INTRODUCTIONAntithrombotic therapy plays an essential role in the prevention of thrombotic complications during percutaneous coronary intervention (PCI) . The benefits of antithrombotic agents must be weighed against their potential risk of hemorrhagic complications, especially in complex PCI and patients with high risk of bleeding . Unfractionated heparin (UFH) and bivalirudin have been used most commonly for anticoagulation in PCI . Bivalirudin, a synthetic reversible direct thrombin inhibitor, can selectively block clot‐bound thrombin, potentially achieving a more potent and more predictable anticoagulant response than UFH . Numerous trials have consistently shown that bivalirudin could reduce bleeding complications compared with UFH . Therefore, bivalirudin appears to be a suitable alternative for anticoagulation in PCI. However, the safety and efficacy of bivalirudin in complex PCI procedure like chronic total occlusion (CTO) lesions are still uncertain.CTO is encountered in 15–30% of patients undergoing diagnostic coronary angiography . Compared to patients without CTO, CTO patients have more comorbidities, more extensive CAD and are more frequently referred for bypass surgery . Successful CTO PCI has been demonstrated to improve quality of life and left ventricular function, and reduce ischemia or the need for subsequent bypass surgery . However, CTO recanalization remains one of the most
Catheterization and Cardiovascular Interventions – Wiley
Published: Jan 1, 2018
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