Teaching CTO Techniques Across Continents: Dr. Michael Megaly Delivers Two Invited Lectures at Multi-level CTO Middle East, Cairo 2024

In October 2024, Dr. Michael Megaly traveled from the United States as invited international faculty to the Multi-level CTO Middle East conference in Cairo, Egypt, where he delivered two lectures on the planning and technical execution of chronic total occlusion percutaneous coronary intervention.

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is among the most technically demanding procedures in interventional cardiology. A CTO is a coronary artery that has been completely blocked for at least 3 months, and reopening it often requires advanced crossing strategies that fall outside the scope of general interventional training. The retrograde approach — reaching the occlusion from its far side via collateral channels — and dissection and re-entry maneuvers, such as the "knuckle wire," are reserved for operators with dedicated CTO expertise.

The Multi-level CTO Middle East conference convenes leading CTO operators to teach these techniques to interventional cardiologists across the region. For the 2024 meeting in Cairo, the program drew its teaching faculty largely from the Middle East, with a limited number of operators invited from abroad. Dr. Megaly was among that international contingent, invited from his practice in the United States to teach physicians from Egypt and the surrounding region.

He delivered two invited lectures. In "Setting the Scene for CTO PCI," he addressed case selection, angiographic assessment, and procedural planning — the foundational decisions that determine whether a complex occlusion can be crossed safely and successfully. In "Controlling Your Knuckle in Retrograde CTO PCI," he focused on a specific technical challenge: directing and limiting the knuckle-wire loop during retrograde dissection and re-entry, a maneuver that risks vessel injury and procedural failure when poorly controlled.

His selection as international faculty reflects his standing in the global CTO community. Dr. Megaly is a co-author of The Manual of CTO PCI with Dr. Emmanouil Brilakis, has written multiple book chapters on retrograde and hybrid CTO strategies, and serves as invited faculty at major meetings, including Cardiovascular Research Technologies (CRT) and CTO Plus.

For patients, the techniques taught at meetings like this translate directly into care. Operators trained in retrograde access, controlled dissection, and re-entry can treat patients whose occlusions would otherwise be deemed uncrossable — patients who might otherwise remain on medical therapy alone or be referred for bypass surgery.

The teaching role is also a two-way exchange: faculty who instruct internationally stay at the leading edge of the methods they bring back to their own practice.

Dr. Michael Megaly specializes in complex and high-risk coronary interventions, chronic total occlusion (CTO) PCI, surgical turn-downs, complex peripheral artery disease, and limb salvage at Integris Health Heart Hospital in Oklahoma City.