. Hybrid approach to CTO is based on routine dual catheter contrast injection in each CTO lesion indicated for PCI, and only depending on the angiographic assessment of the proximal cap, collateral circulation visualization, and the appearance of the distal target by collateral circulation, one of the following strategies is selected: anterograde CTO wire escalation (AWE), anterograde dissection and re-entry with dedicated materials (“Crossboss and Stingray”) (ADR), retrograde CTO wire escalation (RWE), or reverse CART (retrograde dissection and re-entry into true lumen).

Results: After the process of hybrid approach adoption to CTO interventions during 2016, the number of redo procedures in our center decreased considerably, whereas the success rate increased. In the period after the full adoption of the hybrid approach between July 2017 and July 2018, 52 CTO interventions were indicated, of which 34 on the right coronary artery. Proportions of final PCI strategies were: AWE 46/52, ADR 2/52, RWE 2/52, and reverse CART 2/52. Total success rate was 84.6%. Repeated procedure was indicated in 4/52 patients. Periprocedural complications were rare: 1 coronary perforation needing cardiac surgery and 1 coronary perforation treated in Cath lab without need for cardiac surgery. No periprocedural mortality was recorded.

Conclusion: The hybrid approach to CTO PCI proved to be a safe, efficient, and economical method, and should be adopted as a routine approach to CTO intervention.