151
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Azzalini L, Alaswad K, Uretsky BF, Agostoni P, Galassi AR, Harada Ribeiro M, Filho EM, Morales-Victorino N, Attallah A, Gupta A, Zivelonghi C, Montorfano M, Bellini B, Carlino M. Multicenter experience with the antegrade fenestration and reentry technique for chronic total occlusion recanalization. Catheter Cardiovasc Interv 2020; 97:E40-E50. [PMID: 32320133 DOI: 10.1002/ccd.28941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/09/2020] [Accepted: 04/13/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We aimed to evaluate the efficacy and safety of antegrade fenestration and reentry (AFR) for chronic total occlusion (CTO) recanalization in a multicenter registry. BACKGROUND Adoption of antegrade dissection/reentry (ADR) for CTO recanalization has been limited, and novel ADR techniques are needed. METHODS AFR involves the balloon-induced creation of multiple fenestrations between the false and true lumen. A targeted true lumen reentry is subsequently achieved with a low tip-load polymer-jacketed guidewire. Following the initial description and dissemination of AFR, patients undergoing AFR-based CTO recanalization at nine centers were included in the present registry. Study endpoints were AFR success, procedural success, and target-lesion failure (TLF) on follow-up. RESULTS We included 41 patients. Mean J-CTO score was 2.5 ± 1.4. In 80.5% of cases, AFR was performed after failed antegrade wire escalation. Another ADR technique was used before AFR in one-third of cases. AFR achieved distal true lumen reentry in n = 27/41 (65.9%) cases. In n = 14/41 (34.1%) cases with AFR failure, use of alternative techniques led to successful CTO recanalization in eight additional patients. The overall technical and procedural success rates were 85.4% and 82.9%, respectively. No AFR-related complications were observed. One-year TLF rate was 8.3% overall, with no differences between successful and failed AFR. CONCLUSIONS We report on AFR feasibility in a multicenter registry of patients undergoing CTO recanalization. We observed a moderate success rate, coupled with the absence of complications. Moreover, even a failed AFR attempt did not preclude the use of alternative techniques to achieve recanalization. Further studies should confirm and extend our findings.
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Affiliation(s)
- Lorenzo Azzalini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Barry F Uretsky
- Department of Cardiology, University of Arkansas for Medical Sciences (UAMS) and Central Arkansas Veterans Health System (CAVHS), Little Rock, Arkansas, USA
| | | | - Alfredo R Galassi
- Department of PROMISE, University of Palermo, Palermo, Italy.,Department of Cardiology, Royal Brompton & Harefield Hospital, London, UK
| | - Marcelo Harada Ribeiro
- SOS CÁRDIO Hospital, Florianópolis, Santa Catarina, Brazil.,Heart Institute, São Paulo University School of Medicine, São Paulo, São Paulo, Brazil
| | - Evandro Martins Filho
- Interventional Cardiology, Santa Casa de Misericórdia de Maceió, Maceió, Alagoas, Brazil
| | | | | | - Ankur Gupta
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Carlo Zivelonghi
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Matteo Montorfano
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
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152
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Nagamatsu W, Tsuchikane E, Oikawa Y, Sumitsuji S, Igarashi Y, Yoshikawa R, Muto M, Okada H, Katoh O. Successful guidewire crossing via collateral channel at retrograde percutaneous coronary intervention for chronic total occlusion: the J-Channel score. EUROINTERVENTION 2020; 15:e1624-e1632. [DOI: 10.4244/eij-d-18-00993] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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153
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Malik AO, Spertus JA, Grantham JA, Peri-Okonny P, Gosch K, Sapontis J, Moses J, Lombardi W, Karmpaliotis D, Nicholson WJ, Al Badarin F, Salisbury AC. Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Renal Dysfunction. Am J Cardiol 2020; 125:1046-1053. [PMID: 31955832 DOI: 10.1016/j.amjcard.2019.12.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
Although contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is performed with high success rates, 10% to 13% of patients presenting with CTOs have chronic kidney disease (CKD), and the comparative safety, efficacy, and health status benefit of CTO PCI in these patients, has not been well defined. We examined the association of baseline renal function with periprocedural major adverse cardiovascular and cerebral events and health status outcomes in 957 consecutive patients (mean age 65.3 ± 10.3 years, 19.4% women, 90.3% white, 23.6 CKD [estimated glomerular filtration rate {eGFR} < 60]) in the OPEN-CTO (Outcomes, Patients Health Status, and Efficiency in Chronic Total Occlusions Registry) study. Hierarchical multivariable regression models were used to examine the independent association of baseline eGFR with technical success, periprocedural complications and change in health status, using Seattle Angina Questionnaire (SAQ) over 1 year. Crude rates of acute kidney injury were higher (13.5% vs 4.4%, p <0.001) and technical success lower (81.8% vs 88.4%, p = 0.01) in patients with CKD. There were no significant differences in other periprocedural complications. After adjustment for confounding factors, there was no significant association of baseline eGFR with technical success or periprocedural major adverse cardiovascular and cerebral events (death, myocardial infarction, emergent bypass surgery, stroke, perforation), whereas patients with lower eGFR had higher rates of acute kidney injury. The difference in SAQ summary score, between patients on the 10th and 90th percentile for baseline eGFR distribution was not clinically significant (1 month: -0.91; 1 year: -3.06 points). In conclusion, CTO PCI success, complication rates, and the health status improvement after CTO PCI are similar in patients across a range of baseline eGFRs.
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154
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Impact of Subintimal or Plaque Modification on Repeat Chronic Total Occlusion Angioplasty Following an Unsuccessful Attempt. JACC Cardiovasc Interv 2020; 13:1010-1012. [DOI: 10.1016/j.jcin.2020.01.214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 11/17/2022]
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155
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Ojeda S, Luque A, Pan M, Bellini B, Xenogiannis I, Lostalo A, Montorfano M, Hidalgo F, Venuti G, La Manna A, Carlino M, Brilakis ES, Azzalini L. Percutaneous coronary intervention in aorto-ostial coronary chronic total occlusion: outcomes and technical considerations in a multicenter registry. ACTA ACUST UNITED AC 2020; 73:1011-1017. [PMID: 32146121 DOI: 10.1016/j.rec.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/15/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Percutaneous coronary intervention (PCI) for aorto-ostial chronic total coronary occlusion (CTO) can be a particularly challenging lesion subset. The aim of this study was to analyze the technical aspects and outcomes of aorto-ostial CTO PCI in a multicenter registry. METHODS Patients undergoing aorto-ostial CTO PCI at 4 centers between February 2013 and December 2018 were included. Success rates, as well as procedural aspects and outcomes, were analyzed. RESULTS A total of 103 patients were included. Mean age was 64±10 years and the mean J-CTO score was 3.1±1.1. Thirty-one lesions (30.4%) were flush ostial CTOs. Technical and procedural success were achieved in 79 (76.7%) and 78 (75.7%) of the patients, respectively. The retrograde approach was the most frequent successful crossing technique (n=49; 62.0%), especially in flush vs nonflush aorto-ostial CTOs (82.6% vs 53.5%; P=.02). The only variable independently associated with technical failure was the absence of interventional collaterals (OR, 12.38; 95%CI, 4.02-38.15; P <.001). Coronary perforation occurred in 4 patients (3.9%) requiring covered stent implantation (without subsequent cardiac tamponade) and 2 patients (1.9%) had a stroke (one of which was a transient ischemic attack). During a median follow-up of 31 months, 3 (2.9%) patients died from cardiovascular causes and 13 (12.6%) required repeat target vessel revascularization. CONCLUSIONS Aorto-ostial occlusions represent a challenging subset for PCI. However, an acceptable success rate with favorable outcomes during follow-up can be achieved by experienced operators. The presence of interventional collaterals allowing the use of the retrograde approach is key for achieving procedural success.
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Affiliation(s)
- Soledad Ojeda
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
| | - Aurora Luque
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Manuel Pan
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Barbara Bellini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Iosif Xenogiannis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, United States
| | - Adrián Lostalo
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Matteo Montorfano
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francisco Hidalgo
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Giuseppe Venuti
- Division of Cardiology, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Alessio La Manna
- Division of Cardiology, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, United States
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy; Cardiac Catheterization Laboratory, The Mount Sinai Hospital, New York, NY, United States
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156
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Zhao Y, Peng H, Li X, Liu J. The impact of dissection and re-entry versus wire escalation techniques on long-term clinical outcomes in patients with chronic total occlusion lesions following percutaneous coronary intervention: An updated meta-analysis. Cardiol J 2020; 28:369-383. [PMID: 32104900 DOI: 10.5603/cj.a2020.0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/25/2020] [Accepted: 02/16/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The meta-analysis was performed to evaluate the effect of dissection and re-entry (DR) vs. wire escalation (WE) techniques on long-term clinical outcomes in patients with chronic total occlusion (CTO) lesions undergoing percutaneous coronary intervention. METHODS Studies were searched in electronic databases from inception to September, 2019. Results were pooled using random effects model and fixed effects model and are presented as risk ratios (RR) with 95% confidence intervals (CI). RESULTS Pooled analyses revealed that patients with DR techniques had overall higher complexity CTO lesions than patients with WE techniques and required a greater number of stents and a greater mean stent length. The "extensive" DR techniques may have a higher incidence of target vessel revascularization (TVR) (RR = 2.30, 95% CI: 1.77-2.98), in-stent restenosis (RR = 1.71, 95% CI: 1.30-2.23), in-stent reocclusion (RR = 1.86, 95% CI: 1.03-3.3) and death/myocardial infarction/TVR (RR = 2.10, 95% CI: 1.71-2.58), when compared with WE techniques, during the long-term follow-up. However, "limited" DR techniques result in more promising outcomes, and are comparable to conventional WE techniques. CONCLUSIONS Dissection and re-entry techniques were associated with increased risk of long-term negative clinical events, especially "extensive" DR techniques. However, "limited" DR techniques resulted in good long-term outcomes, comparable to WE techniques.
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Affiliation(s)
- Yejing Zhao
- Beijing Anzhen Hospital, Capital University.
| | | | - Xiaonan Li
- Beijing Anzhen Hospital, Capital University
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157
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Saxon JT, Grantham JA, Salisbury AC, Sapontis J, Lombardi WL, Karmpaliotis D, Moses J, Nicholson WJ, Tang Y, Cohen DJ, Spertus JA, Safley DM. Appropriate Use Criteria and Health Status Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the OPEN-CTO Registry. Circ Cardiovasc Interv 2020; 13:e008448. [PMID: 32069112 DOI: 10.1161/circinterventions.119.008448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The American College of Cardiology/American Heart Association Appropriate Use Criteria were designed to aid clinical decision-making, yet their association with health status outcomes after chronic total occlusion percutaneous coronary intervention (PCI) is unknown. METHODS We analyzed 769 patients with baseline and 1-year health status data after chronic total occlusion PCI. Procedures were categorized as appropriate, may be appropriate, or rarely appropriate. Mean changes in patient-reported health status, assessed by the Seattle Angina Questionnaire (SAQ), were compared across appropriate use criteria categories from baseline to 1 year. Change in SAQ summary score was stratified as little to no benefit (≤10 points), intermediate (10-19 points), large (20-29 points), and very large (≥30 points). RESULTS The appropriate use criteria indication was appropriate in 573 patients (74.5%), may be appropriate in 191 (24.8%), and rarely appropriate in 5 (0.7%). Patients in the appropriate group reported greater improvement in SAQ summary scores (27.3±21.3 points) at 1 year compared with the may be appropriate (22.5±20.9; P=0.01). A similar pattern was noted for SAQ angina frequency (mean change 24.0±27.2 versus 18.7±25.6; P=0.02). The appropriate group had the highest proportion of very large improvements in SAQ summary scores (44.5% versus 33.3%; P=0.01). CONCLUSIONS Among patients undergoing chronic total occlusion PCI, the rate of rarely appropriate PCI was low. The rate of appropriate PCI was high and was associated with the greatest health status improvement at 1 year. A substantial proportion of patients in the may be appropriate group experienced meaningful health status benefits as well.
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Affiliation(s)
- John T Saxon
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | | | | | | | - Jeffery Moses
- Columbia University Medical Center/New York-Presbyterian Hospital (D.K., J.M.)
| | | | - Yuanyuan Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.)
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - David M Safley
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
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158
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Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention via Saphenous Vein Graft. JACC Cardiovasc Interv 2020; 13:517-526. [DOI: 10.1016/j.jcin.2019.10.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/16/2019] [Accepted: 10/10/2019] [Indexed: 11/22/2022]
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159
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Rinfret S, Dautov R. When SVGs “Had Enough”. JACC Cardiovasc Interv 2020; 13:527-529. [DOI: 10.1016/j.jcin.2019.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
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160
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Quadros A, Belli KC, de Paula JET, de Magalhães Campos CAH, da Silva ACB, Santiago R, Ribeiro MH, de Oliveira PP, Lamelas P, Abelin AP, Bezerra CG, Filho EM, Fuchs FC, de Los Santos FD, de Andrade PB, Quesada FLH, Araya M, Perez LA, Côrtes LA, Zukowski CN, Alcantara M, Muniz AJ, Martinelli GC, de Carvalho Cantarelli MJ, Brito FS, Baradel S, de Alencar Araripe Falcão B, Mangione JA, Medeiros CR, Degrazia RC, Lecaro JAN, Gioppato S, Ybarra LF, Weilenmann D, Gottschall CAM, Lemke V, Padilla L. Chronic total occlusion percutaneous coronary intervention in Latin America. Catheter Cardiovasc Interv 2020; 96:1046-1055. [PMID: 31990453 DOI: 10.1002/ccd.28744] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To report clinical, angiographic characteristics, outcomes, and predictors of unsuccessful procedures in patients who underwent chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in Latin America. BACKGROUND CTO PCI has been increasingly performed worldwide, but there is a lack of information in this region. METHODS An international multicenter registry was developed to collect data on CTO PCI performed in centers in Latin America. Patient, angiographic, procedural and outcome data were evaluated. Predictors of unsuccessful procedures were assessed by multivariable analysis. RESULTS We have included data related to 1,040 CTO PCIs performed in seven countries in Latin America (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, and Puerto Rico). The mean age was 64 ± 10 years, and CTO PCI was performed mainly for angina control (81%) or treatment of a large ischemic area (30%). Overall technical success rate was 82.5%, and it was achieved with antegrade wire escalation in 81%, antegrade dissection/re-entry in 8% and with retrograde techniques in 11% of the successful procedures. Multivariable analysis identified moderate/severe calcification, a blunt proximal cap and a previous attempt as independent predictors of unsuccessful procedures. In-hospital major adverse cardiovascular events (MACE) occurred in 3.1% of the cases, death in 1% and cardiac tamponade in 0.9% CONCLUSIONS: CTO PCI in Latin America has been performed mainly for ischemia relief. Procedures were associated with a success rate above 80% and low incidence of MACE. Predictors of unsuccessful procedures were similar to those previously reported in the literature.
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Affiliation(s)
- Alexandre Quadros
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil.,Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista, Brazil
| | - Karlyse C Belli
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | | | | | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | - Félix D de Los Santos
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.,Hospital San Ángel, Mexico City, Mexico
| | | | | | | | - Luis A Perez
- Hospital Clinico Regional Dr Guillermo Grant Benavente, Concepción, Chile
| | | | | | | | - Antônio J Muniz
- Santa Casa de Misericórdia Juiz de Fora, Juiz de Fora, Brazil
| | | | | | | | - Sandra Baradel
- Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista, Brazil
| | | | | | - César R Medeiros
- Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista, Brazil.,Hospital Badim, Rio de Janeiro, Brazil.,Hospital Unimed Rio, Rio de Janeiro, Brazil
| | - Ramiro C Degrazia
- Hospital Unimed RS, Caxias do Sul, Brazil.,Hospital Nossa Senhora de Pompeia, Caxias do Sul, Brazil.,Hospital Circulo Operario Caxiense, Caxias do Sul, Brazil
| | - José A N Lecaro
- Hospital de Especialidades Eugenio Espejo, Quito, Ecuador.,Hospital de Los Valles, Quito, Ecuador
| | - Silvio Gioppato
- Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista, Brazil.,Hospital de Clínicas da UNICAMP, Campinas, Brazil.,Hospital Vera Cruz, Campinas, Brazil
| | - Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | | | - Viviana Lemke
- Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista, Brazil
| | - Lucio Padilla
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
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161
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Okamura A, Iwakura K, Iwamoto M, Nagai H, Sumiyoshi A, Tanaka K, Tanaka T, Inoue K, Koyama Y, Fujii K. Tip Detection Method Using the New IVUS Facilitates the 3-Dimensional Wiring Technique for CTO Intervention. JACC Cardiovasc Interv 2020; 13:74-82. [DOI: 10.1016/j.jcin.2019.07.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/25/2019] [Accepted: 07/30/2019] [Indexed: 11/17/2022]
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162
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Vasiliev DK, Rudenko BA. Modern considerations of myocardial revascularization in coronary chronic total occlusion. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-6-69-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- D. K. Vasiliev
- National Medical Research Center for Preventive Medicine
| | - B. A. Rudenko
- National Medical Research Center for Preventive Medicine
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163
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Rougé A, Abdellaoui M, Monségu J, Faurie B. Transcoronary Rapid Pacing Solving a Complex Retrograde Chronic Total Occlusion Procedure. JACC Case Rep 2019; 1:832-837. [PMID: 34316941 PMCID: PMC8289134 DOI: 10.1016/j.jaccas.2019.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 12/01/2022]
Abstract
We report a case of revascularization of the right coronary artery via the epicardial collateral, for which we used transcoronary rapid pacing to obtain cardiac standstill while puncturing the distal chronic total occlusion (CTO) cap. To our knowledge, this is the first case in which this technique has been used in CTO. (Level of Difficulty: Advanced.)
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164
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Megaly M, Ali A, Saad M, Omer M, Xenogiannis I, Werner GS, Karmpaliotis D, Russo JJ, Yamane M, Garbo R, Gagnor A, Ungi I, Rinfret S, Pershad A, Wojcik J, Garcia S, Mashayekhi K, Sianos G, Galassi AR, Burke MN, Brilakis ES. Outcomes with retrograde versus antegrade chronic total occlusion revascularization. Catheter Cardiovasc Interv 2019; 96:1037-1043. [PMID: 31778041 DOI: 10.1002/ccd.28616] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/27/2019] [Accepted: 11/11/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate the outcomes of retrograde versus antegrade approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND The retrograde approach has increased the success rate of CTO PCI but has been associated with a higher risk for complications. METHODS We conducted a meta-analysis of studies published between 2000 and August 2019 comparing the in-hospital and long-term outcomes with retrograde versus antegrade CTO PCI. RESULTS Twelve observational studies (10,240 patients) met our inclusion criteria (retrograde approach 2,789 patients, antegrade approach 7,451 patients). Lesions treated with the retrograde approach had higher J-CTO score (2.8 vs. 1.9, p < .001). Retrograde CTO PCI was associated with a lower success rate (80.9% vs. 87.4%, p < .001). Both approaches had similar in-hospital mortality, urgent revascularization, and cerebrovascular events. Retrograde CTO PCI was associated with higher risk of in-hospital myocardial infarction (MI; odds ratio [OR] 2.37, 95% confidence intervals [CI] 1.7, 3.32, p < .001), urgent pericardiocentesis (OR 2.53, 95% CI 1.41-4.51, p = .002), and contrast-induced nephropathy (OR 2.12, 95% CI 1.47-3.08; p < .001). During a mean follow-up of 48 ± 31 months retrograde crossing had similar mortality (OR 1.79, 95% CI 0.84-3.81, p = .13), but a higher incidence of MI (OR 2.07, 95% CI 1.1-3.88, p = .02), target vessel revascularization (OR 1.92, 95% CI 1.49-2.46, p < .001), and target lesion revascularization (OR 2.08, 95% CI 1.33-3.28, p = .001). CONCLUSIONS Compared with antegrade CTO PCI, retrograde CTO PCI is performed in more complex lesions and is associated with a higher risk for acute and long-term adverse events.
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Affiliation(s)
- Michael Megaly
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.,Department of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Abdelrahman Ali
- Department of Medicine, Mercy Hospital and Medical Center, Chicago, Illinois
| | - Marwan Saad
- Division of Cardiovascular Medicine, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,Department of Cardiovascular Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - Mohamed Omer
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.,Department of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Gerald S Werner
- Medizinische Klinik I (Cardiology and Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany
| | | | - Juan J Russo
- Department of Cardiology, Columbia University, New York, New York
| | | | - Roberto Garbo
- Department of Invasive Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Imre Ungi
- Division of Invasive Cardiology, University of Szeged, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary
| | - Stephane Rinfret
- Division of Interventional Cardiology, McGill University Health Centre, Montreal, Canada
| | - Ashish Pershad
- Division of Cardiology, Banner-University Medical Center, Phoenix, Arizona
| | - Jaroslaw Wojcik
- Department of Cardiology, Hospital of Invasive Cardiology IKARDIA, Nałęczów, Poland
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Georgios Sianos
- First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Alfredo R Galassi
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
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165
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Wu EB, Brilakis ES, Lo S, Kalyanasundaram A, Mashayekhi K, Kao HL, Lim ST, Ge L, Chen JY, Qian J, Lee SW, Harding SA, Tsuchikane E. Advances in CrossBoss/Stingray use in antegrade dissection reentry from the Asia Pacific Chronic Total Occlusion Club. Catheter Cardiovasc Interv 2019; 96:1423-1433. [PMID: 31769597 PMCID: PMC7754104 DOI: 10.1002/ccd.28607] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 11/15/2022]
Abstract
Antegrade dissection reentry with Stingray device (Boston Scientific, Marlborough, MA) accounts for 20–34% of the chronic total occlusion (CTO) cases in the various hybrid operators' CTO registries and is an important component of CTO crossing algorithms. The Stingray device can facilitate antegrade dissection and reentry, however its use is low outside North America and Europe. The Asia Pacific CTO Club along with three experience Stingray operators from the US, Europe and India, created an algorithm guiding use of the CrossBoss and Stingray catheter. This APCTO Stingray algorithm defines when to use the CrossBoss and Stingray device recommending a reduction in CrossBoss use except for in‐stent restenosis lesions and immediate transition from knuckle wiring to the Stingray device. When antegrade wiring fails, choice of Stingray‐facilitated reentry versus parallel wiring depends on operator experience, device availability, cost concerns, and anatomical factors. When the antegrade wire enters the subintimal space, we recommend using a rotational microcatheter to produce a channel and deliver the Stingray balloon—so called the “bougie technique.” We recommend early switch to Stingray rather than persisting with single wire redirection or parallel wire. We recommend choosing a suitable reentry zone based on preprocedural computer tomography or angiogram, routine use of stick and swap, routine use of Subintimal TRAnscatheter Withdrawal (STRAW) through the Stingray balloon, and the multi stick and swap technique. We believe these techniques and algorithm can facilitate incorporation of the Stingray balloon into the practice of CTO interventionists globally.
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Affiliation(s)
- Eugene B Wu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University Hong Kong, Shatin, Hong Kong
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
| | | | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Soo-Teik Lim
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Lei Ge
- Department of Cardiology, Shanghai Zhongshan Hospital, Shanghai, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong General Hospital, Guangzhou, Guangdong, China
| | - Jie Qian
- Department of Cardiology, Beijing Fuwai Hospital, Beijing, China
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Centre, Seoul, South Korea
| | - Scott A Harding
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine, Toyohashi Heart Centre, Toyohashi, Aichi, Japan
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166
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Riley RF, Yeh RW. Myocardial Perfusion After Coronary Chronic Total Occlusion Percutaneous Coronary Intervention: Does It Matter to Myocytes How You Cross the Lesion? Circ Cardiovasc Interv 2019; 12:e008568. [PMID: 31672033 DOI: 10.1161/circinterventions.119.008568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert F Riley
- Christ Hospital Network (R.F.R.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robert W Yeh
- Smith Center for Outcomes Research in Cardiology (R.W.Y.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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167
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Schumacher SP, Stuijfzand WJ, Driessen RS, van Diemen PA, Bom MJ, Everaars H, Kockx M, Raijmakers PG, Boellaard R, van de Ven PM, van Rossum AC, Opolski MP, Nap A, Knaapen P. Impact of Specific Crossing Techniques in Chronic Total Occlusion Percutaneous Coronary Intervention on Recovery of Absolute Myocardial Perfusion. Circ Cardiovasc Interv 2019; 12:e008064. [DOI: 10.1161/circinterventions.119.008064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background:
Multiple crossing techniques in chronic total occlusion (CTO) percutaneous coronary intervention have been developed. This study compared recovery of quantitative myocardial blood flow (MBF) after different CTO percutaneous coronary intervention techniques.
Methods:
Consecutive patients with [
15
O]H
2
O positron emission tomography perfusion imaging before and 3 months after successful CTO percutaneous coronary intervention between 2013 and 2018 were included. Changes in hyperemic MBF, coronary flow reserve, and perfusion defect size were compared between antegrade wire escalation, retrograde wire escalation, antegrade dissection and reentry (ADR), and retrograde dissection and reentry.
Results:
One hundred ninety-three patients were treated with antegrade wire escalation (N=90), retrograde wire escalation (N=24), ADR (N=35), and retrograde dissection and reentry (N=44). Increase in hyperemic MBF (1.19±0.77, 0.94±0.65, 1.09±0.63, and 1.02±0.75 mL·min
-1
·g
-1
, respectively;
P
=0.40) and coronary flow reserve (1.34±1.08, 1.14±1.09, 1.31±0.96, and 1.24±0.99, respectively;
P
=0.84) and decrease in defect size (3.2±2.1, 3.0±2.2, 2.7±2.1, and 2.9±1.9 segments, respectively;
P
=0.77) were comparable between the 4 approaches. In addition, recovery of hyperemic MBF was less pronounced after subintimal crossing with knuckle-wire-technique compared with CrossBoss in controlled ADR and retrograde dissection and reentry (0.93±0.69 versus 1.54±0.65 mL·min
-1
·g
-1
,
P
=0.02), and less after reentry using subintimal tracking and reentry in ADR compared with controlled ADR (Stingray) or limited antegrade subintimal tracking (0.60±0.53 versus 1.18±0.54 [
P
=0.04] and versus 1.49±0.57 mL·min
-1
·g
-1
, [
P
<0.01]).
Conclusions:
Recovery of hyperemic MBF, coronary flow reserve, and perfusion defect size after CTO percutaneous coronary intervention was comparable between different approaches. Although sometimes necessary to cross a complex CTO lesion, subintimal knuckle wiring and subintimal tracking and reentry resulted in less hyperemic MBF improvement compared with other subintimal crossing and reentry techniques.
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Affiliation(s)
- Stefan P. Schumacher
- Department of Cardiology (S.P.S., W.J.S., R.S.D., P.A.v.D., M.J.B., H.E., M.K., A.C.v.R., A.N., P.K.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Wijnand J. Stuijfzand
- Department of Cardiology (S.P.S., W.J.S., R.S.D., P.A.v.D., M.J.B., H.E., M.K., A.C.v.R., A.N., P.K.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel S. Driessen
- Department of Cardiology (S.P.S., W.J.S., R.S.D., P.A.v.D., M.J.B., H.E., M.K., A.C.v.R., A.N., P.K.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pepijn A. van Diemen
- Department of Cardiology (S.P.S., W.J.S., R.S.D., P.A.v.D., M.J.B., H.E., M.K., A.C.v.R., A.N., P.K.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michiel J. Bom
- Department of Cardiology (S.P.S., W.J.S., R.S.D., P.A.v.D., M.J.B., H.E., M.K., A.C.v.R., A.N., P.K.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Henk Everaars
- Department of Cardiology (S.P.S., W.J.S., R.S.D., P.A.v.D., M.J.B., H.E., M.K., A.C.v.R., A.N., P.K.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marly Kockx
- Department of Cardiology (S.P.S., W.J.S., R.S.D., P.A.v.D., M.J.B., H.E., M.K., A.C.v.R., A.N., P.K.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pieter G. Raijmakers
- Department of Radiology and Nuclear Medicine (P.G.R., R.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine (P.G.R., R.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Peter M. van de Ven
- Department of Epidemiology and Biostatistics (P.M.v.d.V.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Albert C. van Rossum
- Department of Cardiology (S.P.S., W.J.S., R.S.D., P.A.v.D., M.J.B., H.E., M.K., A.C.v.R., A.N., P.K.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maksymilian P. Opolski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland (M.P.O.)
| | - Alexander Nap
- Department of Cardiology (S.P.S., W.J.S., R.S.D., P.A.v.D., M.J.B., H.E., M.K., A.C.v.R., A.N., P.K.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology (S.P.S., W.J.S., R.S.D., P.A.v.D., M.J.B., H.E., M.K., A.C.v.R., A.N., P.K.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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168
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Poletti E, Azzalini L, Ayoub M, Ojeda S, Zivelonghi C, La Manna A, Bellini B, Lostalo A, Luque A, Venuti G, Montorfano M, Agostoni P, Pan M, Carlino M, Mashayekhi K. Conventional vascular access site approach versus fully trans-wrist approach for chronic total occlusion percutaneous coronary intervention: a multicenter registry. Catheter Cardiovasc Interv 2019; 96:E45-E52. [PMID: 31596537 DOI: 10.1002/ccd.28513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/01/2019] [Accepted: 09/17/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the incidence of vascular complication and major bleeding in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with a fully trans-wrist access (TWA) approach versus a conventional approach based on trans-femoral access (TFA). BACKGROUND TFA is the preferred vascular access in CTO PCI, but it has been associated with a non-negligible risk of complications. METHODS This retrospective registry included all patients undergoing CTO PCI at five institutions between July 2011 and October 2018. Patients were divided into two groups: Conventional (patients treated with at least one TFA) and Fully TWA (subjects exclusively treated with one or two TWA). The primary safety endpoint was a composite of vascular complications and major bleeding. The primary efficacy endpoint was procedural success. RESULTS We included 1,900 patients (Conventional n = 1,496 and Fully TWA n = 404). Conventional patients showed higher occlusion complexity (J-CTO score 2.1 ± 1.2 vs. 1.5 ± 1.1, p < .001). Procedural success showed no significant difference between both groups (85.7 vs. 83.0%, p = .17). The primary safety endpoint occurred more frequently in the Conventional group (10.3 vs. 4.5%, p < .001), driven by vascular complications (9.4 vs. 3.7%, p < .001). On multivariate analysis, not using a Fully TWA approach was an independent predictor of the study endpoint, after adjusting for age, sex, diabetes, body mass index, chronic kidney disease, prior coronary artery bypass graft, and J-CTO score. CONCLUSIONS Embracing a Fully TWA approach for CTO PCI might be associated with lower incidence of a composite endpoint of vascular complications and major bleeding, compared with a Conventional approach.
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Affiliation(s)
- Enrico Poletti
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mohamed Ayoub
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Soledad Ojeda
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Carlo Zivelonghi
- Hartcentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Alessio La Manna
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Barbara Bellini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Adrián Lostalo
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Aurora Luque
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Giuseppe Venuti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Matteo Montorfano
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Manuel Pan
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
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169
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Iannaccone G, Scarparo P, Wilschut J, Daemen J, Den Dekker W, De Jaegere P, Zijlstra F, Van Mieghem NM, Diletti R. Current approaches for treatment of coronary chronic occlusions. Expert Rev Med Devices 2019; 16:941-954. [PMID: 31594416 DOI: 10.1080/17434440.2019.1676729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Coronary chronic total occlusions (CTO) represent a challenging subset in interventional cardiology.Areas covered: During the last decade, improvements in materials, techniques, and meticulous pre-procedural lesion assessment have increased the success rate in CTO lesions. Several scores have been developed to address overall lesion evaluation and help select the most appropriate treatment strategy. In addition, specific algorithms such as the hybrid algorithm have been introduced to provide a framework for CTO operators and a rapid management of the various challenging aspects of the procedure. The hybrid approach requires operator's ability to switch from one treatment strategy to another when the first one appears to be unsuccessful. Adequate training and operators' experience remain crucial to improve the likelihood of success.Expert opinion: The aim of this review is to provide insights and guidance for operators on current approaches for treatment of CTO and complication management.
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Affiliation(s)
- Giulia Iannaccone
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Paola Scarparo
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wijnand Den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Peter De Jaegere
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
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170
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Vo MN, Brilakis ES, Pershad A, Grantham JA. Modified subintimal transcatheter withdrawal: A novel technique for hematoma decompression to facilitate distal reentry during coronary chronic total occlusion recanalization. Catheter Cardiovasc Interv 2019; 96:E98-E101. [PMID: 31584234 DOI: 10.1002/ccd.28500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/22/2019] [Accepted: 08/30/2019] [Indexed: 11/06/2022]
Abstract
A controlled antegrade dissection and reentry technique is the most commonly employed crossing strategy for long coronary chronic total occlusions. The development of compressive hematoma is a recognized complication and results in the impairment of distal vessel visualization and hinders successful reentry attempts. We describe a novel technique utilizing a widely available microcatheter to decompress the subintimal hematoma to restore distal visualization and allow successful reentry.
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Affiliation(s)
- Minh N Vo
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | | | - Ashish Pershad
- Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, Missouri
| | - J Aaron Grantham
- Banner University Medical Center Phoenix and University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
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171
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Riley RF, Henry TD. CTO PCI: When at first you don't succeed…. Catheter Cardiovasc Interv 2019; 94:525-526. [PMID: 31602803 DOI: 10.1002/ccd.28518] [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: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Robert F Riley
- The Christ Hospital and Lindner Center for Research and Education, Cincinnati, Ohio
| | - Timothy D Henry
- The Christ Hospital and Lindner Center for Research and Education, Cincinnati, Ohio
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172
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Sekiguchi M, Muramatsu T, Kishi K, Muto M, Oikawa Y, Kawasaki T, Fujita T, Hamazaki Y, Okada H, Tsuchikane E. Assessment of reattempted percutaneous coronary intervention strategy for chronic total occlusion after prior failed procedures: Analysis of the Japanese CTO-PCI Expert Registry. Catheter Cardiovasc Interv 2019; 94:516-524. [PMID: 31062477 DOI: 10.1002/ccd.28315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/06/2019] [Accepted: 04/14/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We aimed to investigate strategies for reattempted percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs) by highly skilled operators after a failed attempt. BACKGROUND Development of complex techniques and algorithms has been standardized for CTO-PCI. However, there is no appropriate strategy for CTO-PCI after a failed procedure. METHOD From 2014 to 2016, the Japanese CTO-PCI Expert Registry included 4,053 consecutive CTO-PCIs (mean age: 66.8 ± 10.9 years; male: 85.6%; Japanese CTO [J-CTO] score: 1.92 ± 1.15). Initial outcomes and strategies for reattempted CTO-PCIs were evaluated and compared with first-attempt CTO-PCIs. RESULTS Reattempt CTO-PCIs were performed in 820 (20.2%) lesions. The mean J-CTO score of reattempt CTO-PCIs was higher than that of first-attempt CTO-PCIs (2.86 ± 1.03 vs. 1.68 ± 1.05, p < .001). The technical success rate of reattempt CTO-PCIs was lower than that of first-attempt CTO-PCIs (86.7% vs. 90.8%, p < .001). Regarding successful CTO-PCIs, the strategies comprised antegrade alone (reattempt: 36.1%, first attempt: 63.8%), bidirectional approach (reattempt: 54.4%, first attempt: 30.3%), and antegrade approach following a failed bidirectional approach (reattempt: 9.4%, first attempt: 5.4%). Parallel wire technique, intravascular ultrasound guide crossing, and bidirectional approach technique were frequently performed in reattempt CTO-PCIs. Reattempt CTO-PCIs showed higher rates of myocardial infarction (2.1% vs. 0.9%, p < .001) and coronary perforation (6.9% vs. 4.2%, p = .002) than first-attempt CTO-PCIs. CONCLUSIONS The technical success rate of reattempt CTO-PCIs is lower than that of first-attempt CTO-PCIs. However, using more complex strategies, the success rate of reattempt CTO-PCI can be improved by highly skilled operators.
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Affiliation(s)
- Makoto Sekiguchi
- Department of Cardiology, Fukaya Red Cross Hospital, Saitama, Japan
| | | | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Makoto Muto
- Department of Cardiology, Saitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan
| | - Yuji Oikawa
- Department of Cardiology, The Cardiovascular Institute, Tokyo, Japan
| | | | - Tsutomu Fujita
- Department of Cardiology, Sapporo Cardio Vascular Clinic and Sapporo Heart Center, Hokkaido, Japan
| | - Yuji Hamazaki
- Divison of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
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Xhepa E, Cassese S, Rroku A, Joner M, Pinieck S, Ndrepepa G, Kastrati A, Fusaro M. Subintimal Versus Intraplaque Recanalization of Coronary Chronic Total Occlusions: Mid-Term Angiographic and OCT Findings From the ISAR-OCT-CTO Registry. JACC Cardiovasc Interv 2019; 12:1889-1898. [PMID: 31521651 DOI: 10.1016/j.jcin.2019.04.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/19/2019] [Accepted: 04/30/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The aim of this study was to compare angiographic and optical coherence tomography findings following subintimal as opposed to intraplaque recanalization of chronic total occlusions (CTOs). BACKGROUND There is ongoing controversy regarding outcomes of intraplaque versus subintimal CTO recanalization. METHODS Consecutive patients undergoing angiography and intravascular optical coherence tomography following CTO recanalization were included in the ISAR-OCT-CTO (Intracoronary Stenting and Angiographic Results - Optical Coherence Tomography for Chronic Total Occlusions) registry. The study endpoints were percent diameter stenosis and late lumen loss as well as rate of uncovered and malapposed struts. Independent correlates of uncovered and malapposed struts were assessed by multivariate analysis. RESULTS The study included 75 patients. Intraplaque and dissection and re-entry techniques (DART) were used in 46 and 29 patients, respectively. There were no differences in terms of in-segment percent diameter stenosis (median 36.9 [interquartile range (IQR): 26.4 to 43.1] vs. 31.2 [IQR: 23.2 to 49.5]; p = 0.656), in-stent late lumen loss (0.215 mm [IQR: 0.063 to 0.495 mm] vs. 0.230 mm [IQR: 0.060 to 0.645 mm]; p = 0.837), or in-segment late lumen loss (0.030 mm [IQR: -0.278 to 0.510 mm] vs. 0.130 mm [IQR: -0.120 to 0.500 mm]; p = 0.395) at follow-up between the 2 techniques. Optical coherence tomography analysis showed comparable strut coverage (79.9% vs. 71.3%; p = 0.255) but significantly higher strut malapposition (6.6% vs. 13.6%; p < 0.001) following DART. Use of DART independently correlated with presence of strut malapposition (odds ratio: 3.41; 95% confidence interval: 1.24 to 9.36; p = 0.017) but not of strut coverage (odds ratio: 0.65; 95% confidence interval: 0.28 to 1.49; p = 0.314). CONCLUSIONS Intraplaque and subintimal recanalization techniques are associated with comparable mid-term angiographic results. Although the rate of uncovered struts is high following CTO recanalization, the recanalization technique does not independently correlate with presence of uncovered struts. There is a high rate of strut malapposition following CTO recanalization, particularly if achieved by means of DART.
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Affiliation(s)
- Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Andi Rroku
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Susanne Pinieck
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
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174
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Hirai T, Kearney K, Kataruka A, Gosch KL, Brandt H, Nicholson WJ, Lombardi WL, Grantham JA, Salisbury AC. Initial report of safety and procedure duration of robotic-assisted chronic total occlusion coronary intervention. Catheter Cardiovasc Interv 2019; 95:165-169. [PMID: 31483078 DOI: 10.1002/ccd.28477] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/10/2019] [Accepted: 08/20/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND No previous reports have examined the impact of robotic-assisted (RA) chronic total occlusion (CTO) PCI on procedural duration or safety compared to totally manual CTO PCI. METHODS Among 95 patients who underwent successful PCI of a single CTO lesion at two centers, 49 (52%) were performed RA and were performed 46 (48%) totally manually. Cockpit time was the time the primary operator entered to robotic cockpit until the procedure was complete. "Theoretical" cockpit time in the control group was time the primary operator would have entered the cockpit after lesion crossing until the procedure was complete. Major adverse events (MAEs) were the composite of death, myocardial infarction, clinical perforation, significant vessel dissection, arrhythmia, acute thrombosis, and stroke. RESULTS The lesion characteristics, procedural time, and contrast dose were similar. All procedures except for one (2%) selected for robotic completion after lesion crossing were completed successfully. The frequency of MAE was similar between groups and there were no in-hospital deaths. The cockpit time was 8 min longer in RA CTO PCI than the theoretical cockpit time in totally manual CTO PCI (40.6 ± 12.7 vs. 32.1 ± 17.8, p < .01). CONCLUSION RA CTO PCI was not associated with excess adverse events compared with totally manual CTO PCI and resulted in an average 41 min cockpit time equaling to 48% of procedure time without radiation exposure or requirement for the primary operator to wear a lead apron. Understanding the relationship between cockpit time and reductions in radiation exposure and lead apron-related orthopedic complications for operators requires future study.
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Affiliation(s)
- Taishi Hirai
- Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,Department of Medicine, Division of Cardiology, University of Missouri Kansas City, Kansas City, Missouri
| | - Kathleen Kearney
- Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - Akash Kataruka
- Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - Kensey L Gosch
- Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Hunter Brandt
- Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - William J Nicholson
- Department of Medicine, Division of Cardiology, York Hospital, York, Pennsylvania
| | - William L Lombardi
- Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - J Aaron Grantham
- Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,Department of Medicine, Division of Cardiology, University of Missouri Kansas City, Kansas City, Missouri
| | - Adam C Salisbury
- Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,Department of Medicine, Division of Cardiology, University of Missouri Kansas City, Kansas City, Missouri
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175
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Young MN, Secemsky EA, Kaltenbach LA, Jaffer FA, Grantham JA, Rao SV, Yeh RW. Examining the Operator Learning Curve for Percutaneous Coronary Intervention of Chronic Total Occlusions. Circ Cardiovasc Interv 2019; 12:e007877. [DOI: 10.1161/circinterventions.119.007877] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Advances in chronic total occlusion percutaneous coronary intervention (CTO PCI) techniques have led to increased procedural success rates among operators. While utilization of CTO PCI has disseminated widely, the learning curve for new operators has not been well-defined.
Methods:
Between July 2009 and December 2015, 93 875 CTO PCI cases were extracted from the CathPCI Registry. We delineated a cohort of new CTO operators performing <10 CTO PCI cases per given year. In-hospital outcomes for subsequent CTO PCIs were stratified by the number of prior cases accrued by each operator. Multivariable regression models were used to estimate differences in outcomes with increasing experience. The primary outcome was major adverse cardiovascular events defined as the composite of death, myocardial infarction, stroke, tamponade, or urgent coronary artery bypass grafting.
Results:
Among 70 916 cases performed by 7251 new operators, procedure success rate was 61.4% and major adverse cardiovascular event rate was 4.2%. Meanwhile, the rate of major bleeding was 4.0%, myocardial infarction 2.0%, mortality 0.6%, tamponade 0.3%, and renal failure 0.2%. Adjusted regression models demonstrated piecewise linear improvements in guidewire crossing, stent placement, and procedure success with accrued volume, albeit with increased contrast use, fluoroscopy time, and bleeding. Major adverse cardiovascular event rates were stable beyond the 12th case (odds ratio per 5 case increase 1.00; 95% CI, 0.98–1.03,
P
=0.7980).
Conclusions:
Among a large number of new CTO PCI operators in the United States, there exists an experiential learning curve for procedural success. However, there were higher rates of bleeding despite case experience, while major adverse cardiovascular events remained relatively unchanged after initiation.
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Affiliation(s)
- Michael N. Young
- Cardiology Division, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (M.N.Y.)
| | - Eric A. Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.)
| | - Lisa A. Kaltenbach
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.A.K., S.V.R.)
| | - Farouc A. Jaffer
- Cardiology Division, Massachusetts General Hospital, Boston (F.A.J.)
| | - James A. Grantham
- St Luke’s Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (J.A.G.)
| | - Sunil V. Rao
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.A.K., S.V.R.)
| | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.)
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176
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Corcos T. Radial is better, smaller is better, distal radial is even better! Catheter Cardiovasc Interv 2019; 94:903-904. [PMID: 31364810 DOI: 10.1002/ccd.28406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/06/2019] [Indexed: 11/08/2022]
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177
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Retrograde Approach for a Failed Antegrade PCI: Watch Out for the Back Door. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:86-90. [PMID: 31358398 DOI: 10.1016/j.carrev.2019.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 11/20/2022]
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178
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Huang CC, Lee CK, Meng SW, Hung CS, Chen YH, Lin MS, Yeh CF, Kao HL. Collateral Channel Size and Tortuosity Predict Retrograde Percutaneous Coronary Intervention Success for Chronic Total Occlusion. Circ Cardiovasc Interv 2019; 11:e005124. [PMID: 29311284 DOI: 10.1161/circinterventions.117.005124] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is little evidence on how to select an interventional collateral channel (CC) in retrograde chronic total occlusion (CTO) percutaneous coronary intervention. We aimed to identify independent angiographic predictors of CC tracking and technical success in retrograde CTO percutaneous coronary intervention. METHODS AND RESULTS From January 2012 to December 2015, a total of 216 consecutive retrograde CTO percutaneous coronary intervention attempts by a high-volume operator in a tertiary university-affiliated hospital were enrolled. The clinical, angiographic, and procedural details were collected. The characteristics analyzed included channel type, size, tortuosity, angle of attack, length to emerging point, and the Multicenter CTO Registry of Japan score. The Multicenter CTO Registry of Japan score was 4.2±0.8. A total of 242 CCs were attempted for intervention. CC tracking success rate was 83.5%, and the technical success rate (per CC) was 81.4%. The per-patient technical success rate was 91.2%, and the major procedural complication rate was 4.6%. The atrioventricular groove, epicardial, and septal CCs were used in 36 (14.9%), 84 (34.7%), and 122 (50.4%) tracking attempts, respectively. In multivariable analysis, only large channel size and lack of tortuosity were significant independent predictors of CC tracking and technical success. A new scoring system was developed, while large size was given 1 point and lack of tortuosity was given 2 points. The receiver-operating characteristic area by the new model to predict CC tracking and technical success were 0.800 and 0.752, respectively. CONCLUSIONS In retrograde CTO percutaneous coronary intervention, only size and tortuosity of a CC are independent angiographic predictors of CC tracking and technical success.
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Affiliation(s)
- Ching-Chang Huang
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Chih-Kuo Lee
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Shih-Wei Meng
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Chi-Sheng Hung
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Ying-Hsien Chen
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Mao-Shin Lin
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Chih-Fan Yeh
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Hsien-Li Kao
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.).
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179
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Brilakis ES, Mashayekhi K, Tsuchikane E, Abi Rafeh N, Alaswad K, Araya M, Avran A, Azzalini L, Babunashvili AM, Bayani B, Bhindi R, Boudou N, Boukhris M, Božinović NŽ, Bryniarski L, Bufe A, Buller CE, Burke MN, Büttner HJ, Cardoso P, Carlino M, Christiansen EH, Colombo A, Croce K, Damas de Los Santos F, De Martini T, Dens J, Di Mario C, Dou K, Egred M, ElGuindy AM, Escaned J, Furkalo S, Gagnor A, Galassi AR, Garbo R, Ge J, Goel PK, Goktekin O, Grancini L, Grantham JA, Hanratty C, Harb S, Harding SA, Henriques JPS, Hill JM, Jaffer FA, Jang Y, Jussila R, Kalnins A, Kalyanasundaram A, Kandzari DE, Kao HL, Karmpaliotis D, Kassem HH, Knaapen P, Kornowski R, Krestyaninov O, Kumar AVG, Laanmets P, Lamelas P, Lee SW, Lefevre T, Li Y, Lim ST, Lo S, Lombardi W, McEntegart M, Munawar M, Navarro Lecaro JA, Ngo HM, Nicholson W, Olivecrona GK, Padilla L, Postu M, Quadros A, Quesada FH, Prakasa Rao VS, Reifart N, Saghatelyan M, Santiago R, Sianos G, Smith E, C Spratt J, Stone GW, Strange JW, Tammam K, Ungi I, Vo M, Vu VH, Walsh S, Werner GS, Wollmuth JR, Wu EB, Wyman RM, Xu B, Yamane M, Ybarra LF, Yeh RW, Zhang Q, Rinfret S. Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention. Circulation 2019; 140:420-433. [PMID: 31356129 DOI: 10.1161/circulationaha.119.039797] [Citation(s) in RCA: 231] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.
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Affiliation(s)
- Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (E.S.B., M.N.B.)
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II University Heart Center Freiburg Bad Krozingen, Germany (K.M., H.J.B.)
| | | | - Nidal Abi Rafeh
- St. George Hospital University Medical Center, Beirut, Lebanon (N.A.R.)
| | | | - Mario Araya
- Clínica Alemana and Instituto Nacional del Tórax, Santiago, Chile (M.A.)
| | - Alexandre Avran
- Arnault Tzank Institut St. Laurent Du Var Nice, France (A.A.)
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (L.A., M.C.)
| | - Avtandil M Babunashvili
- Department of Cardiovascular Surgery, Center for Endosurgery and Lithotripsy, Moscow, Russian Federation (A.M.B.)
| | - Baktash Bayani
- Cardiology Department, Mehr Hospital, Mashhad, Iran (B.B.)
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital and Kolling Institute, University of Sydney, Australia (R.B.)
| | | | - Marouane Boukhris
- Cardiology department, Abderrahment Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia (M.B.)
| | - Nenad Ž Božinović
- Department of Interventional Cardiology Clinic for Cardiovascular Diseases University Clinical Center Nis, Serbia (N.Z.B.)
| | - Leszek Bryniarski
- II Department of Cardiology and Cardiovascular Interventions Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland (L.B.)
| | - Alexander Bufe
- Department of Cardiology, Heartcentre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany, Institute for Heart and Circulation Research, University of Cologne, Germany, and University of Witten/Herdecke, Witten, Germany (A.B.)
| | | | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (E.S.B., M.N.B.)
| | - Heinz Joachim Büttner
- Department of Cardiology and Angiology II University Heart Center Freiburg Bad Krozingen, Germany (K.M., H.J.B.)
| | - Pedro Cardoso
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre (CAML) and Centro Cardiovascular da Universidade de Lisboa (CCUL), Portugal (P.C.)
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (L.A., M.C.)
| | | | - Antonio Colombo
- San Raffaele Hospital and Columbus Hospital, Milan, Italy (A.C.)
| | - Kevin Croce
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (K.C.)
| | - Felix Damas de Los Santos
- Interventional Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez Mexico City, Mexico (F.D.d.l.S.)
| | - Tony De Martini
- SIU School of Medicine, Memorial Medical Center, Springfield, IL (T.D.M.)
| | - Joseph Dens
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium (J.D.)
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (C.D.M.)
| | - Kefei Dou
- Center for Coronary Heart Disease, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (K.D.)
| | - Mohaned Egred
- Freeman Hospital and Newcastle University, Newcastle upon Tyne, United Kingdom (M.E.)
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Egypt (A.M.E.).,National Heart and Lung Institute, Imperial College London, United Kingdom (A.M.E.)
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Spain (J.E.)
| | - Sergey Furkalo
- Department of Endovascular Surgery and Angiography, National Institute of Surgery and Transplantology of AMS of Ukraine, Kiev (S.F.)
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy (A.G.)
| | - Alfredo R Galassi
- Chair of Cardiology, Department of PROMISE, University of Palermo, Italy (A.R.G.)
| | - Roberto Garbo
- Director of Interventional Cardiology, San Giovanni Bosco Hospital, Turin, Italy (R.G.)
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China (J.G.)
| | - Pravin Kumar Goel
- Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow, India (P.K.G.)
| | | | - Luca Grancini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy (L.G.)
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.G.)
| | - Colm Hanratty
- Belfast Health and Social Care Trust, United Kingdom (C.H., S.W.)
| | - Stefan Harb
- LKH Graz II, Standort West, Kardiologie, Teaching Hospital of the University of Graz, Austria (S.H.)
| | - Scott A Harding
- Wellington Hospital, Capital and Coast District Health Board, New Zealand (S.A.H.)
| | - Jose P S Henriques
- Academic Medical Centre of the University of Amsterdam, The Netherlands (J.P.S.H.)
| | | | - Farouc A Jaffer
- Cardiology Division, Massachusetts General Hospital, Boston (F.A.J.)
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea (Y.J.)
| | | | - Artis Kalnins
- Department of Cardiology, Eastern Clinical University Hospital, Riga, Latvia (A. Kalnins)
| | | | | | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei(H.-L.K.)
| | | | - Hussien Heshmat Kassem
- Cardiology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Egypt(H.H.K.).,Fujairah Hospital, United Arab Emirates (H.H.K.)
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (P.K.)
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, "Sackler" School of Medicine, Tel Aviv University, Petach Tikva, Israel (R.K.)
| | | | - A V Ganesh Kumar
- Department of Cardiology, Dr LH Hiranandani Hospital, Mumbai, India (A.V.G.K.)
| | - Peep Laanmets
- North Estonia Medical Center Foundation, Tallinn, Estonia(P. Laanmets)
| | - Pablo Lamelas
- Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular de Buenos Aires, Argentina (P. Lamelas).,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada (P. Lamelas)
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.-W.L.)
| | - Thierry Lefevre
- Institut Cardiovasculaire Paris Sud Hopital prive Jacques Cartier, Massy, France (T.L.)
| | - Yue Li
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, China (Y.L.)
| | - Soo-Teik Lim
- Department of Cardiology, National Heart Centre Singapore (S.-T.L.)
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital and The University of New South Wales, Sydney, Australia (S.L.)
| | | | | | | | - José Andrés Navarro Lecaro
- Médico Cardiólogo Universitario - Hemodinamista en Hospital de Especialidades Eugenio Espejo y Hospital de los Valles, Ecuador (J.A.N.L.)
| | | | | | | | - Lucio Padilla
- Department of Interventional Cardiology and Endovascular Therapeutics, ICBA, Instituto Cardiovascular, Buenos Aires, Argentina (L.P.)
| | - Marin Postu
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases "Prof. Dr. C.C. Iliescu," Bucharest, Romania (M.P.)
| | - Alexandre Quadros
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil (A.Q.)
| | - Franklin Hanna Quesada
- Interventional Cardiology Department, Clinica Comfamiliar Pereira City, Colombia (F.H.Q.)
| | | | - Nicolaus Reifart
- Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany (N.R.)
| | | | - Ricardo Santiago
- Hospital Pavia Santurce, PCI Cardiology Group, San Juan, Puerto Rico (R.S.T.)
| | - George Sianos
- AHEPA University Hospital, Thessaloniki, Greece (G.S.)
| | - Elliot Smith
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (E.S.)
| | - James C Spratt
- St George's University Hospital NHS Trust, London, United Kingdom (J.S.)
| | - Gregg W Stone
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center (G.W.S.)
| | - Julian W Strange
- Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J.W.S.)
| | - Khalid Tammam
- Cardiac Center of Excellence, International Medical Center, Jeddah, Saudi Arabia (K.T.)
| | - Imre Ungi
- 2nd Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary (I.U.)
| | - Minh Vo
- Mazankowski Alberta Heart Institute, Edmonton, AB, Canada (M.V.)
| | - Vu Hoang Vu
- Interventional Cardiology Department, Heart Center, University Medical Center at Ho Chi Minh City, and University of Medicine and Pharmacy, Vietnam (H.V.)
| | - Simon Walsh
- Belfast Health and Social Care Trust, United Kingdom (C.H., S.W.)
| | - Gerald S Werner
- Medizinische Klinik I Klinikum Darmstadt GmbH, Germany (G.W.)
| | | | | | | | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing (B.X.)
| | - Masahisa Yamane
- Saitima St. Luke's International Hospital, Tokyo, Japan (M.Y.)
| | - Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (L.F.Y.)
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y.)
| | - Qi Zhang
- Shanghai East Hospital, Tongji University, China (Q.Z.)
| | - Stephane Rinfret
- McGill University Health Centre, McGill University, Montreal, QC, Canada (S.R.)
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180
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Kwon O, Lee PH, Lee SW, Lee JY, Kang DY, Ahn JM, Park DW, Kang SJ, Kim YH, Lee CW, Park SW, Park SJ. Retrograde approach for the percutaneous recanalisation of coronary chronic total occlusions: contribution to clinical practice and long-term outcomes. EUROINTERVENTION 2019; 15:e354-e361. [DOI: 10.4244/eij-d-18-00538] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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181
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Brilakis ES, Xenogiannis I, Burke MN. Chronic total occlusion percutaneous coronary intervention: the road ahead. EUROINTERVENTION 2019; 15:137-139. [PMID: 31217153 DOI: 10.4244/eijv15i2a27] [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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182
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CTO-PCI: Finding the Right Patient and using the Right Technique. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:452-453. [PMID: 31160004 DOI: 10.1016/j.carrev.2019.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 11/21/2022]
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183
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Galassi AR, Werner GS, Boukhris M, Azzalini L, Mashayekhi K, Carlino M, Avran A, Konstantinidis NV, Grancini L, Bryniarski L, Garbo R, Bozinovic N, Gershlick AH, Rathore S, Di Mario C, Louvard Y, Reifart N, Sianos G. Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club. EUROINTERVENTION 2019; 15:198-208. [DOI: 10.4244/eij-d-18-00826] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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184
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Schumacher SP, Stuijfzand WJ, Opolski MP, van Rossum AC, Nap A, Knaapen P. Percutaneous Coronary Intervention of Chronic Total Occlusions: When and How to Treat. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:513-522. [DOI: 10.1016/j.carrev.2018.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 01/31/2023]
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185
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Wu EB, Tsuchikane E, Lo S, Lim ST, Ge L, Chen JY, Qian J, Lee SW, Kao HL, Harding SA. Chronic Total Occlusion Wiring: A State-of-the-Art Guide From The Asia Pacific Chronic Total Occlusion Club. Heart Lung Circ 2019; 28:1490-1500. [PMID: 31128985 DOI: 10.1016/j.hlc.2019.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/07/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Despite the advances in wire technology and development of algorithm-driven methodology for chronic total occlusion (CTO) intervention, there is a void in the literature about the technical aspects of CTO wiring. The Asia Pacific CTO Club, a group of 10 experienced operators in the Asia Pacific region, has tried to fill this void with this state-of-the-art review on CTO wiring. METHODS This review explains, for proximal cap puncture: choices of wires, shaping of the wire, use of dual lumen catheter, and method of step-down of wire penetration force for successful wiring. In wiring the CTO body, the techniques of loose tissue tracking, intentional intimal plaque tracking, and intentional subintimal wiring are described in detail. For distal lumen wiring, a blunt distal cap, presence of a distal cap side branch, calcium, and sharp tapered distal stump predict cap toughness, and wire penetration force should be stepped-up in these cases. The importance of choosing between redirection, parallel wiring, and Stingray (Boston Scientific, Marlborough, MA, USA) for angiographic guidance is discussed along with which will be more successful. On the retrograde side, the problems encountered with distal cap puncture and methods to overcome these problems are explained. The method of wiring the CTO body through a retrograde approach depending on the morphology of the CTO is described. Different reverse controlled antegrade and retrograde tracking (CART) wiring methods - including end balloon wiring, side balloon entry, and conventional reverse CART - are explained in detail. CONCLUSION This is a systematic CTO wiring review, which is believed to be beneficial for CTO operators worldwide.
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Affiliation(s)
- Eugene B Wu
- Prince of Wales Hospital, Chinese University, Hong Kong.
| | | | - Sidney Lo
- Liverpool Hospital, Sydney, NSW, Australia
| | | | - Lei Ge
- Shanghai Zhongshan Hospital, Shanghai, China
| | - Ji-Yan Chen
- Guangdong General Hospital, Guangdong, China
| | - Jie Qian
- Beijing Fuwai Hospital, Beijing, China
| | | | - Hsien-Li Kao
- National Taiwan University Hospital, Taipei, Taiwan
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186
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Phrommintikul A, Chanchai R, Wongcharoen W. Effects of Curcuminoids on Myocardial Injury After Percutaneous Coronary Intervention. J Med Food 2019; 22:680-684. [PMID: 31045465 DOI: 10.1089/jmf.2018.4321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The rise of cardiac troponin post-percutaneous coronary intervention (PCI) is associated with a high risk of long-term cardiovascular events. Previous studies have shown that curcuminoids decreased myocardial injury post-coronary bypass graft surgery through anti-oxidant and anti-inflammatory effects. We sought to examine whether curcuminoids could prevent PCI-related myocardial injury. One-hundred enrolled patients receiving elective PCI were randomized to obtain curcuminoids or placebo 4 g/day at least 1 day before and after the scheduled PCI. Cardiac troponin-T and 12-lead electrocardiogram were evaluated before PCI and at 24 and 48 h post-PCI. The definitions of PCI-related myocardial injury and myocardial infarction were in line with the third universal definition of myocardial infarction. Baseline characteristics of patients and procedures did not differ between the curcuminoids and placebo groups. The mean age was 63.9 ± 10.8 years. The incidence of PCI-related myocardial injury was not different between curcuminoids and placebo groups (32% vs. 38%, P = .675). The peak high-sensitive cardiac troponin T levels after PCI were not different between the curcuminoids and placebo groups (201.0 ± 547.0 ng/L vs. 187.0 ± 703.9 ng/L respectively, P = .912). Further, the high-sensitive C-reactive protein levels post-PCI were similar in patients receiving curcuminoids and placebo (7.2 ± 18.8 mg/dL vs. 6.6 ± 17.5 mg/dL, respectively, P = .873). We found that short-term treatment with curcuminoids did not reduce the occurrence of PCI-related myocardial injury. We did not observe the role of anti-oxidative and anti-inflammatory effects of curcuminoids in the PCI-related myocardial injury.
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Affiliation(s)
- Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rattanachai Chanchai
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wanwarang Wongcharoen
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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187
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Kalyanasundaram A, Seth A. Chronic total occlusion or non-chronic total occlusion percutaneous coronary intervention: Do myocytes really care? Catheter Cardiovasc Interv 2019; 93:1067-1068. [PMID: 31025521 DOI: 10.1002/ccd.28275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 11/08/2022]
Abstract
Chronic total occlusions subtend a more extensive perfusion defect size compared to non-chronic total occlusion lesions. Chronic total occlusion percutaneous coronary intervention (CTO PCI) results in significant improvement in myocardial blood flow and reduction in perfusion defect size. Improvement in hyperemic myocardial blood Flow (MBF), coronary flow reserve (CFR) and perfusion defect size is comparable in CTO and hemodynamically significant non-CTO PCI.
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Affiliation(s)
- Arun Kalyanasundaram
- Cardiovascular Sciences & Interventional Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Ashok Seth
- Cardiovascular Sciences & Interventional Cardiology, Fortis Escorts Heart Institute, New Delhi, India
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188
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Finn MT, Redfors B, Karmpaliotis D, Kirtane AJ, Green P, McAndrew T, Liu M, Cloney MB, Witzenbichler B, Weisz G, Stuckey TD, Brodie BR, Rinaldi MJ, Neumann FJ, Metzger DC, Henry TD, Cox DA, Duffy PL, Mazzaferri EL, Mehran R, Stone GW. Adverse events in patients with high platelet reactivity following successful chronic total occlusion PCI: The Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents (ADAPT-DES) study. Am Heart J 2019; 211:68-76. [PMID: 30897527 DOI: 10.1016/j.ahj.2019.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 02/12/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) typically requires a greater number of stents and longer stent length than non-CTO PCI, placing these patients at greater risk for adverse ischemic events. We sought to determine whether the association between high platelet reactivity (HPR) and the risk of ischemic events is stronger after CTO than non-CTO PCI. METHODS Patients undergoing successful PCI in the multicenter ADAPT-DES study were stratified according to whether they underwent PCI of a CTO. HPR was defined as VerifyNow platelet reaction units >208. The study primary endpoint was the 2-year risk target vessel failure ([TVF] defined as cardiac death, myocardial infarction, or target lesion revascularization). RESULTS CTO PCI was performed in 400 of 8448 patients. HPR was present in 34.5% of CTO PCI patients and 43.1% of non-CTO PCI patients (P = .0007). Patients undergoing CTO PCI with versus without HPR had significantly higher 2-year rates of TVF (15.0% versus 8.3%, P = .04) without significant differences in bleeding. HPR was an independent predictor of 2-year TVF (adjusted HR 1.16, 95% CI 1.02-1.34, P = .03) whereas CTO PCI was not (adjusted HR 0.89, 95% CI 0.65-1.22, P = .48). There was a significant interaction between CTO versus non-CTO PCI and PRU as a continuous variable for 2-year TVF (Pinteraction = 0.02). CONCLUSIONS In ADAPT-DES, HPR was associated with an increased 2-year risk of TVF after PCI, an association that was at least as strong after CTO PCI compared with non-CTO PCI.
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189
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Lee SW, Lee PH, Ahn JM, Park DW, Yun SC, Han S, Kang H, Kang SJ, Kim YH, Lee CW, Park SW, Hur SH, Rha SW, Her SH, Choi SW, Lee BK, Lee NH, Lee JY, Cheong SS, Kim MH, Ahn YK, Lim SW, Lee SG, Hiremath S, Santoso T, Udayachalerm W, Cheng JJ, Cohen DJ, Muramatsu T, Tsuchikane E, Asakura Y, Park SJ. Randomized Trial Evaluating Percutaneous Coronary Intervention for the Treatment of Chronic Total Occlusion. Circulation 2019; 139:1674-1683. [DOI: 10.1161/circulationaha.118.031313] [Citation(s) in RCA: 221] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Seung-Whan Lee
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Pil Hyung Lee
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-Cheol Yun
- Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seungbong Han
- Department of Applied Statistics, Gachon University, Seongnam, Korea (S.H.)
| | - Heejun Kang
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo-Jin Kang
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Whan Lee
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Ho Hur
- Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.)
| | - Seung-Woon Rha
- Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.)
| | - Sung-Ho Her
- Department of Cardiology, The Catholic University of Korea, Daejeon St. Mary’s Hospital (S.-H.H.)
| | - Si Wan Choi
- Department of Cardiology, Chungnam National University Hospital, Daejeon, Korea (S.W.C.)
| | - Bong-Ki Lee
- Department of Cardiology, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.)
| | - Nae-Hee Lee
- Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Korea (N.-H.L.)
| | - Jong-Young Lee
- Department of Cardiology, Kangbuk Samsung Medical Center, Seoul, Korea (J.-Y.L.)
| | - Sang-Sig Cheong
- Department of Cardiology, Gangneung Asan Hospital, Korea (S.-S.C.)
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Korea (M.H.K.)
| | - Young-Keun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea (Y.-K.A.)
| | - Sang Wook Lim
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Korea (S.W.L.)
| | - Sang-Gon Lee
- Department of Cardiology, Ulsan University Hospital, Korea (S.-G.L.)
| | | | - Teguh Santoso
- Department of Cardiology, Medistra Hospital, Jakarta, Indonesia (T.S.)
| | - Wasan Udayachalerm
- Department of Cardiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand (W.U.)
| | - Jun Jack Cheng
- Department of Cardiology, Shin Kong Hospital, Taipei, Taiwan (J.J.C.)
| | - David J. Cohen
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (D.J.C.)
| | | | | | - Yasushi Asakura
- Department of Cardiology, Hakujikai Memorial Hospital, Tokyo, Japan (Y.A.)
| | - Seung-Jung Park
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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190
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Depression and Angina Among Patients Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:651-658. [DOI: 10.1016/j.jcin.2018.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/18/2018] [Accepted: 12/26/2018] [Indexed: 12/27/2022]
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191
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Sheehy JP, Qintar M, Arnold SV, Hirai T, Sapontis J, Jones PG, Tang Y, Lombardi W, Karmpaliotis D, Moses JW, Patterson C, Cohen DJ, Amin AP, Nicholson WJ, Spertus JA, Grantham JA, Salisbury AC. Anti-anginal medication titration among patients with residual angina 6-months after chronic total occlusion percutaneous coronary intervention: insights from OPEN CTO registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:370-379. [DOI: 10.1093/ehjqcco/qcz015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 01/09/2023]
Abstract
Abstract
Aims
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been shown to reduce angina and improve quality of life, but the frequency of new or residual angina after CTO PCI and its relationship with titration of anti-anginal medications (AAMs) has not been described.
Methods and results
Among consecutive CTO PCI patients treated at 12 US centres in the OPEN CTO registry, angina was assessed 6 months after the index PCI using the Seattle Angina Questionnaire (SAQ) Angina Frequency scale (a score <100 defined new or residual angina). We then compared the proportion of patients with AAM escalation (defined as an increase in the number or dosage of AAMs between discharge and follow-up) between those with and without 6-month angina. Of 901 patients who underwent CTO PCI, 197 (21.9%) reported angina at 6-months, of whom 80 (40.6%) had de-escalation, 66 (33.5%) had no change, and only 51 (25.9%) had escalation of their AAM by the 6-month follow-up. Rates of AAM escalation were similar when stratifying patients by the ultimate success of the CTO PCI, completeness of physiologic revascularization, presence or absence of angina at baseline, history of heart failure, and by degree of symptomatic improvement after CTO PCI.
Conclusions
One in five patients reported angina 6 months after CTO PCI. Although patients with new or residual angina were more likely to have escalation of AAMs in follow-up compared with those without residual symptoms, only one in four patients with residual angina had escalation of AAMs. Although it is unclear whether this finding reflects maximal tolerated therapy at baseline or therapeutic inertia, these findings suggest an important potential opportunity to further improve symptom control in patients with complex stable ischaemic heart disease.
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Affiliation(s)
- Justin P Sheehy
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
| | - Mohammed Qintar
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
| | - Suzanne V Arnold
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - Taishi Hirai
- Section of Cardiology, University of Chicago Medical Center, 924 East 57th Street, Chicago, IL, USA
| | - James Sapontis
- Monash Heart, Cardiovascular Research Centre, Monash Medical Centre, 246 Clayton Road, Clayton Victoria, Australia
| | - Philip G Jones
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - Yuanyuan Tang
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - William Lombardi
- Division of Cardiology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, USA
| | - Dimitiri Karmpaliotis
- Division of Cardiology, New York Presbyterian Hospital, 161 Fort Washington Ave, New York, NY, NY, USA
| | - Jeffrey W Moses
- Division of Cardiology, New York Presbyterian Hospital, 161 Fort Washington Ave, New York, NY, NY, USA
| | - Christian Patterson
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - David J Cohen
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - Amit P Amin
- Division of Cardiology, Washington University in Saint Louis, 660 S Euclid Ave, St. Louis, MO, USA
| | | | - John A Spertus
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - James Aaron Grantham
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - Adam C Salisbury
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
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193
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Tanaka T, Okamura A, Iwakura K, Iwamoto M, Nagai H, Yamasaki T, Sumiyoshi A, Tanaka K, Inoue K, Koyama Y, Masuyama T, Ishihara M, Fujii K. Efficacy and Feasibility of the 3-Dimensional Wiring Technique for Chronic Total Occlusion Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:545-555. [DOI: 10.1016/j.jcin.2018.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
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194
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Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients with Diabetes Mellitus: a Treatment-Risk Paradox. Curr Cardiol Rep 2019; 21:9. [PMID: 30790113 DOI: 10.1007/s11886-019-1091-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). This review aims to summarize the available evidence on CTO recanalization in patients with DM. RECENT FINDINGS Coronary artery bypass grafting (CABG) surgery is the recommended revascularization modality for patients with DM and multivessel coronary artery disease (CAD). However, the optimal management strategy in diabetic patients with CTO and single-vessel disease or prior CABG remains a clinical dilemma. Contemporary, large-scale, observational registries support the notion that CTO PCI, if performed at high-volume CTO PCI centers by highly experienced operators, conveys similar high procedural success and low complication rates in patients with and without DM. Although DM patients have more frequently CTOs and may derive greater benefit from complete revascularization, they are less frequently exposed to CTO PCI than non-DM patients (treatment-risk paradox). CTO PCI performed by highly experienced operators constitutes a safe and effective treatment option for selected diabetic CTO patients who are not candidates for CABG. Randomized studies are warranted to compare long-term outcomes of CTO PCI and medical therapy in this high-risk subset.
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Tajti P, Alaswad K, Karmpaliotis D, Jaffer FA, Yeh RW, Patel M, Mahmud E, Choi JW, Burke MN, Doing AH, Dattilo P, Toma C, Smith AC, Uretsky BF, Holper E, Potluri S, Wyman RM, Kandzari DE, Garcia S, Krestyaninov O, Khelimskii D, Koutouzis M, Tsiafoutis I, Khatri JJ, Jaber W, Samady H, Jefferson B, Patel T, Abdullah S, Moses JW, Lembo NJ, Parikh M, Kirtane AJ, Ali ZA, Doshi D, Xenogiannis I, Stanberry LI, Rangan BV, Ungi I, Banerjee S, Brilakis ES. Procedural Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusions Via the Radial Approach. JACC Cardiovasc Interv 2019; 12:346-358. [DOI: 10.1016/j.jcin.2018.11.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/25/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
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The Cost of Percutaneous Coronary Intervention for Chronic Total Occlusions in Our Current Cost-Conscious Environment. JACC Cardiovasc Interv 2019; 12:332-334. [DOI: 10.1016/j.jcin.2018.10.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 11/20/2022]
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197
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Salisbury AC, Karmpaliotis D, Grantham JA, Sapontis J, Meng Q, Magnuson EA, Gada H, Lombardi W, Moses J, Li H, Arnold SV, Baron SJ, Spertus JA, Cohen DJ. In-Hospital Costs and Costs of Complications of Chronic Total Occlusion Angioplasty. JACC Cardiovasc Interv 2019; 12:323-331. [DOI: 10.1016/j.jcin.2018.10.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/27/2018] [Accepted: 10/09/2018] [Indexed: 11/28/2022]
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Impact of diabetes mellitus on 5-year clinical outcomes in patients with chronic total occlusion lesions. Coron Artery Dis 2019; 29:119-126. [PMID: 28938238 DOI: 10.1097/mca.0000000000000562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is a major predictor of cardiovascular morbidity and mortality. However, there are limited data on the impact of DM in patients who have chronic total occlusion (CTO) lesion on long-term outcomes. PATIENTS AND METHODS A total of 822 CTO patients who underwent coronary angiography, treated by either percutaneous coronary intervention or optimal medical therapy, were enrolled and divided into two groups: (i) diabetic group (n=363) and (ii) nondiabetic group (n=459). Individual and composite major clinical outcomes were compared up to 5 years. RESULTS Propensity score matching analysis was carried out generating two groups (298 pairs, n=596, C-statistic=0.655) with balanced baseline characteristics. Up to 5 years, the DM group showed a higher trend toward revascularization (19.5 vs. 13.5%, P=0.051) and major adverse cardiovascular events (MACE) (24.7 vs. 19.1%, P=0.097) compared with the nondiabetic group. However, there was no difference in the incidence of death and myocardial infarction between the two groups. Subgroup analysis showed that the chronic kidney disease (CKD) subgroup was associated with a higher incidence of all-cause death, cardiac death, myocardial infarction, revascularization, and MACE in comparison with diabetic patients without CKD and nondiabetic patients, respectively (total MACE: 39 vs. 20.5 vs. 19.2% , P=0.001). Insulin-dependent diabetic patients had a significantly higher incidence of MACE (hazard ratio=1.58; 95% confidence interval: 1.04-2.40; P=0.03) compared with the nondiabetic patients. CONCLUSION Diabetic patients with CTO were associated with a trend toward a higher incidence of revascularization and total MACE up to 5 years. Insulin-dependent and diabetic patients with CKD subgroups had a significantly higher incidence of total MACE.
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Grantham JA. Survival and Chronic Total Occlusion Percutaneous Coronary Intervention: The Never-Ending Debate Continues. JACC Cardiovasc Interv 2019; 10:876-878. [PMID: 28473109 DOI: 10.1016/j.jcin.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/11/2017] [Accepted: 03/12/2017] [Indexed: 01/07/2023]
Affiliation(s)
- J Aaron Grantham
- University of Missouri Kansas City and Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
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Anantha-Narayanan M, Garcia S. Contemporary Approach to Chronic Total Occlusion Interventions. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:1. [PMID: 30659365 DOI: 10.1007/s11936-019-0704-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Chronic total occlusion (CTO) poses one of the greatest technical challenges to interventional cardiologists. Despite recent advancements in techniques and clinical trials showing significant benefits of CTO percutaneous coronary interventions (PCI), the proportion of patients with untreated CTOs remains high. We therefore aim to perform a comprehensive review of the various techniques available, recent advancements, benefits, and complications associated with CTO PCI. RECENT FINDINGS Three randomized clinical trials examining the benefits of CTO PCI have recently been presented. Scoring systems have been developed to facilitate pre-procedural estimation of success and complications of CTO PCI. Technological enhancements in coronary wires and other interventional equipment along with dedicated training for CTO operators have improved the likelihood of successful recanalization of CTOs. CTO PCI has been shown to improve patient symptoms and quality of life. It is therefore important to have an in-depth knowledge of the various CTO techniques, appropriate equipment, and complications when performing these complex procedures. Clinicians should weigh the risks and benefits and choose the appropriate patient population who may benefit from revascularization.
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Affiliation(s)
- Mahesh Anantha-Narayanan
- Division of Cardiovascular Disease, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Santiago Garcia
- Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 E 28th Street, Suite 300, Minneapolis, MN, 55407, USA.
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