ABSTRACT

This chapter highlights the use of intracoronary fibrinolytic therapy (ICL) in the recanalization and interventional management of chronic total occlusions (CTOs) in the native coronary circulation, and also includes the treatment of chronically occluded aortocoronary saphenous vein grafts. It discusses trials utilizing ICL in the management of CTO in the native coronary circulation. The use of fibrinolytic therapy has been proposed as a mechanism to lyse the most recent clot component of CTO, allowing the passage of the guidewire and facilitating percutaneous coronary intervention. The use of ICL to facilitate recanalization of CTOs that have failed a previous attempt is successful in over 50% of cases in the coronary circulation. Thrombolytics should be considered as a valuable tool in the management of CTOs. A multicenter randomized trial is underway to test the benefit of lytic therapy prior to primary recanalization of de-novo coronary CTOs.