Global Chronic Total Occlusion Crossing Algorithm JACC State-of-the-Art Review


Research output: Contribution to journalReview articlepeer-review


The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.

Original languageEnglish
Pages (from-to)840-853
Number of pages14
JournalJournal of the American College of Cardiology
Issue number8
Publication statusPublished - Aug 24 2021


  • chronic total occlusion
  • global
  • percutaneous coronary intervention
  • treatment algorithm

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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