201
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HASEGAWA TASUKU, GODINO COSMO, BASAVARAJAIAH SANDEEP, TAKAGI KENSUKE, REZQ AHMED, LATIB AZEEM, ALAIDE CHIEFFO, MONTORFANO MATTEO, CARLINO MAURO, COLOMBO ANTONIO. Differences in the Clinical and Angiographic Characteristics of Chronic Total Occlusion Lesions in the Three Major Coronary Arteries. J Interv Cardiol 2013; 27:44-9. [DOI: 10.1111/joic.12085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- TASUKU HASEGAWA
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
| | - COSMO GODINO
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - SANDEEP BASAVARAJAIAH
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
| | - KENSUKE TAKAGI
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
| | - AHMED REZQ
- Department of Cardiology; Ain Shams University; Cairo Egypt
| | - AZEEM LATIB
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
| | - CHIEFFO ALAIDE
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - MATTEO MONTORFANO
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - MAURO CARLINO
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - ANTONIO COLOMBO
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
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202
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MICHAEL TESFALDETT, MOGABGAB OWEN, FUH ERIC, PATEL VISHALG, EL SABBAGH ABDALLAH, ALOMAR MOHAMMEDE, RANGAN BAVANAV, ABDULLAH SHUAIBM, BANERJEE SUBHASH, BRILAKIS EMMANOUILS. Application of the “Hybrid Approach” to Chronic Total Occlusion Interventions: A Detailed Procedural Analysis. J Interv Cardiol 2013; 27:36-43. [DOI: 10.1111/joic.12083] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- TESFALDET T. MICHAEL
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - OWEN MOGABGAB
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - ERIC FUH
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - VISHAL G. PATEL
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - ABDALLAH EL SABBAGH
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - MOHAMMED E. ALOMAR
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - BAVANA V. RANGAN
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - SHUAIB M. ABDULLAH
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - SUBHASH BANERJEE
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - EMMANOUIL S. BRILAKIS
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
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203
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Nombela-Franco L, Urena M, Jerez-Valero M, Nguyen CM, Ribeiro HB, Bataille Y, Rodés-Cabau J, Rinfret S. Validation of the J-chronic total occlusion score for chronic total occlusion percutaneous coronary intervention in an independent contemporary cohort. Circ Cardiovasc Interv 2013; 6:635-43. [PMID: 24254710 DOI: 10.1161/circinterventions.113.000447] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Chronic total occlusion (CTO) recanalization is a complex and technically challenging procedure. The J-CTO score has been proposed to stratify case complexity and procedural success rates. However, the score has never been tested outside the setting of the original study. Moreover, its predictive value when using a hybrid antegrade or retrograde approach is unknown. We investigated the performance of the J-CTO score for predicting procedure complexity and success in an independent contemporary cohort. METHODS AND RESULTS A total of 209 consecutive patients who underwent CTO recanalization by a high-volume operator were included. Clinical and angiographic data were prospectively collected. The J-CTO score was applied for each patient, and discrimination and calibration were evaluated in the whole cohort, and according to the approach (antegrade 47% and retrograde 53%). Clinical and angiographic differences were noted between the original and studied cohort. The mean J-CTO score was 2.18±1.26, and successful guidewire crossing within 30 minutes and final angiographic success were 44.5% and 90.4%, respectively. The J-CTO score demonstrated good discrimination (c statistic, >0.70) and calibration (Hosmer-Lemeshow P>0.1) in the whole cohort and for antegrade and retrograde approaches. However, the final success rate was not associated with the J-CTO score. CONCLUSIONS In this independent cohort, the J-CTO score showed good discriminatory and calibration capacity for guidewire CTO crossing within 30 minutes but it does not for final success rate. The J-CTO score helps to predict complexity of CTO recanalization, and the simplicity of the score supports the widespread use as a clinical tool.
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Affiliation(s)
- Luis Nombela-Franco
- From the Multidisciplinary Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute), Laval University, Quebec City, Quebec, Canada
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204
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Jeroudi OM, Alomar ME, Michael TT, El Sabbagh A, Patel VG, Mogabgab O, Fuh E, Sherbet D, Lo N, Roesle M, Rangan BV, Abdullah SM, Hastings JL, Grodin J, Banerjee S, Brilakis ES. Prevalence and management of coronary chronic total occlusions in a tertiary Veterans Affairs hospital. Catheter Cardiovasc Interv 2013; 84:637-43. [PMID: 24142769 DOI: 10.1002/ccd.25264] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/07/2013] [Accepted: 10/14/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We sought to determine the contemporary prevalence and management of coronary chronic total occlusions (CTO) in a veteran population. BACKGROUND The prevalence and management of CTOs in various populations has received limited study. METHODS We collected clinical and angiographic data in consecutive patients that underwent coronary angiography at our institution between January 2011 and December 2012. Coronary artery disease (CAD) was defined as ≥50% diameter stenosis in ≥1 coronary artery. CTO was defined as total coronary artery occlusion of ≥3 month duration. RESULTS Among 1,699 patients who underwent angiography during the study period, 20% did not have CAD, 20% had CAD and prior coronary artery bypass graft surgery (CABG), and 60% had CAD but no prior CABG. The prevalence of CTO among CAD patients with and without prior CABG was 89 and 31%, respectively. Compared to patients without CTO, CTO patients had more co-morbidities, more extensive CAD and were more frequently referred for CABG. Percutaneous coronary intervention (PCI) to any vessel was performed with similar frequency in patients with and without CTO (50% vs. 53%). CTO PCI was performed in 30% of patients without and 15% of patients with prior CABG with high technical (82 and 75%, respectively) and procedural success rates (80 and 73%, respectively). CONCLUSIONS In a contemporary veteran population, coronary CTOs are highly prevalent and are associated with more extensive co-morbidities and higher likelihood for CABG referral. PCI was equally likely to be performed in patients with and without CTO.
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Affiliation(s)
- Omar M Jeroudi
- Veterans Affairs North Texas Healthcare System, Dallas, Texas; University of Texas Southwestern Medical Center, Dallas, Texas
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205
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Niccoli G, De Vita MR, Montone RA, Burzotta F, Trani C. Access route for coronary chronic total occlusion: femoral or radial approach? Interv Cardiol 2013. [DOI: 10.2217/ica.13.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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206
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Karmpaliotis D. Does prior coronary artery bypass grafting affect percutaneous chronic total occlusion revascularization? Interv Cardiol 2013. [DOI: 10.2217/ica.13.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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207
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Patel Y, Depta JP, DeMartini TJ. Complications of chronic total occlusion percutaneous coronary intervention. Interv Cardiol 2013. [DOI: 10.2217/ica.13.48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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208
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Yamamoto E, Natsuaki M, Morimoto T, Furukawa Y, Nakagawa Y, Ono K, Mitsudo K, Nobuyoshi M, Doi O, Tamura T, Tanaka M, Kimura T. Long-term outcomes after percutaneous coronary intervention for chronic total occlusion (from the CREDO-Kyoto registry cohort-2). Am J Cardiol 2013; 112:767-74. [PMID: 23735646 DOI: 10.1016/j.amjcard.2013.05.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 02/08/2023]
Abstract
Despite improving success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions, the clinical benefit of recanalization of CTO is still a matter of debate. Of 13,087 patients who underwent PCI in the CREDO-Kyoto registry cohort-2, 1,524 patients received PCI for CTO (CTO-PCI). Clinical outcomes were compared between 1,192 patients with successful CTO-PCI and 332 patients with failed CTO-PCI. In-hospital death tended to occur less frequently in the successful CTO-PCI group than in the failed CTO-PCI group (1.4% vs 3.0%, p = 0.053). Through 3-year follow-up, the cumulative incidence of all-cause death was not significantly different between the successful and failed CTO-PCI groups (9.0% vs 13.1%, p = 0.18), whereas the cumulative incidence of cardiac death was significantly less in the successful CTO-PCI group than in the failed CTO-PCI group (4.5% vs 8.4%, p = 0.03). However, after adjusting confounders, successful CTO-PCI was associated with lesser risk for neither all-cause death (hazard ratio 0.93, 95% confidence interval 0.64 to 1.37, p = 0.69) nor cardiac death (hazard ratio 0.71, 95% confidence interval 0.44 to 1.16, p = 0.16). The cumulative incidence of coronary artery bypass grafting (CABG) was remarkably less in patients with successful PCI compared with those with failed PCI (1.8% vs 19.6%, p <0.0001). In conclusion, successful CTO-PCI compared with failed PCI was not associated with lesser risk for 3-year mortality. However, successful CTO-PCI was associated with significantly less subsequent CABG.
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209
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Cockburn J, Shaw E, Bhindi R, Hansen P. Treatment of a left anterior descending artery chronic total occlusion using a bio-absorbable scaffold, utilising optical coherence tomography. Int J Cardiol 2013; 167:e123-6. [DOI: 10.1016/j.ijcard.2013.04.009] [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: 02/15/2013] [Accepted: 04/04/2013] [Indexed: 11/27/2022]
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210
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Procedural outcomes of revascularization of chronic total occlusion of native coronary arteries (from a multicenter United States registry). Am J Cardiol 2013; 112:488-92. [PMID: 23672987 DOI: 10.1016/j.amjcard.2013.04.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 01/06/2023]
Abstract
Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) is a rapidly evolving area of interventional cardiology. We sought to examine the immediate procedural and in-hospital clinical outcomes of native coronary artery CTO PCI from a multicenter United States (US) registry. We retrospectively examined the procedural outcomes of 1,361 consecutive native coronary artery CTO PCIs performed at 3 US institutions from January 2006 to November 2011. Mean age was 65 ± 11 years, 85% of patients were men, 40% had diabetes, 37% had previous coronary artery bypass graft surgery, and 42% had previous 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 minutes, 42 ± 29 minutes, and 294 ± 158 ml, respectively. In multivariate analysis, female gender, no previous coronary artery bypass surgery, and years since initiation of CTO PCI at each center were independent predictors of procedural success. Major complications occurred in 24 patients (1.8%). In conclusion, among selected US-based institutions with experienced operators, native coronary artery CTO PCI can be performed with high success and low major complication rates.
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211
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Damluji A, Gilchrist IC. Teaching old dogs new tricks. Catheter Cardiovasc Interv 2013; 82:9-10. [PMID: 23788382 DOI: 10.1002/ccd.25017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 05/15/2013] [Indexed: 11/07/2022]
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212
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Rolf A, Werner GS, Schuhbäck A, Rixe J, Möllmann H, Nef HM, Gundermann C, Liebetrau C, Krombach GA, Hamm CW, Achenbach S. Preprocedural coronary CT angiography significantly improves success rates of PCI for chronic total occlusion. Int J Cardiovasc Imaging 2013; 29:1819-27. [DOI: 10.1007/s10554-013-0258-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/14/2013] [Indexed: 11/25/2022]
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213
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Michael TT, Karmpaliotis D, Brilakis ES, Abdullah SM, Kirkland BL, Mishoe KL, Lembo N, Kalynych A, Carlson H, Banerjee S, Lombardi W, Kandzari DE. Impact of prior coronary artery bypass graft surgery on chronic total occlusion revascularisation: insights from a multicentre US registry. Heart 2013; 99:1515-8. [PMID: 23598543 DOI: 10.1136/heartjnl-2013-303763] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tesfaldet T Michael
- Department of Internal Medicine/Cardiology, VA North Texas Healthcare System, , Dallas, Texas, USA
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214
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Karmpaliotis D, Lembo N, Kalynych A, Carlson H, Lombardi WL, Anderson CN, Rinehart S, Kirkland B, Shemwell KC, Kandzari DE. Development of a high-volume, multiple-operator program for percutaneous chronic total coronary occlusion revascularization: procedural, clinical, and cost-utilization outcomes. Catheter Cardiovasc Interv 2013; 82:1-8. [DOI: 10.1002/ccd.24387] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 02/12/2012] [Accepted: 02/20/2012] [Indexed: 11/06/2022]
Affiliation(s)
| | - Nicholas Lembo
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - Anna Kalynych
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - Harold Carlson
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - William L. Lombardi
- PeaceHealth St. Joseph Medical Center; 29779 Squalicum Parkway Suite 101; Bellingham; WA 98225
| | - Chad N. Anderson
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - Sarah Rinehart
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - Ben Kirkland
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - Kathie C. Shemwell
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - David E. Kandzari
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
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215
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Michael TT, Papayannis AC, Banerjee S, Brilakis ES. Subintimal dissection/reentry strategies in coronary chronic total occlusion interventions. Circ Cardiovasc Interv 2013; 5:729-38. [PMID: 23074346 DOI: 10.1161/circinterventions.112.969808] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subintimal dissection/reentry techniques are increasingly being used for crossing coronary chronic total occlusions both antegradely (using a knucle wire or the Bridgepoint system) or retrogradely (using the controlled antegrade and retrograde tracking and dissection, and reverse controlled antegrade and retrograde tracking and dissection technique). Subintimal dissection/reentry techniques can increase procedural success rates, but their subsequent clinical outcomes are poorly studied, and they appear to be associated with high rates of in-stent restenosis and repeat target lesion revascularization. In the present review, we describe in detail the chronic total occlusions subintimal dissection/reentry techniques, clarify the related terminology and summarize the published studies in this area and the current gaps of knowledge.
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Affiliation(s)
- Tesfaldet T Michael
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX 75216, USA
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216
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Patel VG, Brayton KM, Tamayo A, Mogabgab O, Michael TT, Lo N, Alomar M, Shorrock D, Cipher D, Abdullah S, Banerjee S, Brilakis ES. Angiographic Success and Procedural Complications in Patients Undergoing Percutaneous Coronary Chronic Total Occlusion Interventions. JACC Cardiovasc Interv 2013; 6:128-36. [PMID: 23352817 DOI: 10.1016/j.jcin.2012.10.011] [Citation(s) in RCA: 246] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 10/11/2012] [Indexed: 12/20/2022]
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217
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Percutaneous recanalization of chronic total occlusions: wherein lies the body of proof? Am Heart J 2013; 165:133-42. [PMID: 23351815 DOI: 10.1016/j.ahj.2012.10.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/05/2012] [Indexed: 01/28/2023]
Abstract
Although interventional technology and skills have markedly advanced, percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) lesions remains challenging. Indeed, CTO PCI is technically complex, carries the potential for a relatively high likelihood of failure and acute complications, and requires specifically skilled operators and a demanding use of resources. In addition, controversy persists surrounding appropriate indications for attempting CTO revascularization. Finally, there is a wide uncertainty on the actual benefits achieved with successful CTO recanalization. A growing number of studies have reported procedural results and/or assessed functional effects and long-term clinical outcomes of CTO PCI. We therefore sought to review and critically appraise the evidence base for procedural outcomes and potential clinical benefits of CTO PCI.
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218
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Zhang S, Gai L, Jin Q, Gai J, He B, Chen Y. Comparison of coronary angiography-assisted and computed coronary tomography angiography-assisted recanalisation of coronary chronic total occlusion. HEART ASIA 2013; 5:148-53. [PMID: 27326112 DOI: 10.1136/heartasia-2013-010302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/21/2013] [Accepted: 06/30/2013] [Indexed: 11/04/2022]
Abstract
BACKGROUND Computed coronary tomography angiography (CCTA) provides an alternative to coronary angiography (CAG) and a complementary way of imaging. OBJECTIVE To determine whether CT assistance might help increase the recanalisation rate of coronary chronic total occlusion (CTO). METHOD Two experienced physicians took part in the study-one specialised in both CCTA and percutaneous coronary intervention (PCI), and the other had PCI experience only and no knowledge of CCTA. Consecutive patients were enrolled if CTO was diagnosed by CAG or by CCTA. The images were analysed on a dedicated work station which examined the length and characteristics of the occlusion, the calibre of the artery, the best projection for precision guidewire penetration, the use of a side branch and calcification for landmarking and selection of most suitable guidewires. Patients underwent CAG-guided PCI or CCTA-assisted PCI. The main end point was the recanalisation rate. Secondary end points included the time for successful passage of the guidewire, fluoroscopy time, and contrast, guidewire and stent consumption. RESULTS Thirty-six patients underwent CAG and 44 CCTA. The clinical characteristics and laboratory data of the two groups were similar (p>0.05). The patients in the CCTA group had more complex disease than those in the CAG group as shown by the J-CTO score (Multicenter CTO Registry of Japan) (p<0.05). Recanalisation was possible in 75.8% of the CAG group and 72.1% of the CCTA group. However, no statistical significance was found, p>0.05. In five of seven patients who had undergone unsuccessful PCI previously the procedure was successful at the second attempt when CCTA-assisted PCI was used. The patients were divided into those for whom the procedure was a failure or a success. The J-CTO score was an independent predictor of failure (OR=0.290, 95% CI 0.158 to 0.533). CONCLUSION CTO with favourable characteristics does not need CCTA guidance, but CCTA can be used to recanalise CTO with unfavourable characteristics when the procedure has previously failed. ACTRN12611000368932.
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Affiliation(s)
- Shuoyang Zhang
- Department of Cardiology , Chinese PLA General Hospital , Beijing , China
| | - Luyue Gai
- Department of Cardiology , Chinese PLA General Hospital , Beijing , China
| | - Qinhua Jin
- Department of Cardiology , Chinese PLA General Hospital , Beijing , China
| | - Jingjing Gai
- Department of Cardiology , Chinese PLA General Hospital , Beijing , China
| | - Bin He
- Department of Cardiology , Chinese PLA General Hospital , Beijing , China
| | - Yundai Chen
- Department of Cardiology , Chinese PLA General Hospital , Beijing , China
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Maeremans J, Selleslagh P, Serafino LD, Barbato E, Dens J. Chronic total occlusions for intermediate volume operators: An antegrade step-up algorithm allows high success in easy and intermediate difficult CTO lesions. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjcd.2013.39085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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220
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Retrograde Coronary Chronic Total Occlusion Revascularization. JACC Cardiovasc Interv 2012; 5:1273-9. [DOI: 10.1016/j.jcin.2012.06.025] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/19/2012] [Accepted: 06/27/2012] [Indexed: 11/21/2022]
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221
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Sabbagh AE, Banerjee S, Brilakis ES. Illustration of the ‘hybrid’ approach to chronic total occlusion crossing. Interv Cardiol 2012. [DOI: 10.2217/ica.12.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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222
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Geraci S, La Manna A, Tamburino C. How should I treat a massive thrombus embolisation in the left coronary artery during chronic total occlusion revascularisation? EUROINTERVENTION 2012; 8:866-75. [PMID: 23171806 DOI: 10.4244/eijv8i7a130] [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] [Indexed: 11/23/2022]
Abstract
BACKGROUND A 53-year-old man symptomatic for unstable angina, underwent PCI for a severe stenosis of the first obtuse marginal and a CTO of the left circumflex arteries. INVESTIGATIONS Physical examination, myocardial necrosis markers, ECG, transthoracic echocardiography, exercise ECG test, bilateral coronary angiography, cardiac magnetic resonance. DIAGNOSIS During PCI, antegrade contrast injection displaced a large clot from the guiding catheter into the left coronary artery causing massive thrombosis. The patient became haemodynamically unstable. The pressure wave from the guiding catheter was damped. MANAGEMENT Intravenous UFH and abciximab followed by aspiration from the guiding catheter, and then through an aspiration catheter, until clear blood came out and pressure wave was normalised. Subsequent left coronary angiography showed no residual thrombi with TIMI-3 flow. Afterwards, a CMR scan showed no myocardial damage.
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Affiliation(s)
- Salvatore Geraci
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
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223
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Bagur R, Bernier M, Kandzari DE, Karmpaliotis D, Lembo NJ, Rinfret S. A novel application of contrast echocardiography to exclude active coronary perforation bleeding in patients with pericardial effusion. Catheter Cardiovasc Interv 2012; 82:221-9. [DOI: 10.1002/ccd.24564] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 06/09/2012] [Accepted: 07/08/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Rodrigo Bagur
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute) - Laval University; Quebec City Quebec Canada
| | - Mathieu Bernier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute) - Laval University; Quebec City Quebec Canada
| | | | | | | | - Stéphane Rinfret
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute) - Laval University; Quebec City Quebec Canada
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STOJKOVIC SINISA, SIANOS GEORGE, KATOH OSAMU, GALASSI ALFREDOR, BELESLIN BRANKO, VUKCEVIC VLADAN, NEDELJKOVIC MILAN, STANKOVIC GORAN, ORLIC DEJAN, DOBRIC MILAN, TOMASEVIC MILOJE, OSTOJIC MIODRAG. Efficiency, Safety, and Long-Term Follow-up of Retrograde Approach for CTO Recanalization: Initial (Belgrade) Experience with International Proctorship. J Interv Cardiol 2012; 25:540-8. [DOI: 10.1111/j.1540-8183.2012.00754.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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225
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Mibiki Y, Kikuta H, Sumiyoshi T, Shibata M, Osawa N. Percutaneous coronary intervention by retrograde approach for chronic total occlusion of the proximal left anterior descending artery via a gastroepiploic artery graft. Cardiovasc Interv Ther 2012; 28:91-7. [PMID: 22810923 DOI: 10.1007/s12928-012-0120-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 06/29/2012] [Indexed: 11/26/2022]
Abstract
Coronary arteries connecting to septal branch are often occluded in post-coronary artery bypass graft cases. A 70-year-old male had undergone CABG; radial artery graft to the LCX, and gastroepiploic artery (GEA) graft to the RCA. Coronary angiography revealed total occlusion in proximal LAD, while both graft vessels had good flow. Retrograde percutaneous coronary intervention (PCI) procedure from the septal channel via GEA graft to the RCA was performed for total occlusion of LAD. Despite the tortuous GEA, deep engagement with a 4-french guiding catheter ensured powerful back-up force. After retrograde wire crossing, two drug-eluting stents were implanted, successfully.
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Affiliation(s)
- Yoshiaki Mibiki
- Division of Cardiology, Miyagi Prefectural Cardiovascular and Respiratory Center, 55-2 Negishi, Semine, Kurihara, Miyagi, Japan.
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226
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Abstract
CABG surgery is an effective way to improve symptoms and prognosis in patients with advanced coronary atherosclerotic disease. Despite multiple improvements in surgical technique and patient treatment, graft failure after CABG surgery occurs in a time-dependent fashion, particularly in the second decade after the intervention, in a substantial number of patients because of atherosclerotic progression and saphenous-vein graft (SVG) disease. Until 2010, repeat revascularization by either percutaneous coronary intervention (PCI) or surgical techniques was performed in these high-risk patients in the absence of specific recommendations in clinical practice guidelines, and within a culture of inadequate communication between cardiac surgeons and interventional cardiologists. Indeed, some of the specific technologies developed to reduce procedural risk, such as embolic protection devices for SVG interventions, are largely underused. Additionally, the implementation of secondary prevention, which reduces the need for reintervention in these patients, is still suboptimal. In this Review, graft failure after CABG surgery is examined as a clinical problem from the perspective of holistic patient management. Issues such as the substrate and epidemiology of graft failure, the choice of revascularization modality, the specific problems inherent in repeat CABG surgery and PCI, and the importance of secondary prevention are discussed.
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Affiliation(s)
- Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain.
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227
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Spratt JC, Strange JW. Retrograde Procedural Planning, Skills Development, and How to Set Up a Base of Operations. Interv Cardiol Clin 2012; 1:325-338. [PMID: 28582017 DOI: 10.1016/j.iccl.2012.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article addresses the practical steps required when adopting retrograde access as part of the treatment of chronic total occlusions (CTOs). The article focuses on procedure rationale, equipment required, the practical steps, and considerations involved in collateral-channel crossing and setting up a "base of operations" at the proximal cap of the CTO. It also describes simple methods of wire escalation.
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Affiliation(s)
- James C Spratt
- Department of Cardiology, Forth Valley Royal Hospital, Stirling Road, Larbert FK5 4WR, UK.
| | - Julian W Strange
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Level 5, Bristol Royal Infirmary, Marlborough Street, BS1 3NU, Bristol, UK
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228
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Brilakis ES, Karmpaliotis D, Patel V, Banerjee S. Complications of Chronic Total Occlusion Angioplasty. Interv Cardiol Clin 2012; 1:373-389. [PMID: 28582023 DOI: 10.1016/j.iccl.2012.04.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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229
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Karmpaliotis D, Lembo NJ, Brilakis ES, Kandzari DE. Percutaneous Chronic Total Occlusion Revascularization: Program Development, Resource Utilization, and Economic Outcomes. Interv Cardiol Clin 2012; 1:391-395. [PMID: 28582024 DOI: 10.1016/j.iccl.2012.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Against the background of current data supporting indications for chronic total occlusion (CTO) revascularization and strategies that promote incrementally higher procedural success rates, this article introduces a multidisciplinary approach to CTO program development, establishes guidelines for the performance of safe and efficient CTO percutaneous coronary intervention, and reviews considerations related to resource utilization and economic outcomes with complex percutaneous coronary revascularization.
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Affiliation(s)
- Dimitri Karmpaliotis
- Piedmont Heart Institute, 275 Collier Road North West, Suite 300, Atlanta, GA 30309, USA.
| | - Nicholas J Lembo
- Piedmont Heart Institute, 275 Collier Road North West, Suite 300, Atlanta, GA 30309, USA
| | - Emmanouil S Brilakis
- Division of Cardiology, VA North Texas Health Care System, The University of Texas Southwestern Medical Center at Dallas, 4500 South Lancaster Road, Dallas, TX 75216, USA
| | - David E Kandzari
- Piedmont Heart Institute, 275 Collier Road North West, Suite 300, Atlanta, GA 30309, USA
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230
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Vano E, Escaned J, Vano-Galvan S, Fernandez JM, Galvan C. Importance of a Patient Dosimetry and Clinical Follow-up Program in the Detection of Radiodermatitis After Long Percutaneous Coronary Interventions. Cardiovasc Intervent Radiol 2012; 36:330-7. [DOI: 10.1007/s00270-012-0397-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 04/06/2012] [Indexed: 10/28/2022]
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231
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Zimarino M, Corcos T, Bramucci E, Tamburino C. Rotational atherectomy: a "survivor" in the drug-eluting stent era. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2012; 13:185-92. [PMID: 22522057 DOI: 10.1016/j.carrev.2012.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 03/04/2012] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
Mechanical debulking of coronary plaques with rotational atherectomy (RA) has been used for more than 20 years during percutaneous coronary interventions (PCI). Modification of plaque characteristics may be accomplished with selective ablation of inelastic fibrocalcific tissue. The use of RA, though reduced with the development of bare-metal stents (BMS) and even more with drug-eluting stents (DES), has never been completely abandoned. The present review will analyze reasons for conflicting results obtained in large series and randomized trials on this topic in the past, and will identify criteria for an appropriate use in current times.
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Affiliation(s)
- Marco Zimarino
- Institute of Cardiology and Center of Excellence on Aging, G. d'Annunzio University-Chieti, Italy.
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232
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A Percutaneous Treatment Algorithm for Crossing Coronary Chronic Total Occlusions. JACC Cardiovasc Interv 2012; 5:367-79. [PMID: 22516392 DOI: 10.1016/j.jcin.2012.02.006] [Citation(s) in RCA: 428] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 02/07/2012] [Accepted: 02/09/2012] [Indexed: 01/16/2023]
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233
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Mehran R, Claessen BE, Godino C, Dangas GD, Obunai K, Kanwal S, Carlino M, Henriques JPS, Di Mario C, Kim YH, Park SJ, Stone GW, Leon MB, Moses JW, Colombo A. Long-term outcome of percutaneous coronary intervention for chronic total occlusions. JACC Cardiovasc Interv 2012; 4:952-61. [PMID: 21939934 DOI: 10.1016/j.jcin.2011.03.021] [Citation(s) in RCA: 219] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 03/04/2011] [Accepted: 03/16/2011] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). BACKGROUND Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO. METHODS We evaluated long-term clinical outcomes in 1,791 patients who underwent PCI of 1,852 CTO at 3 tertiary care centers in the United States, South Korea, and Italy between 1998 and 2007. Median follow-up was 2.9 years (interquartile range: 1.5 to 4.6 years). RESULTS Procedural success was obtained in 1,226 (68%) patients. Stents were implanted in 1,160 patients (95%); 396 patients (34%) received bare-metal stents (BMS), and 764 patients (66%) received drug-eluting stents (DES). After multivariable analysis, successful CTO PCI was an independent predictor of a lower cardiac mortality (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.21 to 0.75, p < 0.01) and reduced need for coronary artery bypass graft surgery (HR: 0.21, 95% CI: 0.13 to 0.40, p < 0.01); it also correlated with a strong trend toward lower all-cause mortality (HR: 0.63, 95% CI: 0.40 to 1.00, p = 0.05) at 5-year follow-up. Among patients who underwent stent implantation, treatment with DES rather than BMS resulted in less target vessel revascularization at long-term follow-up (17.2% vs. 31.1%, p < 0.01); definite/probable stent thrombosis rates were similar (DES 1.7%, BMS 2.3%, p = 0.58). Within the DES subgroup, patients treated with paclitaxel-eluting stents and sirolimus-eluting stents had similar clinical outcomes. CONCLUSIONS Successful CTO PCI is associated with reduced long-term cardiac mortality and need for coronary artery bypass graft surgery. Treatment of CTO with DES rather than BMS is associated with a significant reduction in target vessel revascularization with similar rates of stent thrombosis. Paclitaxel-eluting stents and sirolimus-eluting stents had similar long-term safety and efficacy outcomes.
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Affiliation(s)
- Roxana Mehran
- Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, New York 10029, USA.
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234
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Strauss BH, Osherov AB, Radhakrishnan S, Mancini GBJ, Manners A, Sparkes JD, Chisholm RJ. Collagenase Total Occlusion-1 (CTO-1) trial: a phase I, dose-escalation, safety study. Circulation 2011; 125:522-8. [PMID: 22179536 DOI: 10.1161/circulationaha.111.063198] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous interventions for chronic total occlusions have low success rates, primarily because of failure of guide wire crossing. Collagen-rich matrix constitutes the main barrier to chronic total occlusion crossing. In preclinical studies, local delivery of a bacterial collagenase formulation improved guide wire crossing. The Collagenase Total Occlusion-1 (CTO-1) Trial is a phase I, dose-escalation trial to assess the safety and efficacy of collagenase therapy to facilitate guide wire crossing in coronary artery chronic occlusions. METHODS AND RESULTS Twenty subjects with ≥1 previous failure of chronic total occlusion guide wire crossing were enrolled at 2 sites. Subjects were treated in 4 distinct cohorts of 5 patients, with escalation of collagenase dose in each cohort from 300 to 1200 μg. Collagenase was locally delivered into the occlusions with either an over-the-wire balloon system (n=8) or a fine-cross microcatheter (n=12) for a period of 30 minutes. Subjects were brought back to the catheterization laboratory for guide wire crossing and angioplasty the next day. Guide wire crossing was successfully achieved in 15 subjects (75%). A soft-tip guide wire (Whisper, Pilot-50, Fielder XT) was either the sole or predominant guide wire used in 75% of successful crossings. Non-ST-segment-elevation myocardial infarctions occurred in 3 patients as a result of side-branch ischemia during stenting. Computed tomographic angiography at 3 months showed no late complications and patent stents in successfully treated chronic total occlusion. Anginal improvement occurred with a reduction in Canadian Cardiovascular Society class from baseline to 3 months (2.5±0.6 versus 0.9±0.9; P<0.001). CONCLUSION Local delivery of collagenase into coronary chronic total occlusion is feasible and safe with encouraging guide wire crossing results in previously failed cases. Larger clinical trials are required to determine efficacy. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01271335.
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Affiliation(s)
- Bradley H Strauss
- Sunnybrook Health Sciences Center, 2075 Bayview Ave, D4-06, Toronto, Ontario, Canada.
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235
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[Successes and complications of angioplasty in chronic occlusive coronary disease]. Ann Cardiol Angeiol (Paris) 2011; 60:329-37. [PMID: 22075190 DOI: 10.1016/j.ancard.2011.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the hands of experienced operators, the rate of success of percutaneous coronary intervention for chronic total occlusion lesion is about 85%. Major cardiac events rate is about 2%. A length of the occluded site more than 20mm, severe calcifications, major tortuosity, blunt stump and a previous attempt by anterograde approach are predictors of procedural failure, previous CABG, distal vessel disease, occlusion duration have been involved too. Operator's experience is one of the major success component, especially his ability to perform retrograde approach. According to EuroCTO club recommendations, performing a minimum number of case to maintain competency seems to be very important.
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236
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Fefer P, Strauss BH. Climbing PCI success rates in complex chronic total occlusions: joining “The Club”. EUROINTERVENTION 2011; 7:421-3. [DOI: 10.4244/eijv7i4a69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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