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Sakes A, Regar E, Dankelman J, Breedveld P. Treating Total Occlusions: Applying Force for Recanalization. IEEE Rev Biomed Eng 2016; 9:192-207. [DOI: 10.1109/rbme.2016.2580218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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152
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Pavlidis AN, Jones DA, Sirker A, Mathur A, Smith EJ. Reducing radiation in chronic total occlusion percutaneous coronary interventions. Curr Cardiol Rev 2016; 12:12-7. [PMID: 25847013 PMCID: PMC4807712 DOI: 10.2174/1573403x11666150407110849] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/13/2015] [Accepted: 03/31/2015] [Indexed: 11/22/2022] Open
Abstract
The field of percutaneous intervention for chronic total occlusion (CTO) has enjoyed significant innovations in the recent years. Novel techniques and technologies have revolutionized the field and have resulted in considerably higher success rates even in patients with high anatomical complexity. Successful CTO recanalization is associated with significant clinical benefits, such as the improvement of angina and quality of life, reduced rates of surgical revascularization, improvement of left ventricular function and decreased mortality rates. However, complex CTO procedures often require prolonged x-ray exposure which have been associated with adverse long term outcomes.
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Affiliation(s)
- Antonis N Pavlidis
- Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK.
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153
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Tanaka H, Morino Y, Abe M, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, Kato K, Shibata Y, Hiasa Y, Doi O, Yamashita T, Morimoto T, Hinohara T, Fujii T, Mitsudo K. Impact of J-CTO score on procedural outcome and target lesion revascularisation after percutaneous coronary intervention for chronic total occlusion: a substudy of the J-CTO Registry (Multicentre CTO Registry in Japan). EUROINTERVENTION 2016; 11:981-8. [DOI: 10.4244/eijv11i9a202] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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154
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Habara M, Tsuchikane E, Muramatsu T, Kashima Y, Okamura A, Mutoh M, Yamane M, Oida A, Oikawa Y, Hasegawa K. Comparison of percutaneous coronary intervention for chronic total occlusion outcome according to operator experience from the Japanese retrograde summit registry. Catheter Cardiovasc Interv 2015; 87:1027-35. [DOI: 10.1002/ccd.26354] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/30/2015] [Accepted: 11/15/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Maoto Habara
- Department of Cardiovascular Medicine; Toyohashi Heart Center; Aichi Japan
| | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine; Toyohashi Heart Center; Aichi Japan
| | - Toshiya Muramatsu
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Yoshifumi Kashima
- Division of Cardiology; Sapporo CardioVascular Clinic; Hokkaido Japan
| | - Atsunori Okamura
- Division of Cardiology; Sakurabashi-Watanabe Hospital; Osaka Japan
| | - Makoto Mutoh
- Division of Cardiology; Saitama Prefecture Cardiovascular and Respiratory Center; Saitama Japan
| | - Masahisa Yamane
- Cardiology Department; Saitama Sekishinkai Hospital; Saitama Japan
| | - Akitsugu Oida
- Department of Cardiology; Takase Clinic; Gunma Japan
| | - Yuji Oikawa
- Department of Cardiovascular; the Cardiovascular Institute; Tokyo Japan
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Comparison of second- and first-generation drug eluting stent for percutaneous coronary chronic total occlusion intervention. Int J Cardiol 2015; 206:7-11. [PMID: 26773761 DOI: 10.1016/j.ijcard.2015.12.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/30/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND The performance of contemporary second-generation drug-eluting stents (DESs) for percutaneous chronic total occlusion (CTO) intervention is not well established. The present study compared the efficacy and safety outcomes of second-generation DESs with those of first-generation DESs in CTO-percutaneous coronary intervention (PCI). METHODS This retrospective analysis included 1049 consecutive CTO patients who underwent successful DES implantation (first-generation; 487 vs. second-generation; 562 patients) between March 2003 and August 2014. The primary endpoint was the composite of all-cause death, Q-wave myocardial infarction (MI), or target-vessel revascularization (TVR). RESULTS During a follow-up of 3 years, the primary endpoint incidence was 10.1% for second- and 7.7% for first-generation DES (p=0.30). After multivariable adjustment, there was no significant difference between these groups in terms of the risk of composite of death, Q-wave MI, or TVR (Hazard ratio [HR] 1.42, 95% confidence interval [CI] 0.88-2.28, p=0.15) nor in the individual risks of death (adjusted HR 1.33, 95% CI 0.69-2.56, p=0.39), Q-wave MI (adjusted HR 1.15, 95% CI 0.30-4.47, p=0.84) and TVR (adjusted HR 1.06, 95% CI 0.52-2.15, p=0.87). The incidence of definite/probable stent thrombosis was relatively low (0.5% vs.0.9%, p=0.17) throughout the follow-up period. CONCLUSION The 3-year clinical outcomes of patients treated with second-generation DESs are comparable to those treated with first-generation DESs for CTO-PCI.
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156
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Abstract
Coronary chronic total occlusion (CTO) is a frequent finding in patients with coronary artery disease. It remains one of the most challenging subsets, accounting for 10-20% of all percutaneous coronary interventions (PCI). Although remarkable progress in PCI has been made, it is reasonable to state that successful recanalization of CTO represents the “last frontier" of PCI. PCI of CTOs has been limited historically by technical success rates of 50-70%. The introduction of enhanced guidewires, microcatheter, channel dilatator with increasing operator experience, and innovative techniques such as the retrograde approach have raised hopes for better outcomes. This article goes into depth into various strategies of retrograde approach in CTO.
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Affiliation(s)
- Debabrata Dash
- S. L Raheja (A Fortis Associate) Hospital Raheja Rugnalaya Marg Mahim (West), Mumbai, 400016 India
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157
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Bijuklic K, Schwencke C, Schofer J. Recanalization of chronic total coronary occlusions--high success rate despite a restrictive use of the retrograde approach. Catheter Cardiovasc Interv 2015; 87:E183-91. [PMID: 26424467 DOI: 10.1002/ccd.26168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 07/27/2015] [Indexed: 11/10/2022]
Abstract
AIM The retrograde approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is increasingly being used as a first-line intervention despite a higher radiation exposure, contrast volume, and a higher major adverse cardiac event (MACE) rate compared with the antegrade approach. It was aimed to evaluate the overall success rate of CTO-PCI over time when the retrograde approach was restrictively used only after a failed antegrade attempt. METHODS AND RESULTS In a prospective single operator registry from January 2008 to December 2012 about 436 consecutive patients underwent a CTO-PCI. Mean age was 63.4 ± 10.3 years, and 86% were male. The overall success rate improved significantly over time [68% (first quartile) to 91% (fourth quartile), P < 0.001] due to a significant increase of the antegrade success rate. This could be achieved by a retrograde approach of less than 20% with no change over time. The overall in-hospital MACE rate was 0.69% with no difference between antegrade and retrograde procedures. CONCLUSIONS A high CTO-PCI success rate of above 90% could be achieved with a restrictive use of the retrograde technique.
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Affiliation(s)
- Klaudija Bijuklic
- Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany
| | - Carsten Schwencke
- Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany
| | - Joachim Schofer
- Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany
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158
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Alessandrino G, Chevalier B, Lefèvre T, Sanguineti F, Garot P, Unterseeh T, Hovasse T, Morice MC, Louvard Y. A Clinical and Angiographic Scoring System to Predict the Probability of Successful First-Attempt Percutaneous Coronary Intervention in Patients With Total Chronic Coronary Occlusion. JACC Cardiovasc Interv 2015; 8:1540-8. [DOI: 10.1016/j.jcin.2015.07.009] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 04/14/2015] [Accepted: 07/02/2015] [Indexed: 01/16/2023]
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159
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Real-World Use and Appropriateness of Coronary Interventions for Chronic Total Occlusion (from a Japanese Multicenter Registry). Am J Cardiol 2015; 116:858-64. [PMID: 26183792 DOI: 10.1016/j.amjcard.2015.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 06/10/2015] [Accepted: 06/10/2015] [Indexed: 12/14/2022]
Abstract
Little is known about the outcomes and indications of chronic total occlusion percutaneous coronary intervention (CTO-PCI), other than in high-volume centers. We sought to provide a real-world overview of the clinical outcomes and appropriateness of PCI for CTO. The analysis included 4,950 consecutive PCIs for nonacute indications registered in the multicenter Japanese PCI registry in collaboration with the US National Cardiovascular Data Registry (Cath-PCI). Data included demographics, clinical outcomes (procedural success and complication rates), and the indication appropriateness, based on the 2012 appropriate use criteria for revascularization. The overall procedural success and major adverse cardiac event rates of 501 cases with CTO-PCI (10.1%) were 76% and 3.2%, respectively. Based on the criteria, mapping failures occurred in 2,521 procedures; the remaining 2,429 PCIs were successfully mapped. The CTO-PCIs were performed for more appropriate indications than PCIs for lesions without CTO. The rate of inappropriate indications was significantly lower in CTO-PCIs than in non-CTO-PCIs (23.0% vs 31.4%, p = 0.04). Only 17% of CTO-PCIs were directly assigned to CTO-specific scenarios because such scenarios are only intended for "Lone" CTO; the rest of the CTO-PCI cases were secondarily mapped to non-CTO-specific scenarios. In conclusion, as many as 10% of the elective PCIs were performed for CTO lesions in a contemporary multicenter Japanese PCI registry; CTO-PCI was associated with lower procedural success and higher complication rates than non-CTO-PCI. Its indication was relatively appropriate; however, our findings emphasize the need for more rigorous evaluation in terms of the present insufficient CTO-related clinical scenarios.
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160
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Roth C, Berger R, Scherzer S, Krenn L, Gangl C, Dalos D, Delle-Karth G, Neunteufl T. Comparison of magnetic wire navigation with the conventional wire technique for percutaneous coronary intervention of chronic total occlusions: a randomised, controlled study. Heart Vessels 2015; 31:1266-76. [PMID: 26369660 DOI: 10.1007/s00380-015-0739-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/28/2015] [Indexed: 12/21/2022]
Abstract
Wire crossing of a chronic total coronary occlusion (CTO) is time consuming and limited by the amount of contrast agent and time of radiation exposure. Magnetic wire navigation (MWN) might accelerate wire crossing by maintaining a coaxial vessel orientation. This study compares MWN with the conventional approach for recanalization of CTOs. Forty symptomatic patients with CTO were randomised to MWN (n = 20) or conventional approach (n = 20) for antegrade crossing of the occlusion. In the intention-to-treat analysis, MWN showed a shorter crossing time (412 versus 1131 s; p = 0.001), and, consequently, lower usage of contrast agent (primary endpoint 42 versus 116 ml; p = 0.01), and lower radiation exposure (dose-area product: 29 versus 80 Gy*cm(2); p = 0.002) during wire crossing compared to the conventional approach. Accordingly, in the per-protocol analysis, the wire-crossing rate was, in trend, higher using the conventional approach (17 of 31) compared to MWN (9 of 28; p = 0.08). The use of MWN for revascularisation of CTOs is feasible and reduces crossing time, use of contrast agent, and radiation exposure. However, due to a broader selection of wires, the conventional approach enables wire crossing in cases failed by MWN and seems to be the more successful choice.
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Affiliation(s)
- Christian Roth
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Berger
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria.
- Department of Internal Medicine I, Cardiology and Nephrology, Hospital of St. John of God, Eisenstadt, Austria.
| | - Sabine Scherzer
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Lisa Krenn
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Clemens Gangl
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Daniel Dalos
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Delle-Karth
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine IV, Cardiology, Hospital of Hietzing, Vienna, Austria
| | - Thomas Neunteufl
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine I, Cardiology, University Hospital of Krems, Krems an der Donau, Austria
- Karl Landsteiner Private University for Health Sciences, Krems an der Donau, Austria
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161
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Carlino M, Ruparelia N, Thomas G, Brooks M, Uretsky BF, Brilakis ES, Karmpaliotis D, Hanratty C, Walsh S, Spratt J, Colombo A. Modified contrast microinjection technique to facilitate chronic total occlusion recanalization. Catheter Cardiovasc Interv 2015; 87:1036-41. [DOI: 10.1002/ccd.26242] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/30/2015] [Accepted: 08/24/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | - Neil Ruparelia
- San Raffaele Scientific Institute; Milan Italy
- Imperial College; London United Kingdom
| | - Gavin Thomas
- Belfast Healthcare Trust; Belfast Northern Ireland United Kingdom
| | | | | | | | | | - Colm Hanratty
- Belfast Healthcare Trust; Belfast Northern Ireland United Kingdom
| | - Simon Walsh
- Belfast Healthcare Trust; Belfast Northern Ireland United Kingdom
| | - James Spratt
- Edinburgh Royal Infirmary; Edinburgh United Kingdom
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162
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Vo MN, Karmpaliotis D, Brilakis ES. “Move the cap” technique for ambiguous or impenetrable proximal cap of coronary total occlusion. Catheter Cardiovasc Interv 2015; 87:742-8. [DOI: 10.1002/ccd.26079] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 05/06/2015] [Accepted: 05/23/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Minh N. Vo
- Section of Cardiology; University of Manitoba, St. Boniface Hospital; Winnipeg Manitoba Canada
| | - Dimitri Karmpaliotis
- Division of Cardiology, Department of Medicine, Columbia University Medical Center; New York New York
| | - Emmanouil S. Brilakis
- Division of Cardiology, Department of Medicine, VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
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163
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Tomasello SD, Boukhris M, Giubilato S, Marzà F, Garbo R, Contegiacomo G, Marzocchi A, Niccoli G, Gagnor A, Varbella F, Desideri A, Rubartelli P, Cioppa A, Baralis G, Galassi AR. Management strategies in patients affected by chronic total occlusions: results from the Italian Registry of Chronic Total Occlusions. Eur Heart J 2015; 36:3189-98. [DOI: 10.1093/eurheartj/ehv450] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/17/2015] [Indexed: 11/14/2022] Open
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164
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Vaquerizo B, Barros A, Pujadas S, Bajo E, Estrada D, Miranda-Guardiola F, Rigla J, Jiménez M, Cinca J, Serra A. Bioresorbable everolimus-eluting vascular scaffold for the treatment of chronic total occlusions: CTO-ABSORB pilot study. EUROINTERVENTION 2015; 11:555-63. [DOI: 10.4244/eijy14m12_07] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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165
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Galassi AR, Brilakis ES, Boukhris M, Tomasello SD, Sianos G, Karmpaliotis D, Di Mario C, Strauss BH, Rinfret S, Yamane M, Katoh O, Werner GS, Reifart N. Appropriateness of percutaneous revascularization of coronary chronic total occlusions: an overview. Eur Heart J 2015; 37:2692-700. [DOI: 10.1093/eurheartj/ehv391] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/26/2015] [Indexed: 01/24/2023] Open
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166
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Galassi AR, Boukhris M, Azzarelli S, Marzà F, Tomasello SD. Percutaneous Coronary Interventions for Chronic Total Occlusions: More Benefit for the Patient or for the Interventionist's Ego? Can J Cardiol 2015; 31:974-9. [DOI: 10.1016/j.cjca.2015.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/25/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022] Open
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167
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Bryniarski L, Surowiec S, Zabojszcz M. Retrograde approach to chronically occluded coronary arteries – a step forward in CTO PCI. Interv Cardiol 2015. [DOI: 10.2217/ica.15.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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168
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Christopoulos G, Karmpaliotis D, Alaswad K, Yeh RW, Jaffer FA, Wyman RM, Lombardi WL, Menon RV, Grantham JA, Kandzari DE, Lembo N, Moses JW, Kirtane AJ, Parikh M, Green P, Finn M, Garcia S, Doing A, Patel M, Bahadorani J, Tarar MNJ, Christakopoulos GE, Thompson CA, Banerjee S, Brilakis ES. Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry. Int J Cardiol 2015; 198:222-8. [PMID: 26189193 DOI: 10.1016/j.ijcard.2015.06.093] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/22/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND A hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) prioritizing and combining all available crossing techniques was developed to optimize procedural efficacy, efficiency, and safety, but there is limited published data on its outcomes. METHODS We examined the procedural techniques and outcomes of 1036 consecutive CTO PCIs performed using a hybrid approach between 2012 and 2015 at 11 US centers. RESULTS Mean age was 65 ± 10 years and 86% of the patients were men, with a high prevalence of diabetes mellitus (43%) and prior coronary artery bypass graft surgery (34%). Most target CTOs were located in the right coronary artery (59%), followed by the left anterior descending artery (23%) and the circumflex (19%). Dual injection was used in 71%. Technical success was achieved in 91% and a major procedural complication occurred in 1.7% of cases. The final successful crossing technique was antegrade wire escalation in 46%, antegrade dissection/re-entry in 26%, and retrograde in 28%. The initial crossing strategy was successful in 58% of the lesions, whereas 39% required an additional approach. Overall, antegrade wire escalation was used in 71%, antegrade dissection/re-entry in 36%, and the retrograde approach in 42% of procedures. Median contrast volume, fluoroscopy time, and air kerma radiation dose were 260 (200-360) ml, 44 (27-72) min, and 3.4 (2.0-5.4) Gray, respectively. CONCLUSION Application of a hybrid approach to CTO crossing resulted in high success and low complication rates across a varied group of operators and hospital practice structures, supporting its expanding use in CTO PCI.
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Affiliation(s)
- Georgios Christopoulos
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States
| | | | | | - Robert W Yeh
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Farouc A Jaffer
- Torrance Memorial Medical Center, Torrance, CA, United States
| | - R Michael Wyman
- Torrance Memorial Medical Center, Torrance, CA, United States
| | | | - Rohan V Menon
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States
| | | | | | | | | | | | | | - Philip Green
- Columbia University, New York, NY, United States
| | - Matthew Finn
- Columbia University, New York, NY, United States
| | - Santiago Garcia
- Minneapolis VA Healthcare System, Minneapolis, MN, United States; University of Minnesota, Minneapolis, MN, United States
| | - Anthony Doing
- Medical Center of the Rockies, Loveland, CO, United States
| | - Mitul Patel
- VA San Diego Healthcare System, San Diego, CA, United States; University of California San Diego, San Diego, CA, United States
| | - John Bahadorani
- VA San Diego Healthcare System, San Diego, CA, United States; University of California San Diego, San Diego, CA, United States
| | - Muhammad Nauman J Tarar
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States
| | | | | | - Subhash Banerjee
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States
| | - Emmanouil S Brilakis
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States.
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169
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Knowledge of chronic total occlusion among Polish interventional cardiologists. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:89-94. [PMID: 26161099 PMCID: PMC4495123 DOI: 10.5114/pwki.2015.52280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 08/28/2014] [Accepted: 08/28/2014] [Indexed: 12/23/2022] Open
Abstract
Introduction Chronic total occlusion (CTO) recanalization is indicated in patients with symptoms and evidence of ischemia, but in most cases those types of lesions are still treated medically. In the last few years CTO angioplasty technique has changed dramatically due to considerable advances in techniques and dedicated equipment. Aim An attempt to assess the state of knowledge of technical aspects of CTO angioplasty of coronary arteries among Polish interventional cardiologists. Material and methods Questionnaire survey performed during two major Polish invasive cardiology workshops. Results In the study there participated 113 physicians with an average length of work experience of 13 years, most of them cardiologists certified as independent primary operators. The majority of respondents recognized the need of prevention of thrombotic complications through control of activated coagulation time during the CTO procedures. Prevention of renal complications and X-ray protection are also recognized as a significant part of the procedures. The benefits from the use of over-the-wire microcatheters and balloons, the proper choice of dedicated guidewires, contralateral injections and retrograde technique are underestimated. Conclusions Despite satisfactory knowledge about indications and qualification for the CTO procedure, the awareness of procedural aspects (particularly the retrograde technique) as well as the dedicated CTO equipment among Polish interventional cardiologists is still insufficient.
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170
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Retrograde Percutaneous Coronary Intervention for Chronic Total Occlusion: Going Backward to Go Forward. J Am Coll Cardiol 2015; 65:2401-3. [PMID: 26046733 DOI: 10.1016/j.jacc.2015.03.565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 03/28/2015] [Indexed: 11/20/2022]
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171
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Galassi AR, Sianos G, Werner GS, Escaned J, Tomasello SD, Boukhris M, Castaing M, Büttner JH, Bufe A, Kalnins A, Spratt JC, Garbo R, Hildick-Smith D, Elhadad S, Gagnor A, Lauer B, Bryniarski L, Christiansen EH, Thuesen L, Meyer-Geßner M, Goktekin O, Carlino M, Louvard Y, Lefèvre T, Lismanis A, Gelev VL, Serra A, Marzà F, Di Mario C, Reifart N. Retrograde Recanalization of Chronic Total Occlusions in Europe. J Am Coll Cardiol 2015; 65:2388-400. [DOI: 10.1016/j.jacc.2015.03.566] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/20/2015] [Accepted: 03/20/2015] [Indexed: 12/12/2022]
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172
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Value of Hybrid Imaging with PET/CT to Guide Percutaneous Revascularization of Chronic Total Coronary Occlusion. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015; 8:26. [PMID: 26029338 PMCID: PMC4442975 DOI: 10.1007/s12410-015-9340-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Chronic total coronary occlusions (CTO) are documented in approximately one fifth of diagnostic invasive coronary angiographies (ICA). Percutaneous coronary interventions (PCI) of CTO are challenging and are accompanied by higher complication and lower success rates in comparison with non-CTO PCI. Scrutinous evaluation of ischemia and viability to justify percutaneous revascularization is therefore of importance to select eligible patients for such a procedure. Furthermore, knowledge of the anatomical features of the occlusion may predict the chances of success of PCI CTO and could even guide the procedural strategy to augment the likelihood of recanalization. Positron emission tomography (PET) is unequivocally accepted as the reference standard for ischemia and viability testing, whereas coronary computed tomography angiography (CCTA) currently allows for non-invasive detailed three-dimensional imaging of the coronary anatomy that adds morphological information over two-dimensional ICA. Hybrid PET/CT could therefore be useful for optimal patient selection as well as procedural planning. This review discusses the potential value of PET/CT to guide PCI in CTOs.
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173
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Reifart N. IVUS-guided stenting: still not a must? EUROINTERVENTION 2015; 10:1379-81. [PMID: 25912389 DOI: 10.4244/eijv10i12a240] [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]
Affiliation(s)
- Nicolaus Reifart
- Kardiologisches Institut Prof. Reifart & Partner, Bad Soden, Germany
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174
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Jaguszewski M, Ciecwierz D, Gilis-Malinowska N, Fijalkowski M, Targonski R, Masiewicz E, Strozyk A, Duda M, Chmielecki M, Lewicki L, Dubaniewicz W, Burakowski S, Drewla P, Skarzynski P, Rynkiewicz A, Alibegovic J, Landmesser U, Gruchala M. Successful versus unsuccessful antegrade recanalization of single chronic coronary occlusion: Eight-year experience and outcomes by a propensity score ascertainment. Catheter Cardiovasc Interv 2015; 86:E49-57. [DOI: 10.1002/ccd.25841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/10/2015] [Indexed: 01/24/2023]
Affiliation(s)
- Milosz Jaguszewski
- Department of Cardiology; Medical University of Gdansk; Poland
- Department of Cardiology; Campus Benjamin Franklin; Charite Berlin Germany
| | | | | | | | | | | | - Aneta Strozyk
- Department of Cardiology; Medical University of Gdansk; Poland
| | - Maciej Duda
- Department of Cardiac Surgery; Medical University of Gdansk; Poland
| | | | - Lukasz Lewicki
- Cardiology; Pomeranian Cardiology Centres; Gdansk Poland
| | | | | | - Piotr Drewla
- Department of Cardiology; Medical University of Gdansk; Poland
| | | | - Andrzej Rynkiewicz
- Cardiology; Pomeranian Cardiology Centres; Gdansk Poland
- Department of Cardiology and Cardiac Surgery; University of Warmia and Mazury; Olsztyn Poland
| | - Jasmina Alibegovic
- Department of Cardiology; University Heart Center; University Hospital Zurich; Switzerland
| | - Ulf Landmesser
- Department of Cardiology; Campus Benjamin Franklin; Charite Berlin Germany
| | - Marcin Gruchala
- Department of Cardiology; Medical University of Gdansk; Poland
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175
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Pavlidis AN, Jones DA, Sirker A, Mathur A, Smith EJ. Prevention of contrast-induced acute kidney injury after percutaneous coronary intervention for chronic total coronary occlusions. Am J Cardiol 2015; 115:844-51. [PMID: 25638517 DOI: 10.1016/j.amjcard.2014.12.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/13/2014] [Accepted: 12/13/2014] [Indexed: 10/24/2022]
Abstract
Chronic total occlusions (CTOs) represent a major challenge in percutaneous coronary revascularization. The recent advances in strategies and techniques and the development of dedicated equipment, such as microcatheters and wires, have resulted in considerably higher success rates. Although successful CTO recanalization is associated with significant clinical benefits, including improvement of angina, quality of life, reduced need for surgical revascularization, and improvement of left ventricular function, CTO procedures may require prolonged x-ray exposure and use of larger volumes of contrast compared with non-CTO procedures. Large volumes of contrast medium have been associated with increased rates of contrast-induced acute kidney injury (CI-AKI) and adverse short- and long-term outcomes. Application of specific measures and algorithms should be considered by all CTO operators to prevent CI-AKI.
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176
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Incidence, treatment, and in-hospital outcome of bifurcation lesions in patients undergoing percutaneous coronary interventions for chronic total occlusions. Coron Artery Dis 2015; 26:142-9. [DOI: 10.1097/mca.0000000000000194] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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177
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Boukhris M, Tomasello SD, Marzà F, Azzarelli S, Galassi AR. Iatrogenic Aortic Dissection Complicating Percutaneous Coronary Intervention for Chronic Total Occlusion. Can J Cardiol 2015; 31:320-7. [DOI: 10.1016/j.cjca.2014.11.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/17/2014] [Accepted: 11/30/2014] [Indexed: 11/29/2022] Open
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Boukhris M, Tomasello SD, Azzarelli S, Elhadj ZI, Marzà F, Galassi AR. Coronary perforation with tamponade successfully managed by retrograde and antegrade coil embolization. J Saudi Heart Assoc 2015; 27:216-21. [PMID: 26136637 PMCID: PMC4481427 DOI: 10.1016/j.jsha.2015.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 02/02/2015] [Accepted: 02/09/2015] [Indexed: 11/18/2022] Open
Abstract
In recent years, retrograde approach for chronic total occlusions has rapidly evolved, enabling a higher rate of revascularization success. Compared to septal channels, epicardial collaterals tend to be more tortuous, more difficult to negotiate, and more prone to rupture. Coronary perforation is a rare but potentially life-threatening complication of coronary angioplasty, often leading to emergency cardiac surgery. We report a case of a retrograde chronic total occlusion revascularization through epicardial collaterals, complicated by both retrograde and antegrade coronary perforation with tamponade, and successfully managed by coil embolization.
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Affiliation(s)
- Marouane Boukhris
- Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, 95021 Catania, Italy
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Salvatore Davide Tomasello
- Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, 95021 Catania, Italy
| | - Salvatore Azzarelli
- Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, 95021 Catania, Italy
| | - Zied Ibn Elhadj
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Francesco Marzà
- Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, 95021 Catania, Italy
| | - Alfredo Ruggero Galassi
- Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, 95021 Catania, Italy
- Corresponding author at: Via Antonello da Messina 75, Acicastello, 95021 Catania, Italy. Tel.: +39 095 7263122; fax: +39 095 7263124.
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179
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Lupi A, Rognoni A, Schaffer A, Secco GG, Bongo AS. Complex Coronary Interventions with the Novel Mozec ™ CTO Balloon: The MOZART Registry. CLINICAL MEDICINE INSIGHTS: CARDIOLOGY 2015; 9:91-6. [PMID: 26379450 PMCID: PMC4554352 DOI: 10.4137/cmc.s25552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Mozec™ CTO is a novel semicompliant rapid-exchange PTCA balloon catheter with specific features dedicated to treat complex coronary lesions like chronic total occlusions (CTOs). However, no data have been reported about the performance of this device in an all-comers population with complex coronary lesions. METHODS We evaluated the safety and success rate of Mozec™ CTO balloon in 41 consecutive patients with chronic stable angina and complex coronary lesions (15 severe calcified coronary stenoses, 15 bifurcation lesions with planned two-stent intervention, and 11 CTOs). Safety was assessed reporting the balloon burst rate after inflation exceeding the rated burst pressure (RBP) according to the manufacturer’s reference table. Success was defined as the possibility to advance the device further the target lesion. RESULTS The Mozec™ CTO balloon showed an excellent performance with a 93.3% success in crossing tight and severely calcified lesions (14/15 pts), a 93.3% success in engaging jailed side branches after stent deployment across bifurcations (14/15 pts), and a 90.9% success in crossing CTO lesions (10/11 pts). The burst rate at RBP of the Mozec™ CTO balloon was 6.7% (1/15 balloons) in the tight and severely calcified lesions, 6.7% (1/15 balloons) when dilating jailed vessels, and 9.1% (1/11 balloons) in CTOs. CONCLUSIONS The novel Mozec™ CTO balloon dilatation catheter showed promising results when employed to treat complex lesions in an all-comers population. Further studies should clarify if this kind of balloon might reduce the need of more costly devices like over-the-wire balloons and microcatheters for complex lesions treatment.
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Affiliation(s)
- Alessandro Lupi
- 2nd Division of Cardiology, “Maggiore della Carità” Hospital, Novara, Italy
| | - Andrea Rognoni
- 2nd Division of Cardiology, “Maggiore della Carità” Hospital, Novara, Italy
| | - Alon Schaffer
- Department of Cardiology, Eastern Piedmont University, Novara, Italy
| | - Gioel G. Secco
- 2nd Division of Cardiology, “Maggiore della Carità” Hospital, Novara, Italy
| | - Angelo S. Bongo
- 2nd Division of Cardiology, “Maggiore della Carità” Hospital, Novara, Italy
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180
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Wiebe J, Liebetrau C, Dörr O, Most A, Weipert K, Rixe J, Bauer T, Möllmann H, Elsässer A, Hamm CW, Nef HM. Feasibility of everolimus-eluting bioresorbable vascular scaffolds in patients with chronic total occlusion. Int J Cardiol 2015; 179:90-4. [DOI: 10.1016/j.ijcard.2014.10.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/30/2014] [Accepted: 10/18/2014] [Indexed: 11/24/2022]
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181
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Percutaneous Coronary Intervention and the Various Coronary Artery Disease Syndromes. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_23] [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: 11/25/2022]
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182
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Carlino M, Magri CJ, Uretsky BF, Brilakis ES, Walsh S, Spratt JC, Hanratty C, Grantham JA, Rinfret S, Thompson CA, Lombardi WL, Galassi AR, Sianos G, Latib A, Garbo R, Karmpaliotis D, Kandzari DE, Colombo A. Treatment of the chronic total occlusion: A call to action for the interventional community. Catheter Cardiovasc Interv 2014; 85:771-8. [DOI: 10.1002/ccd.25736] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 11/07/2014] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Barry F. Uretsky
- University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Emmanouil S. Brilakis
- VA North Texas Health Care System, and University of Texas Southwestern Medical Center; Dallas Texas
| | - Simon Walsh
- Department of Cardiology; Belfast Health and Social Care Trust; Belfast United Kingdom
| | | | - Colm Hanratty
- Department of Cardiology; Belfast Health and Social Care Trust; Belfast United Kingdom
| | | | - Stéphane Rinfret
- Quebec Heart and Lung Institute, Laval University; Quebec City Canada
| | | | | | - Alfredo R. Galassi
- Department of Medical Sciences and Pediatrics; Clinical Division of Cardiology, Cannizzaro Hospital, University of Catania; Italy
| | - George Sianos
- Department of Cardiology; AHEPA University Hospital; Thessaloniki Greece
| | - Azeem Latib
- San Raffaele Scientific Institute; Milan Italy
| | | | | | | | - Antonio Colombo
- San Raffaele Scientific Institute; Milan Italy
- EMO-GVM Centro Cuore Columbus; Milan Italy
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183
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Werner GS, Coenen A, Tischer KH. Periprocedural ischaemia during recanalisation of chronic total coronary occlusions: the influence of the transcollateral retrograde approach. EUROINTERVENTION 2014; 10:799-805. [DOI: 10.4244/eijv10i7a139] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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184
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Reifart N, Werner GS. Subintimal wire pathway: part of the game of crossing chronic total coronary occlusions. EUROINTERVENTION 2014; 10:655-7. [PMID: 25330498 DOI: 10.4244/eijv10i6a115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Nicolaus Reifart
- Medizinische Klinik 1 (Kardiologie), Main-Taunus-Kliniken, Bad Soden, Germany
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185
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Muramatsu T, Tsuchikane E, Oikawa Y, Otsuji S, Fujita T, Ochiai M, Kawasaki T, Abe M, Sakurada M, Kishi K. Incidence and impact on midterm outcome of controlled subintimal tracking in patients with successful recanalisation of chronic total occlusions: J-PROCTOR registry. EUROINTERVENTION 2014; 10:681-8. [DOI: 10.4244/eijv10i6a119] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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187
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MICHAEL TESFALDETT, MOGABGAB OWEN, ALOMAR MOHAMMED, KOTSIA ANNA, CHRISTOPOULOS GEORGE, RANGAN BAVANAV, ABDULLAH SHUAIB, GRODIN JERROLD, BANERJEE SUBHASH, BRILAKIS EMMANOUILS. Long-Term Outcomes of Successful Chronic Total Occlusion Percutaneous Coronary Interventions Using the Antegrade and Retrograde Approach. J Interv Cardiol 2014; 27:465-71. [DOI: 10.1111/joic.12149] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- TESFALDET T. MICHAEL
- Knight Cardiovascular Institute; Oregon Health & Science University; Portland Oregon
| | - OWEN MOGABGAB
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - MOHAMMED ALOMAR
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - ANNA KOTSIA
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - GEORGE CHRISTOPOULOS
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - BAVANA V. RANGAN
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - SHUAIB ABDULLAH
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - JERROLD GRODIN
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - SUBHASH BANERJEE
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - EMMANOUIL S. BRILAKIS
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
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188
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Råmunddal T, Hoebers L, Henriques JPS, Dworeck C, Angerås O, Odenstedt J, Ioanes D, Olivecrona G, Harnek J, Jensen U, Aasa M, Jussila R, James S, Lagerqvist B, Matejka G, Albertsson P, Omerovic E. Chronic total occlusions in Sweden--a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). PLoS One 2014; 9:e103850. [PMID: 25117457 PMCID: PMC4130518 DOI: 10.1371/journal.pone.0103850] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 07/04/2014] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Evidence for the current guidelines for the treatment of patients with chronic total occlusions (CTO) in coronary arteries is limited. In this study we identified all CTO patients registered in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and studied the prevalence, patient characteristics and treatment decisions for CTO in Sweden. METHODS AND RESULTS Between January 2005 and January 2012, 276,931 procedures (coronary angiography or percutaneous coronary intervention) were performed in 215,836 patients registered in SCAAR. We identified all patients who had 100% luminal diameter stenosis known or assumed to be ≥ 3 months old. After exclusion of patients with previous coronary artery bypass graft (CABG) surgery or coronary occlusions due to acute coronary syndrome, we identified 16,818 CTO patients. A CTO was present in 10.9% of all coronary angiographies and in 16.0% of patients with coronary artery disease. The majority of CTO patients were treated conservatively and PCI of CTO accounted for only 5.8% of all PCI procedures. CTO patients with diabetes and multivessel disease were more likely to be referred to CABG. CONCLUSION CTO is a common finding in Swedish patients undergoing coronary angiography but the number of CTO procedures in Sweden is low. Patients with CTO are a high-risk subgroup of patients with coronary artery disease. SCAAR has the largest register of CTO patients and therefore may be valuable for studies of clinical importance of CTO and optimal treatment for CTO patients.
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Affiliation(s)
- Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Loes Hoebers
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Christian Dworeck
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Olivecrona
- Department of Coronary Heart Disease, Skåne University Hospital, Scania, Sweden
| | - Jan Harnek
- Department of Coronary Heart Disease, Skåne University Hospital, Scania, Sweden
| | - Ulf Jensen
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Mikael Aasa
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Risto Jussila
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Stefan James
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bo Lagerqvist
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Göran Matejka
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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189
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Galassi A, Grantham A, Kandzari D, Lombardi W, Moussa I, Thompson C, Werner G, Chambers C, Brilakis E. Percutaneous Treatment of Coronary Chronic Total Occlusions Part 1: Rationale and Outcomes. Interv Cardiol 2014; 9:195-200. [PMID: 29588802 DOI: 10.15420/icr.2014.9.3.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Coronary chronic total occlusions (CTOs) are commonly encountered in patients with coronary artery disease. Compared to patients without coronary CTOs, those with CTO have worse clinical outcomes and lower likelihood of complete coronary revascularisation. Successful CTO percutaneous coronary intervention (PCI) can significantly improve angina and improve left ventricular function. Although currently unproven, successful CTO PCI might also reduce the risk for arrhythmic events in patients with ischaemic cardiomyopathy, provide better tolerance of future acute coronary syndrome, and possibly improve survival. Evaluation by a heart team comprised of both interventional and non-interventional cardiologists and cardiac surgeons is important for determining the optimal revascularisation strategy in patients with coronary artery disease and CTOs. Ad hoc CTO PCI is generally not recommended, so as to allow sufficient time for (a) discussion with the patient about the indications, goals, risks, and alternatives to PCI; (b) careful procedural planning; and (c) contrast and radiation exposure minimisation. Use of drug-eluting stents is recommended for CTO PCI, given the lower rates of angiographic restenosis compared to bare metal stents.
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Affiliation(s)
| | - Aaron Grantham
- Saint Luke's Mid America Heart Institute and University of Missouri Kansas City, Missouri, US
| | | | | | | | | | | | - Charles Chambers
- Penn State University College of Medicine, Hershey, Pennsylvania, US
| | - Emmanouil Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, US
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190
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Qu X, Fang W, Gong K, Ye J, Guan S, Li R, Xu Y, Shen Y, Zhang M, Liu H, Xie W. Clinical significance of a single multi-slice CT assessment in patients with coronary chronic total occlusion lesions prior to revascularization. PLoS One 2014; 9:e98242. [PMID: 24905494 PMCID: PMC4048204 DOI: 10.1371/journal.pone.0098242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 04/29/2014] [Indexed: 11/18/2022] Open
Abstract
Accurate assessment of coronary chronic total occlusion (CTO) lesion is essential to design an appropriate procedural strategy before revascularization. The present study aims to evaluate the significance of a single multislice computed tomography (MSCT) examination in patients with CTO lesion. We retrospectively analyzed the clinical data of 23 CTO lesions in twenty patients underwent computed tomography coronary angiography (CTCA) and SPECT. The CTCA was more powerful and sensitive to determine the CTO lesion length (100% v.s 47.8%) and to identify the length and location of calcification in occluded vessels compared with the coronary angiography (CAG). The LVEF measured by MSCT was comparable to that from the gated SPECT. Myocardial perfusion imaging showed that the location of the early defect region identified by MSCT was corresponded to the nuclide filling defect on the stressed 201thallium-SPECT imaging. The late hyperenhancement on MSCT was presented as incomplete nuclide filling on the 99mTc-MIBI imaging. The results suggested that a single MSCT examination in previous myocardial infarction without revascularization facilitates to provide some valuable information on the nature of the occluded lesion, myocardial perfusion and globe cardiac function, which would be helpful to design appropriate revascularization strategy in these subjects.
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Affiliation(s)
- Xinkai Qu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weiyi Fang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
| | - Kaizheng Gong
- Department of Cardiology, The Second Clinical Medical School of Yangzhou University, Jiangsu Province, China
| | - Jianding Ye
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shaofeng Guan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yingjia Xu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Shen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Liu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Xie
- Department of Nuclear medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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191
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El Sabbagh A, Patel VG, Jeroudi OM, Michael TT, Alomar ME, Mogabgab O, Fuh E, Roesle M, Rangan BV, Abdullah S, Hastings JL, Grodin J, Kumbhani DJ, Alexopoulos D, Fasseas P, Banerjee S, Brilakis ES. Angiographic success and procedural complications in patients undergoing retrograde percutaneous coronary chronic total occlusion interventions: A weighted meta-analysis of 3482 patients from 26 studies. Int J Cardiol 2014; 174:243-8. [DOI: 10.1016/j.ijcard.2014.04.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 03/09/2014] [Accepted: 04/01/2014] [Indexed: 11/30/2022]
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Abstract
Chronic total occlusions (CTOs) are often detected on diagnostic coronary angiograms, but percutaneous coronary intervention (PCI) for CTO is currently infrequently performed owing to high technical difficulty, perceived risk of complications, and a lack of randomized data. However, successful CTO-PCI can significantly increase a patient's quality of life, improve left ventricular function, reduce the need for subsequent CABG surgery, and possibly improve long-term survival. A number of factors must be taken into account for the selection of patients for CTO-PCI, including the extent of ischaemia surrounding the occlusion, the level of myocardial viability, coronary location of the CTO, and probability of procedural success. Moreover, in patients with ST-segment elevation myocardial infarction, a CTO in a noninfarct-related artery might lead to an increase in infarct area, increased end-diastolic left ventricular pressure, and decreased left ventricular function, which are all associated with poor clinical outcomes. In this Review, we provide an overview of the anatomy and histopathology of CTOs, perceived benefits of CTO-PCI, considerations for patient selection for this procedure, and a summary of emerging techniques for CTO-PCI.
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193
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Estevez-Loureiro R, Ghione M, Kilickesmez K, Agudo P, Lindsay A, Di Mario C. The role for adjunctive image in pre-procedural assessment and peri-procedural management in chronic total occlusion recanalisation. Curr Cardiol Rev 2014; 10:120-6. [PMID: 24694101 PMCID: PMC4021282 DOI: 10.2174/1573403x10666140331143731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 12/15/2013] [Accepted: 01/20/2014] [Indexed: 11/28/2022] Open
Abstract
Non invasive coronary angiography with multislice computed tomography has exquisite sensitivity to detect
calcium and even the faintest late contrast filling of the distal vessel. Calcium burden and occlusion length are still valuable
markers of duration, complexity and success of the recanalisation procedure. The ability to visualise the vessel also in
the occluded segment, especially if calcified, can also help the operator to understand where to pierce the proximal cap in
stumpless occlusions and to predict unusual courses, especially in very tortuous arteries. Imaging side by side CT images
and angiography during the recanalisation procedure is an established practice in many active CTO laboratories and algorithms
for co-registration are designed to overcome the challenges of systo-diastolic and respiratory motion. Intravascular
ultrasound is used in almost all cases by the experienced Japanese CTO operators but most of the times its main use is a
better identification of the diseased segment after predilatation to ensure complete stent cover and appropriate stent expansion,
an application similar to other complex non occlusive lesions. The specificity of IVUS during CTO recanalisation is
the identification of the vessel path in stumpless occlusions and the guidance of wire reentry especially during reverse
Controlled Retrograde Anterograde Tracking. Optical coherence tomography has limitations in the setting of CTO recanalisation
because of the need of forceful contrast flushing to clear blood, contraindicated in the presence of anterograde
dissections, and the limited penetration. The variability in the use of both non-invasive and invasive imaging during CTO
recanalisation is immense, going from more than 90% in Japan to less than 20% in Europe and intermediate penetration in
the USA. Probably the explanation is almost only in availability and cost because all countries see a progressive increase
of use suggesting that these methods are becoming an established tool for guidance of CTO recanalisation.
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Affiliation(s)
| | | | | | | | | | - Carlo Di Mario
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK.
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194
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Advances in the management of coronary chronic total occlusions. J Cardiovasc Transl Res 2014; 7:426-36. [PMID: 24634196 DOI: 10.1007/s12265-014-9556-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/24/2014] [Indexed: 12/16/2022]
Abstract
Chronic total occlusions (CTOs) have been called "the last frontier" of percutaneous coronary intervention (PCI) due to traditionally low success rates and high risk for restenosis and re-occlusion. Recent advances in equipment and crossing techniques have significantly increased CTO PCI success rates while maintaining low risk of complications. Specifically, the retrograde approach and controlled antegrade dissection and re-entry in conjunction with advanced guidewires and microcatheters have significantly improved procedural success rates. Moreover, the introduction of the "hybrid" approach has created a unified framework for operators to approach CTOs in a systematic and efficient fashion. Finally, drug-eluting stents, especially second generation, have improved long-term patency after CTO PCI.
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195
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Intravascular ultrasound-guided chronic total occlusion wiring technique using 6 Fr catheters via bilateral transradial approach. Cardiovasc Interv Ther 2014; 30:68-71. [PMID: 24535707 DOI: 10.1007/s12928-014-0251-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
Abstract
A blunt stump-type entry of chronic total occlusion (CTO) is one of the most difficult morphologic features to overcome in percutaneous coronary intervention (PCI), which often requires the guidance of intravascular ultrasound (IVUS) to identify the entry point. However, real-time, IVUS-guided PCI usually requires an 8 Fr guiding catheter. In this report, we describe a successful PCI for blunt stump CTO using bi-radial, IVUS-guided CTO wiring technique. Two 6 Fr guiding catheters (one as an operating guidewire; second for IVUS imaging) were simultaneously inserted into the left coronary artery via bilateral radial arteries. This technique may be useful for CTO intervention.
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196
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197
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Michael TT, Karmpaliotis D, Brilakis ES, Alomar M, Abdullah SM, Kirkland BL, Mishoe KL, Lembo N, Kalynych A, Carlson H, Banerjee S, Luna M, Lombardi W, Kandzari DE. Temporal trends of fluoroscopy time and contrast utilization in coronary chronic total occlusion revascularization: insights from a multicenter United States registry. Catheter Cardiovasc Interv 2014; 85:393-9. [PMID: 24407867 DOI: 10.1002/ccd.25359] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 10/28/2013] [Accepted: 12/23/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND The impact of operator experience on fluoroscopy time and contrast utilization during percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs) has received limited study. METHODS We evaluated temporal trends in fluoroscopy time and contrast utilization among 1,363 consecutive CTO PCIs performed at three US institutions between January 2006 and November 2011. RESULTS Mean age was 65 ± 11 years, 85% of patients were men, 40% had diabetes, 37% had prior coronary artery bypass graft surgery, and 42% had prior PCI. The CTO target vessel was the right coronary artery (55%), circumflex (23%), left anterior descending artery (21%), and left main or bypass graft (1%). The retrograde approach was used in 34% of all procedures. The technical and procedural success rates were 85.5 and 84.2%, respectively. The mean procedural time, fluoroscopy time, and contrast utilization were 113 ± 61 min, 42 ± 29 min, and 294 ± 158 mL, respectively. Years since initiation of CTO PCI were independently associated with higher technical success rate (odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.52-1.70, P < 0.001), lower fluoroscopy time (OR = 0.84, 95% CI = 0.75-0.95, P = 0.005), and contrast utilization (OR = 0.84, 95% CI = 0.62-0.79, P < 0.001) during the study period. CONCLUSIONS Among selected US-based institutions performing CTO PCI, we observed a significant reduction in total fluoroscopy time and contrast utilization paralleled with an improved technical success rate over time.
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Affiliation(s)
- Tesfaldet T Michael
- Division of Cardiovascular Diseases, Oregon University Health & Science University, Portland, Oregon
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198
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Teramoto T, Tsuchikane E, Matsuo H, Suzuki Y, Ito T, Ito T, Habara M, Nasu K, Kimura M, Kinoshita Y, Terashima M, Asakura Y, Matsubara T, Suzuki T. Initial Success Rate of Percutaneous Coronary Intervention for Chronic Total Occlusion in a Native Coronary Artery Is Decreased in Patients Who Underwent Previous Coronary Artery Bypass Graft Surgery. JACC Cardiovasc Interv 2014; 7:39-46. [DOI: 10.1016/j.jcin.2013.08.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 07/25/2013] [Accepted: 08/01/2013] [Indexed: 01/21/2023]
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199
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Lo N, Michael TT, Moin D, Patel VG, Alomar M, Papayannis A, Cipher D, Abdullah SM, Banerjee S, Brilakis ES. Periprocedural myocardial injury in chronic total occlusion percutaneous interventions: a systematic cardiac biomarker evaluation study. JACC Cardiovasc Interv 2014; 7:47-54. [PMID: 24332422 PMCID: PMC3927370 DOI: 10.1016/j.jcin.2013.07.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/08/2013] [Accepted: 07/03/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to evaluate the incidence, correlates, and clinical implications of periprocedural myocardial injury (PMI) during percutaneous coronary intervention (PCI) of chronic total occlusions (CTO). BACKGROUND The risk of PMI during CTO PCI may be underestimated because systematic cardiac biomarker measurement was not performed in published studies. METHODS We retrospectively examined PMI among 325 consecutive CTO PCI performed at our institution between 2005 and 2012. Creatine kinase-myocardial band fraction and troponin were measured before PCI and 8 to 12 h and 18 to 24 h after PCI in all patients. PMI was defined as creatine kinase-myocardial band increase ≥ 3 x the upper limit of normal. Major adverse cardiac events during mid-term follow-up were evaluated. RESULTS Mean age was 64 ± 8 years. The retrograde approach was used in 26.8% of all procedures. The technical and procedural success was 77.8% and 76.6%, respectively. PMI occurred in 28 patients (8.6%, 95% confidence intervals: 5.8% to 12.2%), with symptomatic ischemia in 7 of those patients. The incidence of PMI was higher in patients treated with the retrograde than the antegrade approach (13.8% vs. 6.7%, p = 0.04). During a median follow-up of 2.3 years, compared with patients without PMI, those with PMI had a higher incidence of major adverse cardiac events (hazard ratio [HR]: 2.25, p = 0.006). Patients with only asymptomatic PMI also had a higher incidence of major adverse cardiac events on follow-up (HR: 2.26, p = 0.013). CONCLUSIONS Systematic measurement of cardiac biomarkers post-CTO PCI demonstrates that PMI occurs in 8.6% of patients, is more common with the retrograde approach, and is associated with worse subsequent clinical outcomes during mid-term follow-up.
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Affiliation(s)
- Nathan Lo
- Department of Internal Medicine, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tesfaldet T Michael
- Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Danyaal Moin
- Department of Internal Medicine, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vishal G Patel
- Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mohammed Alomar
- Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aristotelis Papayannis
- Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daisha Cipher
- Department of Biostatistics, University of Texas at Arlington College of Nursing, Arlington, Texas
| | - Shuaib M Abdullah
- Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Subhash Banerjee
- Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emmanouil S Brilakis
- Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
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200
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Galassi A, Grantham A, Kandzari D, Lombardi W, Moussa I, Thompson C, Werner G, Chambers C, Brilakis E. Percutaneous Treatment of Coronary Chronic Total Occlusion Part 2: Technical Approach. Interv Cardiol 2014; 9:201-207. [PMID: 29588803 DOI: 10.15420/icr.2014.9.3.201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Dual injection is recommended for nearly all chronic total occlusion (CTO) percutaneous coronary intervention (PCI) to determine the optimal crossing strategy and guide wire advancement into the distal true lumen. Strategies that provide enhanced guide catheter support (such as long sheaths, large-bore guiding catheters, use of guide catheter extensions, and anchor techniques) are important for maximising the success rate and efficiency of CTO PCI. Use of a microcatheter or over-the-wire balloon is strongly recommended in CTO PCI for enhancing the penetrating power of the guidewire, enabling change in tip shape and allowing guidewire change (stiff CTO guidewires are not optimal for crossing non-occluded coronary segments). Adherence to a procedural strategy that standardises CTO technique and facilitates procedural success is recommended. Such a strategy would permit stepwise decision-making for antegrade and retrograde methods; inform guidewire selection; and incorporate alternative approaches for instances of initial failure. Given the paucity of long-term outcomes with use of novel crossing techniques (antegrade dissection/re-entry and retrograde), antegrade wire escalation is the preferred CTO crossing technique, if technically feasible. Using measures to minimise radiation exposure (including but not limited to use of 7.5 frames per second fluoroscopy and use of low magnification) and contrast administration is recommended. CTO PCI is best performed at centres with dedicated CTO PCI experience and expertise. Use of crossing difficulty prediction tools, such as the J-CTO score, can facilitate the selection of cases with a high likelihood of quick crossing that can be attempted at less experienced centres.
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Affiliation(s)
| | - Aaron Grantham
- Saint Luke's Mid America Heart Institute and University of Missouri Kansas City, Missouri, US
| | | | | | | | | | | | - Charles Chambers
- Penn State University College of Medicine, Hershey, Pennsylvania, US
| | - Emmanouil Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, US
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