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Yaginuma K, Moehlis H, Koch M, Tischer K, Werner J, Werner GS. Bioresorbable vascular scaffolds for complex chronic total occlusions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:220-227. [DOI: 10.1016/j.carrev.2018.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/26/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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Szijgyarto Z, Rampat R, Werner GS, Ho C, Reifart N, Lefevre T, Louvard Y, Avran A, Kambis M, Buettner HJ, Di Mario C, Gershlick A, Escaned J, Sianos G, Galassi A, Garbo R, Goktekin O, Meyer-Gessner M, Lauer B, Elhadad S, Bufe A, Boudou N, Sievert H, Martin-Yuste V, Thuesen L, Erglis A, Christiansen E, Spratt J, Bryniarski L, Clayton T, Hildick-Smith D. Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry. JACC Cardiovasc Interv 2019; 12:335-342. [DOI: 10.1016/j.jcin.2018.11.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/09/2018] [Accepted: 11/13/2018] [Indexed: 12/25/2022]
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Karamasis GV, Kalogeropoulos AS, Mohdnazri SR, Al-Janabi F, Jones R, Jagathesan R, Aggarwal RK, Clesham GJ, Tang KH, Kelly PA, Davies JR, Werner GS, Keeble TR. Serial Fractional Flow Reserve Measurements Post Coronary Chronic Total Occlusion Percutaneous Coronary Intervention. Circulation 2018. [PMID: 30571203 DOI: 10.1161/circ.137.suppl_1.p341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The aim of this study was to evaluate the functional result of chronic total occlusion percutaneous coronary intervention (PCI) measured by fractional flow reserve (FFR) immediately post the index procedure and at short-term follow-up. Methods and Results This was a prospective single-center observational study. Consecutive patients with right coronary artery chronic total occlusion scheduled for elective PCI were included. FFR measurements were performed immediately after successful PCI and at 4 months follow-up. Twenty-six patients completed baseline and follow-up measurements. Mean age was 61.2±9.7 years, 88.5% of the patients were male, and 19.2% were diabetic. The mean FFR immediately after successful chronic total occlusion PCI was 0.82±0.10 and significantly increased to 0.89±0.07 at 4 months ( P<0.001). The FFR increased in 77% of the patients with a mean absolute increase of 0.07±0.08. The incidence of FFR ≤0.80 immediately after PCI was significantly higher amongst patients with subintimal versus intraplaque recanalization (23% versus 12%; P=0.03). At 4 months, FFR ≤0.80 was found only in 2 patients with subintimal recanalization. At follow-up, 42.7% of the patients continued to have an FFR <0.90. Conclusions Post chronic total occlusion PCI, FFR increased significantly at short-term follow-up compared with measurements post index procedure. Because FFR remained <0.90 in many cases, further efforts should be made to optimize procedural results.
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Karamasis GV, Kalogeropoulos AS, Mohdnazri SR, Al-Janabi F, Jones R, Jagathesan R, Aggarwal RK, Clesham GJ, Tang KH, Kelly PA, Davies JR, Werner GS, Keeble TR. Serial Fractional Flow Reserve Measurements Post Coronary Chronic Total Occlusion Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2018; 11:e006941. [DOI: 10.1161/circinterventions.118.006941] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Tajti P, Burke MN, Karmpaliotis D, Alaswad K, Werner GS, Azzalini L, Carlino M, Patel M, Mashayekhi K, Egred M, Krestyaninov O, Khelimskii D, Nicholson WJ, Ungi I, Galassi AR, Banerjee S, Brilakis ES. Reply: Strong Bias Toward Performing Percutaneous Coronary Intervention in Patients With Chronic Total Occlusion Despite Lack of Important Benefit at a Very High Cost and Risk to the Patient. JACC Cardiovasc Interv 2018; 11:1541-1542. [PMID: 30093064 DOI: 10.1016/j.jcin.2018.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 11/26/2022]
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Werner GS. Reducing radiation exposure during PCI of chronic total occlusions – better is not good enough. EUROINTERVENTION 2018; 14:e496-e498. [DOI: 10.4244/eijv14i5a88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bufe A, Di Mario C, Landmesser U, Gessner MM, Sianos G, Garbo R, Dini CS, Lauer B, Boudou N, Grancini L, Avran A, Lauten A, Mashayekhi K, Hildick-Smith D, Escaned J, Buettner HJ, Reifart N, Lapp H, Galassi AR, Werner GS. The Experts "Live" Workshop of the EuroCTO Club 2017, Berlin. EUROINTERVENTION 2018; 13:1987-1990. [PMID: 29674299 DOI: 10.4244/eijv13i17a324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Galassi AR, Sumitsuji S, Boukhris M, Brilakis ES, Di Mario C, Garbo R, Spratt JC, Christiansen EH, Gagnor A, Avran A, Sianos G, Werner GS. Utility of Intravascular Ultrasound in Percutaneous Revascularization of Chronic Total Occlusions: An Overview. JACC Cardiovasc Interv 2017; 9:1979-1991. [PMID: 27712732 DOI: 10.1016/j.jcin.2016.06.057] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/13/2016] [Accepted: 06/30/2016] [Indexed: 11/18/2022]
Abstract
Intravascular ultrasound has been used for >20 years to guide percutaneous coronary intervention in different subsets of coronary lesions. During the last decade, the interest in percutaneous coronary intervention for chronic total occlusion (CTO) has increased dramatically, leading to high success rates. Failure of guidewire crossing is the most common reason for failed CTO attempts. Certain angiographic features, such as blunt proximal CTO cap, tortuosity, heavy calcification, and lack of visibility of path in the distal vessel, increase procedural difficulty. A better understanding of the behavior of the guidewire within the CTO segment may represent a key issue to achieve successful outcome. In this respect, intravascular ultrasound imaging might have potential roles in the recanalization of CTOs. In this paper, we focused on the usefulness and the applications of intravascular ultrasound imaging in percutaneous CTO recanalization, underlying its impact on clinical outcome.
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Werner GS, Ahmed WH. Fenestration of a Papyrus PK covered stent to recover the occluded left main bifurcation after sealing a left main perforation during a CTO procedure. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:41-44. [DOI: 10.1016/j.carrev.2017.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 01/10/2023]
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Di Mario C, Sorini Dini C, Werner GS. Thousand Registries Are Not Worth a Randomized Trial. JACC Cardiovasc Interv 2017; 10:1535-1537. [DOI: 10.1016/j.jcin.2017.06.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 11/26/2022]
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Werner GS. Optimal approach to percutaneous intervention for CTO in 2017: the traditional strategy is still the best. EUROINTERVENTION 2017; 12:e1802-e1804. [PMID: 28167459 DOI: 10.4244/eijv12i15a293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Werner GS, Glaser P, Coenen A, Moehlis H, Tischer KH, Koch M, Klingenbeck R. Reduction of radiation exposure during complex interventions for chronic total coronary occlusions: Implementing low dose radiation protocols without affecting procedural success rates. Catheter Cardiovasc Interv 2017; 89:1005-1012. [DOI: 10.1002/ccd.26886] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/29/2016] [Accepted: 11/20/2016] [Indexed: 01/14/2023]
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Werner GS, Brilakis ES. Chronic Total Coronary Occlusion. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Unverdorben M, Vallbracht C, Cremers B, Heuer H, Hengstenberg C, Maikowski C, Werner GS, Antoni D, Kleber FX, Bocksch W, Leschke M, Ackermann H, Boxberger M, Speck U, Degenhardt R, Scheller B. Paclitaxel-coated balloon catheter versus paclitaxel-coated stent for the treatment of coronary in-stent restenosis: the three-year results of the PEPCAD II ISR study. EUROINTERVENTION 2016; 11:926-34. [PMID: 25169589 DOI: 10.4244/eijy14m08_12] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS Treatment of bare metal in-stent restenosis with the paclitaxel-coated balloon catheter based on the PACCOCATH® technology has yielded superior six-month angiographic and one-year clinical results compared to a paclitaxel-eluting stent. The three-year clinical follow-up is presented. METHODS AND RESULTS One hundred and thirty-one patients with coronary bare metal in-stent restenosis (>70%, length: <22 mm, vessel diameter: 2.5-3.5 mm) were randomly treated with the paclitaxel-coated balloon (DCB) (3 µg/mm²) or a paclitaxel-eluting stent (DES). Clinical follow-up information was requested from the patients and from their physicians. Quantitative angiographic and demographic baseline data were statistically not different between the groups. Per intention-to-treat analysis at 12 months, the lesion-related rates of major adverse cardiac events were 7.6% and 16.9% (p=0.11) while at 36 months the respective numbers were 9.1% and 18.5% (p=0.14). These differences were primarily due to reduced target lesion revascularisation (TLR) in DCB 4/66 (6.2%) compared to DES patients 10/65 (15.4%) (p=0.10). From 12 to 36 months, 1/65 (1.5%) DCB patients experienced a myocardial infarction while neither TLR nor death occurred in any study patient in either group during that period. CONCLUSIONS The six-month superiority of the paclitaxel-coated balloon compared to the paclitaxel-eluting stent in the treatment of bare metal coronary in-stent restenosis persisted throughout the three-year clinical follow-up period indicating stability of the lesions treated. (ClinicalTrials.gov Identifier: NCT00393315).
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McEntegart MB, Badar AA, Ahmad FA, Shaukat A, MacPherson M, Irving J, Strange J, Bagnall AJ, Hanratty CG, Walsh SJ, Werner GS, Spratt JC. The collateral circulation of coronary chronic total occlusions. EUROINTERVENTION 2016; 11:e1596-603. [PMID: 27056120 DOI: 10.4244/eijv11i14a310] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Despite advances in understanding the physiological role of collaterals in coronary chronic total occlusions (CTOs), collateral anatomy remains poorly defined. Our aim was to define the anatomy and interventional utility of collaterals within a large population of patients with CTOs. METHODS AND RESULTS We studied the coronary angiograms of 481 patients with 519 CTOs at six centres in the U.K. over four years. Detailed angiographic analysis was performed by interventional cardiologists specialising in CTO percutaneous coronary intervention (PCI). All visible collaterals with a collateral connection (CC) grade ≥1 were recorded. A subgroup of CTOs (n=277) was assessed for interventional capability, defined as whether the collateral supply was able to facilitate retrograde access. We described 45 different collateral patterns: 20 in right coronary artery (RCA), 13 in left anterior descending (LAD), and 12 in circumflex artery CTOs. Septal collaterals from the LAD to the right posterior descending artery (RPDA), and from the posterior descending artery to the LAD were most common, and most often considered as having "interventional capability". CONCLUSIONS This is the largest analysis of collateral circulation anatomy in a population of patients with CTOs. We anticipate that these data will be of significant benefit in angiographic analysis and procedure planning for CTO PCI.
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Debski A, Tyczynski P, Demkow M, Witkowski A, Werner GS, Agostoni P. How should I treat a chronic total occlusion of a saphenous vein graft? Successful retrograde revascularisation. EUROINTERVENTION 2016; 11:e1325-8. [PMID: 26865453 DOI: 10.4244/eijv11i11a257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Galassi AR, Brilakis ES, Boukhris M, Tomasello SD, Sianos G, Karmpaliotis D, Di Mario C, Strauss BH, Rinfret S, Yamane M, Katoh O, Werner GS, Reifart N. Appropriateness of percutaneous revascularization of coronary chronic total occlusions: an overview. Eur Heart J 2015; 37:2692-700. [DOI: 10.1093/eurheartj/ehv391] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/26/2015] [Indexed: 01/24/2023] Open
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Werner GS, Hecht H, Stone GW. Utility of CT Angiography to Guide Coronary Intervention of CTO. JACC Cardiovasc Imaging 2015; 8:814-6. [DOI: 10.1016/j.jcmg.2015.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/10/2015] [Accepted: 04/16/2015] [Indexed: 12/01/2022]
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Galassi AR, Sianos G, Werner GS, Escaned J, Tomasello SD, Boukhris M, Castaing M, Büttner JH, Bufe A, Kalnins A, Spratt JC, Garbo R, Hildick-Smith D, Elhadad S, Gagnor A, Lauer B, Bryniarski L, Christiansen EH, Thuesen L, Meyer-Geßner M, Goktekin O, Carlino M, Louvard Y, Lefèvre T, Lismanis A, Gelev VL, Serra A, Marzà F, Di Mario C, Reifart N. Retrograde Recanalization of Chronic Total Occlusions in Europe. J Am Coll Cardiol 2015; 65:2388-400. [DOI: 10.1016/j.jacc.2015.03.566] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/20/2015] [Accepted: 03/20/2015] [Indexed: 12/12/2022]
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Werner GS. The role of coronary collaterals in chronic total occlusions. Curr Cardiol Rev 2015; 10:57-64. [PMID: 24611646 PMCID: PMC3968594 DOI: 10.2174/1573403x10666140311123814] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/28/2013] [Accepted: 04/19/2013] [Indexed: 11/22/2022] Open
Abstract
A chronic total occlusion (CTO) describes a completely occluded coronary artery. This type of lesion is found in about 18% of all significant lesions in patients with coronary artery disease. A system of collateral connections are observed in almost all of these lesions, which have the capacity to prevent myocardial necrosis and may even uphold metabolic supply to the territory distal to an occlusion to maintain full contractile capacity. During exercise these collaterals are limited in their functional reserve, and more than 90% of patients with a well collateralized occlusion will experience ischemia. in the absence of ideal animal models that mimic the human collateral circulation, we need to rely on studies in man. The knowledge of collateral physiology in man has increased considerably over the past two decades with the advent of intracoronary sensors of coronary pressure and flow velocity. A number of basic physiologic questions have been answered by these studies. The blood supply through coronary arteries depends on a complex array of in general serial resistance systems, with an additional array of multiple parallel resistances on the collateral level. There seems to be a great interindividual variability in the ability to recruit preformed collateral connections in the case of an epicardial occlusion. Collateral function can develop to a similar functional level in patients post myocardial infarction with large akinetic territories as it does in patients with normal preserved regional function. The presence of viability is thus not a prerequisite for collateral development. The question of practical relevance in the era of interventional therapy of chronic occlusions is also, whether a patient with coronary artery disease will remain protected by collaterals after removing the obstruction in the collateralized artery, or whether collaterals regress and lose their functional capacity. Both developments are observed again mainly depending of individual predisposition.
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Werner GS, Coenen A, Tischer KH. Periprocedural ischaemia during recanalisation of chronic total coronary occlusions: the influence of the transcollateral retrograde approach. EUROINTERVENTION 2014; 10:799-805. [DOI: 10.4244/eijv10i7a139] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Reifart N, Werner GS. Subintimal wire pathway: part of the game of crossing chronic total coronary occlusions. EUROINTERVENTION 2014; 10:655-7. [PMID: 25330498 DOI: 10.4244/eijv10i6a115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sachdeva R, Agrawal M, Flynn SE, Werner GS, Uretsky BF. Rebuttal: change in donor artery fractional flow reserve after recanalization of a chronic total occlusion-not as impressive as some might have us believe. Catheter Cardiovasc Interv 2014; 83:1187-9. [PMID: 24259449 DOI: 10.1002/ccd.25304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/16/2013] [Indexed: 11/06/2022]
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Brilakis ES, Karmpaliotis D, Werner GS, Spratt JC, Uretsky BF, Luna M, Banerjee S. Developments in coronary chronic total occlusion percutaneous coronary interventions: 2014 state-of-the-art update. THE JOURNAL OF INVASIVE CARDIOLOGY 2014; 26:261-266. [PMID: 24907082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) is a rapidly developing field. In the present review, we summarize the most important CTO PCI related literature published in 2013.
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