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Kane JA, Tiwana J, Carlino M, Nascimbene A, Moscardelli S, Azzalini L. Sub-Intimal Tracking and Re-Entry and Investment Procedures: Current Applications and Future Directions. Am J Cardiol 2024; 232:26-33. [PMID: 39276960 DOI: 10.1016/j.amjcard.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/29/2024] [Accepted: 09/07/2024] [Indexed: 09/17/2024]
Abstract
In seeking to improve upon chronic total occlusion (CTO) percutaneous coronary intervention success rates and minimize risk, CTO modification procedures (investment procedures) have been developed and utilized with increasing frequency. Two key techniques have emerged: subintimal tracking and re-entry (STAR) and subintimal plaque modification (SPM). Both require a staged approach with an index procedure for plaque modification and a second procedure weeks later for stenting. Both approaches require entry and wiring with a polymer-jacketed wire in the extra-plaque space, yet unlike SPM, which exclusively requires angioplasty of the extra-plaque space throughout the CTO segment, STAR also involves re-entry into the true luminal distal to the CTO before angioplasty. STAR and SPM, in many ways, represent a paradigm shift in our approach to CTO percutaneous coronary intervention from a 1-step to a 2-step approach in complex cases. In this review, we discuss the technical aspects of the procedures, and controversies and ongoing trials pointing to the future of these techniques. We also highlight non-device-based and intravascular ultrasound-based approaches to anterograde dissection and re-entry, which add to the CTO operator's toolkit for challenging cases.
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Affiliation(s)
- Jesse A Kane
- Division of Cardiology, Department of Medicine, University of Vermont, Burlington, Vermont
| | | | - Mauro Carlino
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
| | - Angelo Nascimbene
- Division of Cardiology, Department of Medicine, UT Health McGovern Medical School, Houston, Texas
| | - Silvia Moscardelli
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
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Masoomi R, Boukhris M, Moscardelli S, Azzalini L. Dissection and Re-entry Techniques for Chronic Total Occlusion Percutaneous Coronary Intervention. Interv Cardiol 2024; 19:e16. [PMID: 39309300 PMCID: PMC11413985 DOI: 10.15420/icr.2024.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/26/2024] [Indexed: 09/25/2024] Open
Abstract
Despite early stagnation in success rates for percutaneous coronary intervention for chronic total occlusion with the traditional antegrade wiring approach, the introduction of dissection/re-entry techniques and the retrograde approach opened new avenues for operators to tackle more complex occlusions. Dissection/re-entry techniques (both antegrade and retrograde) are commonly used in angiographic scenarios characterised by long, tortuous and calcified occlusions, as well as in those with proximal cap ambiguity. Familiarity and comfort using the extraplaque space (with either an antegrade or retrograde approach) have become fundamental to achieving safe and effective recanalisation of complex chronic total occlusions. This review provides an overview of different contemporary antegrade and retrograde dissection re-entry techniques and their acute and longer-term outcomes.
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Affiliation(s)
- Reza Masoomi
- Division of Cardiology, University of WashingtonSeattle, WA, US
| | | | - Silvia Moscardelli
- Division of Cardiology, University of WashingtonSeattle, WA, US
- Thoracic, Pulmonary and Cardiovascular Department, University of MilanMilan, Italy
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Hirai T, Kearney K, Azzalini L, Salisbury AC, Stone N, Gosch KL, Pershad A, Nicholson W, Lombardi W, Wyman RM, Davies R, Grantham JA. Optimal timing of staged percutaneous coronary intervention after subintimal tracking and re-entry: Rationale and design of the subintimal tracking and re-entry with deferred stenting study. Catheter Cardiovasc Interv 2024. [PMID: 39044659 DOI: 10.1002/ccd.31161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/19/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Ten to fifteen percent of chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) are unsuccessful in contemporary practice. Subintimal tracking and re-entry (STAR) (one form of "investment procedure") with staged reattempt and stenting may further increase the ultimate success and safety of CTO as a bailout strategy. The optimal timing for staged stenting after STAR is unknown. METHODS AND RESULTS We designed a six-center, prospective randomized trial with a planned enrollment of 150 patients where STAR is utilized in case of impending failure. The primary aim is to evaluate the optimal timing of the staged PCI after STAR by randomizing the timing to earlier (5-7 weeks) versus later (12-14 weeks) staged PCI. The primary endpoint of the study is the technical success rate of the staged procedure. The secondary endpoints include: (1) the rate of thrombolysis in myocardial infarction 3 flow at the start of staged intervention, (2) rate of partial technical and procedural success of the staged procedure, (3) rate of in-hospital and 12-month major cardiac and cerebrovascular adverse events, and (4) change in patient-reported quality at 30 days, 6 months, and 12 months assessed by Seattle Angina Questionnaire. CONCLUSION This study will ascertain the optimal timing of staged stenting after bail-out STAR approach in contemporary CTO PCI (ClinicalTrials.gov NCT05089864).
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Affiliation(s)
- Taishi Hirai
- Division of Cardiology, University of Missouri, Columbia, Missouri, USA
| | - Kathleen Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- Division of Cardiology, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Nancy Stone
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | | | | | - William Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | | | - J Aaron Grantham
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
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Masoomi R, Moscardelli S, Hirai T, Azzalini L. Antegrade techniques for chronic total occlusion percutaneous coronary intervention. Prog Cardiovasc Dis 2024:S0033-0620(24)00098-7. [PMID: 39032669 DOI: 10.1016/j.pcad.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 07/07/2024] [Indexed: 07/23/2024]
Abstract
Antegrade techniques are the foundation of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Antegrade wiring with the intent to achieve an intraplaque guidewire tracking is not always feasible, and crossing into the extraplaque space with subsequent reentry (antegrade dissection and reentry), might be needed, particularly in more complex occlusions. The present article reviews in detail the antegrade approaches to CTO PCI, focusing on equipment, techniques, and overcoming challenges.
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Affiliation(s)
- Reza Masoomi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Silvia Moscardelli
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA; University of Milan, Milan, Italy
| | - Taishi Hirai
- Division of Cardiology, Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
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Bavishi C, Davies RE, Matsuno S, Kobayashi N, Katoh H, Obunai K, Maran A, Kearney K, Kohsaka S, Hirai T. Practice differences and knowledge gaps in complex and high-risk interventions between Japan and the USA: A case-based discussion. J Cardiol 2024; 83:272-279. [PMID: 37863185 DOI: 10.1016/j.jjcc.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/08/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
Advances in percutaneous coronary intervention (PCI) devices and techniques have expanded the pool of eligible patients for revascularization, including those with comorbidities, reduced left ventricular function, or anatomical complexity (defined as CHIP: complex and high-risk interventions in indicated patients). CHIP interventions are typically performed by selected operators who specialize in complex PCI. This review presents two cases performed in the USA, to discuss the similarities and differences in practice patterns between CHIP operators in Japan and the USA. The first case involves a 58-year-old male presenting with myocardial infarction and cardiogenic shock, and the second case involves a 51-year-old female with a history of coronary artery bypass grafting presenting with a chronic total occlusion and PCI complicated by vessel perforation. The discussion focuses on appropriate patient selection, the role of the heart team approach for decision-making, the use of hemodynamic support devices, and other relevant factors. By comparing practices in Japan and the USA, this review highlights opportunities for knowledge exchange and potential areas for improving patient outcomes.
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Alexandrou M, Rempakos A, Mutlu D, Ogaili AA, Choi JW, Poommipanit P, Alaswad K, Basir MB, Davies R, Benton S, Jaffer FA, Chandwaney RH, Kearney KE, ElGuindy AM, Rafeh NA, Goktekin O, Gorgulu S, Khatri JJ, Krestyaninov O, Khelimskii D, Rangan BV, Mastrodemos OC, Burke MN, Sandoval Y, Lombardi WL, Brilakis ES, Azzalini L. Comparative Analysis of Polymer Versus Non-Polymer Jacketed Wires in Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol 2024; 215:10-18. [PMID: 38224729 DOI: 10.1016/j.amjcard.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
There is significant variation in wire utilization patterns for chronic total occlusion (CTO) percutaneous coronary intervention. This study aimed to compare the outcomes of polymer-jacketed wires (PJWs) versus non-PJWs in anterograde procedures. We analyzed clinical and angiographic characteristics, and procedural outcomes of 7,575 anterograde CTO percutaneous coronary interventions that were performed at 47 centers between 2012 and 2023. Cases in which PJWs were exclusively used were classified in the PJW group, whereas cases where at least one non-PJW was employed were classified in the non-PJW group. Study end points were as follows: technical success, coronary perforation, major adverse cardiac event. PJWs were exclusively used in 3,481 cases (46.0%). These cases had lower prevalence of proximal cap ambiguity, blunt stump, and moderate/severe calcification. They also had lower Japanese CTO (J-CTO), Prospective Global Registry for the Study of Chronic Total Occlusion (PROGRESS-CTO), and PROGRESS-CTO complications scores, higher technical success (94.3% vs 85.7%, p <0.001), and lower perforation rates (2.2% vs 3.2%, p = 0.013). Major adverse cardiac event rates did not differ between groups (1.3% vs 1.5%, p = 0.53). Exclusive use of PJWs was independently associated with higher technical success in both the multivariable (odds ratio [OR] 2.66, 95% confidence interval [CI] 2.13 to 3.36, p <0.001) and inverse probability of treatment weight analysis (OR 2.43, 95% CI 2.04 to 2.89, p <0.001). Exclusive use of PJWs was associated with lower risk of perforation in the multivariable analysis (OR 0.69, 95% CI 0.49 to 0.95, p = 0.02), and showed a similar trend in the inverse probability of treatment weight analysis (OR 0.77, 95% CI 0.57 to 1.04, p = 0.09). Exclusive use of PJWs is associated with higher technical success and lower perforation risk in this non-randomized series of patients.
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Affiliation(s)
- Michaella Alexandrou
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Athanasios Rempakos
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Deniz Mutlu
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ahmed Al Ogaili
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Paul Poommipanit
- Section of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Mir Babar Basir
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Rhian Davies
- Department of Cardiology, WellSpan York Hospital, York, Pennsylvania
| | - Stewart Benton
- Department of Cardiology, WellSpan York Hospital, York, Pennsylvania
| | - Farouc A Jaffer
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Raj H Chandwaney
- Department of Invasive Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | - Nidal Abi Rafeh
- Department of Cardiology, North Oaks Health System, Hammond, Louisiana
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | | | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Dmitrii Khelimskii
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Bavana V Rangan
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Olga C Mastrodemos
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - M Nicholas Burke
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - William L Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Emmanouil S Brilakis
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
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Carlino M, Uretsky BF, Azzalini L, Nascimbene A, Brilakis ES, Colombo A, Nakamura S, Godino C, Avran A, Rinfret S, Faurie B. STAR procedure becomes SAFER: First-in-man case series of a new antegrade dissection re-entry technique. Catheter Cardiovasc Interv 2023; 102:577-584. [PMID: 37522283 DOI: 10.1002/ccd.30789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Antegrade dissection and re-entry (ADR) is an integral part of the hybrid algorithm, which has allowed for improved outcomes in chronic total occlusion (CTO) coronary intervention (PCI). METHODS A new ADR method, Subintimal Antegrade FEnestration and Re-entry (SAFER), is described. The results of a first-in-man series are presented. RESULTS SAFER was performed on seven consecutive patients with angiographic and clinical success in all patients. CONCLUSIONS This first-in-man study has shown that the SAFER technique is feasible and effective with the possibility of improving the antegrade PCI CTO success rate.
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Affiliation(s)
- Mauro Carlino
- Cardio-Thoracic-Vascular Department, Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barry F Uretsky
- Central Arkansas Veterans Health System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lorenzo Azzalini
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Angelo Nascimbene
- Advanced Cardiopulmonary Therapies And Transplantation (ACTAT), University of Texas at Houston, Houston, Texas, USA
| | - Emmanouil S Brilakis
- Allina Health Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, USA
| | - Antonio Colombo
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alexandre Avran
- Department of Cardiology, Centre hospitalier de Valenciennes, Valenciennes, France
| | | | - Benjamin Faurie
- Division of Cardiology, Institut Cardiovasculaire, Grenoble, France
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Li W, Wu Z, Liu T, Wu X, Liu J. Long term clinical outcome after success re-attempt percutaneous coronary intervention of chronic total occlusion. BMC Cardiovasc Disord 2023; 23:23. [PMID: 36646993 PMCID: PMC9841955 DOI: 10.1186/s12872-023-03045-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/05/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To evaluate the long-term outcome after re-attempt CTO-PCI. METHODS This is a retrospective cohort study that included 113 re-attempt CTO-PCI patients who were consecutively registered from January 2019 to December 2020 at Beijing Anzhen Hospital's Center of Coronary Artery Disease. All patients were divided into two groups based on procedural success or failure. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause mortality, myocardial infarction and target vessel revascularization (TVR). The secondary endpoint was angina after PCI. RESULTS Overall, the successful re-attempt CTO-PCI was archived in 77 patients, the failed CTO-PCI was performed in 36 patients. After a median follow-up of 21.7 months (interquartile range: 10.9-26.0), the incidence of the primary outcome was significantly lower in the success group [14.2% vs. 38.9%, adjusted hazard ratio (HR) 0.351, 95% CI 0.134-0.917, P = 0.033], mainly driven by the reduction of TVR (9.1% vs. 30.6%, adjusted HR 0.238, 95% CI: 0.078-0.72, P = 0.011). Furthermore, patients who had successful re-attempt CTO-PCI had a lower risk of angina after PCI (27.3% vs.61.1%, adjusted HR 0.357, 95% CI 0.167-0.76, P = 0.008). The risk factors of TVR in the patients with successful re-attempt CTO-PCI were stent length > 100 mm (adjusted HR 21.805, 95% CI 1.765-269.368, P = 0.016) and J-CTO score > 3(adjusted HR: 9.733, 95% CI:1.533-61.797, P = 0.016). CONCLUSIONS For the patients with previous CTO-PCI failure, a successful re-attempt CTO-PCI was associated with significantly lower MACE, which was primarily driven by a lower TVR rate. More complex CTO lesions and longer stents were the independent predictors of TVR after successful CTO-PCI.
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Affiliation(s)
- Wenzheng Li
- grid.411606.40000 0004 1761 5917Center of Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Zheng Wu
- grid.411606.40000 0004 1761 5917Center of Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Tong Liu
- grid.411606.40000 0004 1761 5917Center of Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xiaofan Wu
- grid.411606.40000 0004 1761 5917Center of Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jinghua Liu
- grid.411606.40000 0004 1761 5917Center of Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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Ybarra LF, Rinfret S. Why and How Should We Treat Chronic Total Occlusion? Evolution of State-of-the-Art Methods and Future Directions. Can J Cardiol 2022; 38:S42-S53. [PMID: 33075456 DOI: 10.1016/j.cjca.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022] Open
Abstract
Chronic total occlusions are considered the most complex coronary lesion in interventional cardiology. The absence of visible lumen on angiography obscures the vessel course and makes vessel wiring unlikely with conventional techniques. Often a source of severe ischemia, chronic occlusions are also markers of advanced atherosclerosis that brings other complex features including lesion length, bifurcations, calcification, adverse vessel remodelling, distal disease, and anatomic distortion from previous bypass grafting. Often advanced atherosclerosis is associated with patient characteristics like left ventricular dysfunction, previous coronary bypass surgery, or multivessel disease that increase procedural demands and hazards. To accommodate these challenges new techniques and dedicated technologies have been developed. When applied to appropriate patients, these advances have improved procedural success, safety, and outcomes. Our aim is to provide the general cardiologist with an overview of these advances that can serve as a basis for counselling patients considered for revascularization.
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Affiliation(s)
- Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Stéphane Rinfret
- Division of Cardiology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
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10
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Impact of Subintimal Plaque Modification on Reattempted Chronic Total Occlusions Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2022; 15:1427-1437. [PMID: 35863791 DOI: 10.1016/j.jcin.2022.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/29/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Predictors of success in reattempted chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures remain obscure, mainly owing to the lack of consecutive angiograms and procedural records of initial attempts in the same cohort. OBJECTIVES This study sought to investigate the factors predicting the success of reattempted CTO PCI procedures. METHODS A total of 208 consecutive patients who underwent a failed CTO PCI attempt and received reattempted procedure at the same cardiac center were retrospectively analyzed. Predictors of the success of reattempted procedures were evaluated. RESULTS The overall technical success rate of reattempted CTO PCI procedures was 71.2%. Subintimal plaque modification (SPM) was implemented in 35 (16.8%) procedures in initial attempts. The reattempted technical success rate was 93.3% in cases in which SPM with guidewire (GW) crossing was achieved in the initial attempt; however, the success rate was 55.0% for procedures involving SPM without GW crossing. SPM with GW crossing (OR: 11.21; 95% CI: 1.31-96.16; P = 0.028), referral to high-volume operators (OR: 2.38; 95% CI: 1.14-4.98; P = 0.021), and a bidirectional approach (OR: 2.31; 95% CI: 1.12-4.79; P = 0.024) were positive independent predictors of technical success in the subsequent reattempt. The time interval for reattempt (per 90-day increment) was negatively correlated with the technical success of the reattempted procedures (OR: 0.85; 95% CI: 0.73-0.98; P = 0.030). CONCLUSIONS This study identified independent predictors of success in reattempted CTO PCI procedures. SPM with GW crossing achieved in the initial attempt is associated with a higher success rate in the subsequent reattempt.
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11
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Brilakis ES, Allana S. Chronic Total Occlusion Intervention Failure: When and How to Reattempt. JACC Cardiovasc Interv 2022; 15:1438-1440. [PMID: 35863792 DOI: 10.1016/j.jcin.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
| | - Salman Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Hirai T, Mansour A, Grantham JA, Spaedy A. Use of Subintimal Tracking and Re-entry Technique as a Bailout After Coronary Dissection. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100348. [PMID: 39131938 PMCID: PMC11307598 DOI: 10.1016/j.jscai.2022.100348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/07/2022] [Accepted: 04/17/2022] [Indexed: 08/13/2024]
Affiliation(s)
- Taishi Hirai
- Division of Cardiology, Department of Medicine, University of Missouri, Columbia, Missouri
| | - Abdallah Mansour
- Division of Cardiology, Department of Medicine, University of Missouri, Columbia, Missouri
| | - J. Aaron Grantham
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Anthony Spaedy
- Division of Cardiology, Boone Hospital Center, Columbia, Missouri
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13
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Azzalini L, Karmpaliotis D, Santiago R, Mashayekhi K, Di Mario C, Rinfret S, Nicholson WJ, Carlino M, Yamane M, Tsuchikane E, Brilakis ES. Contemporary Issues in Chronic Total Occlusion Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2022; 15:1-21. [PMID: 34991814 DOI: 10.1016/j.jcin.2021.09.027] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 12/18/2022]
Abstract
Remarkable progress has been achieved in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in recent years, with refinement of the indications and technical aspects of the procedure, imaging, and complication management. Randomized controlled trials and rigorous prospective registries have provided high-quality data on the benefits and risks of CTO PCI. Global collaboration has led to an agreement on nomenclature, indications, endpoint definition, and principles of clinical trial design that have been distilled in global consensus documents such as the CTO Academic Research Consortium. Increased use of preprocedural coronary computed tomography angiography and intraprocedural intravascular imaging, as well as development of novel techniques and structured CTO crossing and complication management algorithms, allow a systematic, stepwise approach to this difficult lesion subset. This state-of-the-art review provides a comprehensive discussion about the most recent developments in the indications, preprocedural planning, technical aspects, complication management, and future directions of CTO PCI.
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Affiliation(s)
- Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
| | - Dimitri Karmpaliotis
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Ricardo Santiago
- PCI Cardiology Group, Bayamon Heart and Lung Institute, Bayamon, Puerto Rico, USA
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Department of Clinical & Experimental Medicine, Florence, Italy
| | | | | | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Masahisa Yamane
- Cardiovascular Division, Saitama-Sekishinkai Hospital, Saitama, Japan
| | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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14
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Farag M, Egred M. CTO in Contemporary PCI. Curr Cardiol Rev 2022; 18:e310521193720. [PMID: 34061015 PMCID: PMC9241114 DOI: 10.2174/1573403x17666210531143519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/26/2021] [Accepted: 04/05/2021] [Indexed: 11/22/2022] Open
Abstract
Percutaneous Coronary Intervention (PCI) of Chronic Total Occlusions (CTO) represents the most challenging procedure in modern endovascular treatments. In recent years, the success rate of CTO PCI has substantially improved, owing to increasing operator expertise and advancements in CTO equipment and algorithms as well as the development of expert consensus documents. In this review, we summarize existing evidence for CTO PCI, its success/ risk prediction scoring tools, procedural principles and complications and provide an insight into the future role of CTO PCI.
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Affiliation(s)
- Mohamed Farag
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK.,Professor in Interventi onal Cardiology and Cardiovascular Medicine, School of Medicine within the Faculty ofHealth Sciences and Wellbeing at the University of Sunderland, UK
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15
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Update on chronic total occlusion percutaneous coronary intervention. Prog Cardiovasc Dis 2021; 69:27-34. [PMID: 34826426 DOI: 10.1016/j.pcad.2021.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/14/2021] [Indexed: 11/22/2022]
Abstract
Chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be challenging to perform. The main indication for CTO PCI is to improve symptoms. Several contemporary studies have reported high CTO PCI success rates at experienced centers but success rates in all-comer registries remain low. Several scores can estimate the difficulty and the likelihood of success of CTO PCI. Dual arterial access and use of CTO crossing algorithms can improve the success and safety of CTO PCI. Intracoronary imaging can optimize stent expansion and minimize adverse cardiovascular events. While complications are more common in CTO PCI, careful planning and prompt diagnosis and treatment can prevent them or minimize their adverse consequences. In this article, we review contemporary data on the indications, safety and efficacy of CTO PCI.
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16
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Davies RE, Rier JD, McEntegart M, Riley RF, Kearney K, Lombardi W. Subintimal tracking and reentry as a tool in CTO-PCI: Past, present, and future. Catheter Cardiovasc Interv 2021; 98:1144-1151. [PMID: 34399015 DOI: 10.1002/ccd.29924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Rhian E Davies
- Department of Cardiology, WellSpan Health, York, Pennsylvania, USA
| | - Jeremy D Rier
- Department of Cardiology, WellSpan Health, York, Pennsylvania, USA
| | | | - Robert F Riley
- The Christ Hospital Health System, Ohio Heart and Vascular, Cincinnati, Ohio, USA
| | - Kathleen Kearney
- Department of Cardiology, University of Washington, Seattle, Washington, USA
| | - William Lombardi
- Department of Cardiology, University of Washington, Seattle, Washington, USA
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17
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Wu NQ, Qian J. Impact of subintimal plaque modification (SPM) technique on failed intervention of coronary artery chronic total occlusion. Chronic Dis Transl Med 2021; 7:135-138. [PMID: 34136773 PMCID: PMC8180460 DOI: 10.1016/j.cdtm.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/06/2021] [Accepted: 03/18/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Na-Qiong Wu
- Department of Endocrinology & Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China
| | - Jie Qian
- Department of Endocrinology & Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China
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18
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Bryniarski L, Opolski MP, Wójcik J, Lesiak M, Pawłowski T, Drozd J, Wojakowski W, Surowiec S, Dąbrowski M, Witkowski A, Dudek D, Grygier M, Bartuś S. Chronic total occlusion percutaneous coronary intervention in everyday clinical practice - an expert opinion of the Association of Cardiovascular Interventions of the Polish Cardiac Society. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:6-20. [PMID: 33868413 PMCID: PMC8039914 DOI: 10.5114/aic.2021.104763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 11/17/2022] Open
Abstract
Coronary chronic total occlusions (CTO) are increasingly encountered during invasive and non-invasive coronary angiography and remain the most challenging lesions for percutaneous revascularization. During recent years success rates and safety outcomes of CTO percutaneous coronary intervention (PCI) have substantially improved, particularly due to the introduction of new techniques and dedicated equipment as well as specialized training programs of CTO operators. Significantly, the steady advances in CTO PCI techniques have coincided with the new data from randomized clinical trials supporting the role of percutaneous recanalization of CTO in relieving angina and improving the quality of life. The current expert consensus document outlines the rationale, clinical outcomes as well as technical, safety and reimbursement issues of CTO PCI. In addition, the requirements for achieving and maintaining competency in CTO PCI among interventional cardiologists are discussed. Finally, we present the modified hybrid algorithm (the so-called Polish hybrid algorithm) providing some unique refinements to the contemporary CTO PCI strategies. Continuous efforts (including active engagement with the payer) are urgently needed to increase guideline-recommended referrals to CTO PCI, and thus improve the quality of life of CTO patients in Poland.
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Affiliation(s)
- Leszek Bryniarski
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Maksymilian P. Opolski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Jarosław Wójcik
- Hospital of Invasive Cardiology IKARDIA, Lublin/Nałęczów, Poland
| | - Maciej Lesiak
- First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Pawłowski
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jakub Drozd
- Department of Cardiology, SP ZOZ MSWiA, Lublin, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Sławomir Surowiec
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej Dąbrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Dariusz Dudek
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Grygier
- First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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19
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Hirai T, Grantham JA, Sapontis J, Nicholson WJ, Lombardi W, Karmpaliotis D, Moses J, Nugent K, Gosch KL, Salisbury AC. Development and validation of a prediction model for angiographic perforation during chronic total occlusion percutaneous coronary intervention: OPEN-CLEAN perforation score. Catheter Cardiovasc Interv 2021; 99:280-285. [PMID: 33438824 DOI: 10.1002/ccd.29466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/27/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Perforation is the most frequent complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and is associated with adverse events including mortality. METHODS Among 1,000 consecutive patients enrolled in 12 center prospective CTO PCI study (OPEN CTO), all perforations were reviewed by the angiographic core-lab. Eighty-nine patients (8.9%) with angiographic perforation were compared to 911 patients without perforation. We sought to describe the clinical and angiographic predictors of angiographic perforation during CTO PCI and develop a risk prediction model. RESULTS Among eight clinically important candidate variables, independent risk factors for perforation included prior CABG (OR 2.0 [95% CI, 1.2-3.3], p < .01), occlusion length (OR 1.2 per 10 mm increase [95% CI, 1.1-1.3], p < .01), ejection fraction (OR 1.2 per 10% decrease [95% CI, 1.1-1.5], p < .01), age (OR 1.3 per 5 year increase [95%CI, 1.1-1.5], p < .01), and heavy calcification (OR 1.7 [95% CI, 1.0-2.7], p = .04). Three other potential candidate variables, glomerular filtration rate, proximal cap ambiguity, and target vessel, were not independently associated with perforation. The model was internally validated using bootstrapping methods. From the full model, a simplified perforation prediction score (OPEN-CLEAN score: CABG, Length [occlusion], EF < 50%, Age, CalcificatioN) was developed, which discriminated the risk of angiographic perforation well (c-statistics = 0.75) and demonstrated good calibration. CONCLUSION This simple 5-variable prediction score may help CTO operators to risk-stratify patients for angiographic perforation using variables available prior to CTO PCI procedures.
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Affiliation(s)
- Taishi Hirai
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.,University of Missouri Kansas City, Kansas City, Missouri, USA.,University of Missouri, Columbia, Missouri, USA
| | - James Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.,University of Missouri Kansas City, Kansas City, Missouri, USA
| | | | | | | | | | - Jeffrey Moses
- Columbia University, New York Presbyterian Hospital, New York, New York, USA
| | - Karen Nugent
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.,University of Missouri Kansas City, Kansas City, Missouri, USA
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20
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Hirai T, Grantham JA. Perforation Mechanisms, Risk Stratification, and Management in the Post-Coronary Artery Bypass Grafting Patient. Interv Cardiol Clin 2020; 10:101-107. [PMID: 33223099 DOI: 10.1016/j.iccl.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Coronary perforations during chronic total occlusion percutaneous coronary intervention (CTO PCI) is a most frequent major complication and the incidence is significantly higher compared with non-CTO PCI. Patients with prior history of coronary bypass have more major adverse events when perforation occurs compared with patients without prior bypass surgery. In this article, the authors discuss the unique challenges in identification and timely treatment of perforations in patients with prior bypass surgery.
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Affiliation(s)
- Taishi Hirai
- University of Missouri, One Hospital Drive, Columbia, MO 65212, USA.
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO 64111, USA; University of Missouri-Kansas City, Kansas City, MO, USA
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21
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Megaly M, Pershad A. Subintimal Plaque Modification and Subintimal Dissection and Reentry: Strategies to Turn Failure into Success. Interv Cardiol Clin 2020; 10:65-73. [PMID: 33223107 DOI: 10.1016/j.iccl.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) depends on the execution of bailout strategies, like subintimal dissection and reentry (STAR) and subintimal plaque modification (SPM). These are invaluable when traditional techniques fail. SPM is a modification of the STAR technique in which angioplasty is performed of the occluded segment without true lumen access in the distal vessel. Available data on SPM has shown favorable outcomes with a greater than 90% success rate when the failed CTO is reattempted in 8-12 weeks after SPM has been performed. Future studies are needed to better assess its role.
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Affiliation(s)
- Michael Megaly
- University of Arizona College of Medicine Phoenix, 475 North 5th Street, Phoenix, AZ 85004, USA
| | - Ashish Pershad
- University of Arizona College of Medicine Phoenix, 475 North 5th Street, Phoenix, AZ 85004, USA.
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22
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Ybarra LF, Bagur R. When Something Can Be Worse Than Failing: Suboptimal Results in CTO PCI. JACC Cardiovasc Interv 2020; 14:289-291. [PMID: 33541540 DOI: 10.1016/j.jcin.2020.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Luiz F Ybarra
- Chronic Total Occlusion Program, London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
| | - Rodrigo Bagur
- Chronic Total Occlusion Program, London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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23
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Sapontis J, Hirai T, Patterson C, Gans B, Yeh RW, Lombardi W, Karmpaliotis D, Moses J, Nicholson WJ, Pershad A, Wyman RM, Spaedy A, Cook S, Doshi P, Federici R, Thompson CA, Nugent K, Gosch K, Grantham JA, Salisbury AC. Intermediate procedural and health status outcomes and the clinical care pathways after chronic total occlusion angioplasty: A report from the OPEN-CTO (outcomes, patient health status, and efficiency in chronic total occlusion hybrid procedures) study. Catheter Cardiovasc Interv 2020; 98:626-635. [PMID: 33108056 DOI: 10.1002/ccd.29343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 09/09/2020] [Accepted: 10/08/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND No previous reports have described the comprehensive care pathways involved in chronic total occlusion percutaneous coronary intervention (CTO PCI). METHODS In a study of 1,000 consecutive patients undergoing CTO PCI using hybrid approach, a systematic algorithm of selecting CTO PCI strategies, the procedural characteristics, complication rates, and patient reported health status outcomes through 12 months were assessed. RESULTS Technical success of the index CTO PCI was 86%, with 89% of patients having at least one successful CTO PCI within 12 months. A total of 13.8% underwent CTO PCI of another vessel or reattempt of index CTO PCI within 1 year. At 1 year, the unadjusted major adverse cardiac and cerebral event (MACCE) rate was lower in patients with successful index CTO PCI compared to patients with unsuccessful index CTO PCI (9.4% vs. 14.6%, p = .04). The adjusted hazard ratios of myocardial infarction and death at 12 months were numerically lower in patients with successful index CTO PCI, compared to patients with unsuccessful index CTO PCI. Patients with successful index CTO PCI reported significantly greater improvement in health status throughout 12-months compared to patients with unsuccessful index CTO PCI. CONCLUSION CTO-PCI in the real-world often require treatment of second CTO, non-CTO PCI or repeat procedures to treat initially unsuccessful lesions. Successful CTO PCI is associated with numerically lower MACCE at 1 year and persistent symptomatic improvement compared to unsuccessful CTO PCI. Understanding the relationship between the care pathways following CTO PCI and health status benefit requires further study.
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Affiliation(s)
| | - Taishi Hirai
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.,University of Missouri-Kansas City, Kansas City, Missouri, USA.,University of Missouri, Columbia, Missouri, USA
| | | | - Benjamin Gans
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.,University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | | | - Jeffrey Moses
- Columbia University, New York Presbyterian Hospital, New York, New York, USA
| | | | - Ashish Pershad
- Banner Good Samaritan Medical Center, Phoenix, AZ and Banner Heart, Mesa, Arizona, USA
| | | | | | - Stephen Cook
- Peacehealth Sacred Heart Medical Center, Springfield, Oregon, USA
| | - Parag Doshi
- Alexian Brothers Medical Center, Chicago, Illinois, USA
| | | | | | - Karen Nugent
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.,University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.,University of Missouri-Kansas City, Kansas City, Missouri, USA
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24
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Modified subintimal plaque modification improving future recanalization of chronic total occlusion percutaneous coronary intervention. J Geriatr Cardiol 2020; 17:393-399. [PMID: 32863821 PMCID: PMC7416063 DOI: 10.11909/j.issn.1671-5411.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Subintimal plaque modification (SPM) is often performed to restore antegrade flow and facilitate subsequent lesion recanalization. This study aimed to compare the safety and efficacy of modified SPM with traditional SPM. METHODS A total of 1454 consecutive patients who failed a chronic total occlusion percutaneous coronary intervention (CTO PCI) attempt and underwent SPM from January 2015 to December 2019 at our hospital were reviewed retrospectively. Fifty-four patients who underwent SPM finally were included in this study. We analyzed the outcomes of all the patients, and the primary endpoint was recanalization rate, which was defined as Thrombolysis in Myocardial Infarction (TIMI) grades 2-3 flow on angiography 30 to 90 days post-procedure. RESULTS The baseline characteristics were similar between the two groups. In the follow-up, the recanalization rate was noticeably higher in the modified SPM group compared with the traditional SPM group (90.9% vs. 62.5%, P < 0.05). The proposed strategy in the modified group was more aggressive, including a larger balloon size (1.83 ± 0.30 vs. 2.48 ± 0.26 mm, P < 0.05) and longer subintimal angioplasty (0.59 ± 0.16 vs. 0.92 ± 0.12 mm, P < 0.05). Also, the common use of a Stingray balloon and guide catheter extension resulted in improvement of patients in the modified SMP group (12.5% vs. 100%, P < 0.05). CONCLUSION Modified SPM, which is associated with a high likelihood of successful recanalization, is an effective and safe CTO PCI bail out strategy.
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25
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Nikolakopoulos I, Vemmou E, Karacsonyi J, Xenogiannis I, Werner GS, Gershlick AH, Rinfret S, Yamane M, Avran A, Egred M, Garcia S, Burke MN, Brilakis ES. Latest developments in chronic total occlusion percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2020; 18:415-426. [PMID: 32594784 DOI: 10.1080/14779072.2020.1787153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Chronic Total Occlusion Percutaneous Coronary Intervention (CTO PCI) is now performed with high success rates and acceptable complication rates. AREAS COVERED We describe recent clinical and technological developments in CTO PCI from 2018 to 2020. EXPERT OPINION After publication of six randomized controlled trials, improving patient symptoms remains the principal indication for CTO PCI. Although good outcomes can be achieved with CTO PCI at experienced centers, success rates are significantly lower at less experienced centers, despite increased use in CTO crossing algorithms and development of novel and improved equipment and techniques.
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Affiliation(s)
- Ilias Nikolakopoulos
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Evangelia Vemmou
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Iosif Xenogiannis
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Gerald S Werner
- Medizinische Klinik I (Cardiology & Intensive Care), Klinikum Darmstadt GmbH , Darmstadt, Germany
| | - Anthony H Gershlick
- Department of Cardiovascular Sciences, University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital , Leicester, UK
| | - Stephane Rinfret
- McGill University Health Centre, McGill University , Montreal, Quebec, Canada
| | - Masahisa Yamane
- Cardiology Department, Saitama Sekishinkai Hospital , Saitama, Japan
| | - Alexandre Avran
- Department of Interventional Cardiology, Clinique Pasteur, Essey-lès-nancy , France
| | - Mohaned Egred
- Cardiothoracic Department, Freeman Hospital, Newcastle University , Newcastle-Upon-Tyne, UK
| | - Santiago Garcia
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
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26
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Azzalini L, Alaswad K, Uretsky BF, Agostoni P, Galassi AR, Harada Ribeiro M, Filho EM, Morales-Victorino N, Attallah A, Gupta A, Zivelonghi C, Montorfano M, Bellini B, Carlino M. Multicenter experience with the antegrade fenestration and reentry technique for chronic total occlusion recanalization. Catheter Cardiovasc Interv 2020; 97:E40-E50. [PMID: 32320133 DOI: 10.1002/ccd.28941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/09/2020] [Accepted: 04/13/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We aimed to evaluate the efficacy and safety of antegrade fenestration and reentry (AFR) for chronic total occlusion (CTO) recanalization in a multicenter registry. BACKGROUND Adoption of antegrade dissection/reentry (ADR) for CTO recanalization has been limited, and novel ADR techniques are needed. METHODS AFR involves the balloon-induced creation of multiple fenestrations between the false and true lumen. A targeted true lumen reentry is subsequently achieved with a low tip-load polymer-jacketed guidewire. Following the initial description and dissemination of AFR, patients undergoing AFR-based CTO recanalization at nine centers were included in the present registry. Study endpoints were AFR success, procedural success, and target-lesion failure (TLF) on follow-up. RESULTS We included 41 patients. Mean J-CTO score was 2.5 ± 1.4. In 80.5% of cases, AFR was performed after failed antegrade wire escalation. Another ADR technique was used before AFR in one-third of cases. AFR achieved distal true lumen reentry in n = 27/41 (65.9%) cases. In n = 14/41 (34.1%) cases with AFR failure, use of alternative techniques led to successful CTO recanalization in eight additional patients. The overall technical and procedural success rates were 85.4% and 82.9%, respectively. No AFR-related complications were observed. One-year TLF rate was 8.3% overall, with no differences between successful and failed AFR. CONCLUSIONS We report on AFR feasibility in a multicenter registry of patients undergoing CTO recanalization. We observed a moderate success rate, coupled with the absence of complications. Moreover, even a failed AFR attempt did not preclude the use of alternative techniques to achieve recanalization. Further studies should confirm and extend our findings.
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Affiliation(s)
- Lorenzo Azzalini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Barry F Uretsky
- Department of Cardiology, University of Arkansas for Medical Sciences (UAMS) and Central Arkansas Veterans Health System (CAVHS), Little Rock, Arkansas, USA
| | | | - Alfredo R Galassi
- Department of PROMISE, University of Palermo, Palermo, Italy.,Department of Cardiology, Royal Brompton & Harefield Hospital, London, UK
| | - Marcelo Harada Ribeiro
- SOS CÁRDIO Hospital, Florianópolis, Santa Catarina, Brazil.,Heart Institute, São Paulo University School of Medicine, São Paulo, São Paulo, Brazil
| | - Evandro Martins Filho
- Interventional Cardiology, Santa Casa de Misericórdia de Maceió, Maceió, Alagoas, Brazil
| | | | | | - Ankur Gupta
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Carlo Zivelonghi
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Matteo Montorfano
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
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27
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Impact of Subintimal or Plaque Modification on Repeat Chronic Total Occlusion Angioplasty Following an Unsuccessful Attempt. JACC Cardiovasc Interv 2020; 13:1010-1012. [DOI: 10.1016/j.jcin.2020.01.214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 11/17/2022]
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28
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Ybarra LF, Dandona S, Daneault B, Rinfret S. Drug‐coated balloon after subintimal plaque modification in failed coronary chronic total occlusion percutaneous coronary intervention: A novel concept. Catheter Cardiovasc Interv 2019; 96:609-613. [DOI: 10.1002/ccd.28663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/06/2019] [Accepted: 12/08/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Luiz F. Ybarra
- London Health Sciences Centre, Schulich School of Medicine & DentistryWestern University London Ontario Canada
- McGill University Health CentreMcGill University Montreal Quebec Canada
| | - Sonny Dandona
- McGill University Health CentreMcGill University Montreal Quebec Canada
| | - Benoit Daneault
- Centre Hospitalier Universitaire de Sherbrooke Sherbrooke Quebec Canada
| | - Stéphane Rinfret
- McGill University Health CentreMcGill University Montreal Quebec Canada
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Xenogiannis I, Choi JW, Alaswad K, Khatri JJ, Doing AH, Dattilo P, Jaffer FA, Uretsky B, Krestyaninov O, Khelimskii D, Patel M, Mahmud E, Potluri S, Koutouzis M, Tsiafoutis I, Jaber W, Samady H, Jefferson BK, Patel T, Megaly MS, Hall AB, Vemmou E, Nikolakopoulos I, Rangan BV, Abdullah S, Garcia S, Banerjee S, Burke MN, Brilakis ES. Outcomes of subintimal plaque modification in chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv 2019; 96:1029-1035. [DOI: 10.1002/ccd.28614] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/19/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Iosif Xenogiannis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital Minneapolis Minnesota
| | | | | | | | | | | | | | - Barry Uretsky
- VA Central Arkansas Healthcare System Little Rock Arkansas
| | | | | | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego La Jolla California
| | - Ehtisham Mahmud
- VA San Diego Healthcare System and University of California San Diego La Jolla California
| | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown Atlanta Georgia
| | - Habib Samady
- Emory University Hospital Midtown Atlanta Georgia
| | | | - Taral Patel
- Tristar Centennial Medical Center Nashville Tennessee
| | - Michael S. Megaly
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital Minneapolis Minnesota
| | - Allison B. Hall
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital Minneapolis Minnesota
| | - Evangelia Vemmou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital Minneapolis Minnesota
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital Minneapolis Minnesota
| | - Bavana V. Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital Minneapolis Minnesota
| | - Shuaib Abdullah
- VA North Texas Health Care System and University of Texas Southwestern Medical Center Dallas Texas
| | - Santiago Garcia
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital Minneapolis Minnesota
| | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center Dallas Texas
| | - M. Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital Minneapolis Minnesota
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital Minneapolis Minnesota
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30
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Riley RF, Yeh RW. Myocardial Perfusion After Coronary Chronic Total Occlusion Percutaneous Coronary Intervention: Does It Matter to Myocytes How You Cross the Lesion? Circ Cardiovasc Interv 2019; 12:e008568. [PMID: 31672033 DOI: 10.1161/circinterventions.119.008568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert F Riley
- Christ Hospital Network (R.F.R.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robert W Yeh
- Smith Center for Outcomes Research in Cardiology (R.W.Y.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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31
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Nakamura K, Dean LS. Novel predictors of late lumen enlargement in distal reference segments after successful recanalization of coronary chronic total occlusion: Do we have the answers? Catheter Cardiovasc Interv 2019; 94:553-554. [PMID: 31602802 DOI: 10.1002/ccd.28514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Kenta Nakamura
- Division of Cardiology, Department of Medicine, UW Medicine Heart Institute, University of Washington, Seattle, Washington
| | - Larry S Dean
- Division of Cardiology, Department of Medicine, UW Medicine Heart Institute, University of Washington, Seattle, Washington
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32
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Brilakis ES, Mashayekhi K, Tsuchikane E, Abi Rafeh N, Alaswad K, Araya M, Avran A, Azzalini L, Babunashvili AM, Bayani B, Bhindi R, Boudou N, Boukhris M, Božinović NŽ, Bryniarski L, Bufe A, Buller CE, Burke MN, Büttner HJ, Cardoso P, Carlino M, Christiansen EH, Colombo A, Croce K, Damas de Los Santos F, De Martini T, Dens J, Di Mario C, Dou K, Egred M, ElGuindy AM, Escaned J, Furkalo S, Gagnor A, Galassi AR, Garbo R, Ge J, Goel PK, Goktekin O, Grancini L, Grantham JA, Hanratty C, Harb S, Harding SA, Henriques JPS, Hill JM, Jaffer FA, Jang Y, Jussila R, Kalnins A, Kalyanasundaram A, Kandzari DE, Kao HL, Karmpaliotis D, Kassem HH, Knaapen P, Kornowski R, Krestyaninov O, Kumar AVG, Laanmets P, Lamelas P, Lee SW, Lefevre T, Li Y, Lim ST, Lo S, Lombardi W, McEntegart M, Munawar M, Navarro Lecaro JA, Ngo HM, Nicholson W, Olivecrona GK, Padilla L, Postu M, Quadros A, Quesada FH, Prakasa Rao VS, Reifart N, Saghatelyan M, Santiago R, Sianos G, Smith E, C Spratt J, Stone GW, Strange JW, Tammam K, Ungi I, Vo M, Vu VH, Walsh S, Werner GS, Wollmuth JR, Wu EB, Wyman RM, Xu B, Yamane M, Ybarra LF, Yeh RW, Zhang Q, Rinfret S. Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention. Circulation 2019; 140:420-433. [PMID: 31356129 DOI: 10.1161/circulationaha.119.039797] [Citation(s) in RCA: 239] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.
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Affiliation(s)
- Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (E.S.B., M.N.B.)
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II University Heart Center Freiburg Bad Krozingen, Germany (K.M., H.J.B.)
| | | | - Nidal Abi Rafeh
- St. George Hospital University Medical Center, Beirut, Lebanon (N.A.R.)
| | | | - Mario Araya
- Clínica Alemana and Instituto Nacional del Tórax, Santiago, Chile (M.A.)
| | - Alexandre Avran
- Arnault Tzank Institut St. Laurent Du Var Nice, France (A.A.)
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (L.A., M.C.)
| | - Avtandil M Babunashvili
- Department of Cardiovascular Surgery, Center for Endosurgery and Lithotripsy, Moscow, Russian Federation (A.M.B.)
| | - Baktash Bayani
- Cardiology Department, Mehr Hospital, Mashhad, Iran (B.B.)
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital and Kolling Institute, University of Sydney, Australia (R.B.)
| | | | - Marouane Boukhris
- Cardiology department, Abderrahment Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia (M.B.)
| | - Nenad Ž Božinović
- Department of Interventional Cardiology Clinic for Cardiovascular Diseases University Clinical Center Nis, Serbia (N.Z.B.)
| | - Leszek Bryniarski
- II Department of Cardiology and Cardiovascular Interventions Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland (L.B.)
| | - Alexander Bufe
- Department of Cardiology, Heartcentre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany, Institute for Heart and Circulation Research, University of Cologne, Germany, and University of Witten/Herdecke, Witten, Germany (A.B.)
| | | | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (E.S.B., M.N.B.)
| | - Heinz Joachim Büttner
- Department of Cardiology and Angiology II University Heart Center Freiburg Bad Krozingen, Germany (K.M., H.J.B.)
| | - Pedro Cardoso
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre (CAML) and Centro Cardiovascular da Universidade de Lisboa (CCUL), Portugal (P.C.)
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (L.A., M.C.)
| | | | - Antonio Colombo
- San Raffaele Hospital and Columbus Hospital, Milan, Italy (A.C.)
| | - Kevin Croce
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (K.C.)
| | - Felix Damas de Los Santos
- Interventional Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez Mexico City, Mexico (F.D.d.l.S.)
| | - Tony De Martini
- SIU School of Medicine, Memorial Medical Center, Springfield, IL (T.D.M.)
| | - Joseph Dens
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium (J.D.)
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (C.D.M.)
| | - Kefei Dou
- Center for Coronary Heart Disease, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (K.D.)
| | - Mohaned Egred
- Freeman Hospital and Newcastle University, Newcastle upon Tyne, United Kingdom (M.E.)
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Egypt (A.M.E.).,National Heart and Lung Institute, Imperial College London, United Kingdom (A.M.E.)
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Spain (J.E.)
| | - Sergey Furkalo
- Department of Endovascular Surgery and Angiography, National Institute of Surgery and Transplantology of AMS of Ukraine, Kiev (S.F.)
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy (A.G.)
| | - Alfredo R Galassi
- Chair of Cardiology, Department of PROMISE, University of Palermo, Italy (A.R.G.)
| | - Roberto Garbo
- Director of Interventional Cardiology, San Giovanni Bosco Hospital, Turin, Italy (R.G.)
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China (J.G.)
| | - Pravin Kumar Goel
- Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow, India (P.K.G.)
| | | | - Luca Grancini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy (L.G.)
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.G.)
| | - Colm Hanratty
- Belfast Health and Social Care Trust, United Kingdom (C.H., S.W.)
| | - Stefan Harb
- LKH Graz II, Standort West, Kardiologie, Teaching Hospital of the University of Graz, Austria (S.H.)
| | - Scott A Harding
- Wellington Hospital, Capital and Coast District Health Board, New Zealand (S.A.H.)
| | - Jose P S Henriques
- Academic Medical Centre of the University of Amsterdam, The Netherlands (J.P.S.H.)
| | | | - Farouc A Jaffer
- Cardiology Division, Massachusetts General Hospital, Boston (F.A.J.)
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea (Y.J.)
| | | | - Artis Kalnins
- Department of Cardiology, Eastern Clinical University Hospital, Riga, Latvia (A. Kalnins)
| | | | | | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei(H.-L.K.)
| | | | - Hussien Heshmat Kassem
- Cardiology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Egypt(H.H.K.).,Fujairah Hospital, United Arab Emirates (H.H.K.)
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (P.K.)
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, "Sackler" School of Medicine, Tel Aviv University, Petach Tikva, Israel (R.K.)
| | | | - A V Ganesh Kumar
- Department of Cardiology, Dr LH Hiranandani Hospital, Mumbai, India (A.V.G.K.)
| | - Peep Laanmets
- North Estonia Medical Center Foundation, Tallinn, Estonia(P. Laanmets)
| | - Pablo Lamelas
- Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular de Buenos Aires, Argentina (P. Lamelas).,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada (P. Lamelas)
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.-W.L.)
| | - Thierry Lefevre
- Institut Cardiovasculaire Paris Sud Hopital prive Jacques Cartier, Massy, France (T.L.)
| | - Yue Li
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, China (Y.L.)
| | - Soo-Teik Lim
- Department of Cardiology, National Heart Centre Singapore (S.-T.L.)
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital and The University of New South Wales, Sydney, Australia (S.L.)
| | | | | | | | - José Andrés Navarro Lecaro
- Médico Cardiólogo Universitario - Hemodinamista en Hospital de Especialidades Eugenio Espejo y Hospital de los Valles, Ecuador (J.A.N.L.)
| | | | | | | | - Lucio Padilla
- Department of Interventional Cardiology and Endovascular Therapeutics, ICBA, Instituto Cardiovascular, Buenos Aires, Argentina (L.P.)
| | - Marin Postu
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases "Prof. Dr. C.C. Iliescu," Bucharest, Romania (M.P.)
| | - Alexandre Quadros
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil (A.Q.)
| | - Franklin Hanna Quesada
- Interventional Cardiology Department, Clinica Comfamiliar Pereira City, Colombia (F.H.Q.)
| | | | - Nicolaus Reifart
- Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany (N.R.)
| | | | - Ricardo Santiago
- Hospital Pavia Santurce, PCI Cardiology Group, San Juan, Puerto Rico (R.S.T.)
| | - George Sianos
- AHEPA University Hospital, Thessaloniki, Greece (G.S.)
| | - Elliot Smith
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (E.S.)
| | - James C Spratt
- St George's University Hospital NHS Trust, London, United Kingdom (J.S.)
| | - Gregg W Stone
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center (G.W.S.)
| | - Julian W Strange
- Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J.W.S.)
| | - Khalid Tammam
- Cardiac Center of Excellence, International Medical Center, Jeddah, Saudi Arabia (K.T.)
| | - Imre Ungi
- 2nd Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary (I.U.)
| | - Minh Vo
- Mazankowski Alberta Heart Institute, Edmonton, AB, Canada (M.V.)
| | - Vu Hoang Vu
- Interventional Cardiology Department, Heart Center, University Medical Center at Ho Chi Minh City, and University of Medicine and Pharmacy, Vietnam (H.V.)
| | - Simon Walsh
- Belfast Health and Social Care Trust, United Kingdom (C.H., S.W.)
| | - Gerald S Werner
- Medizinische Klinik I Klinikum Darmstadt GmbH, Germany (G.W.)
| | | | | | | | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing (B.X.)
| | - Masahisa Yamane
- Saitima St. Luke's International Hospital, Tokyo, Japan (M.Y.)
| | - Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (L.F.Y.)
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y.)
| | - Qi Zhang
- Shanghai East Hospital, Tongji University, China (Q.Z.)
| | - Stephane Rinfret
- McGill University Health Centre, McGill University, Montreal, QC, Canada (S.R.)
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33
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Galassi AR, Werner GS, Boukhris M, Azzalini L, Mashayekhi K, Carlino M, Avran A, Konstantinidis NV, Grancini L, Bryniarski L, Garbo R, Bozinovic N, Gershlick AH, Rathore S, Di Mario C, Louvard Y, Reifart N, Sianos G. Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club. EUROINTERVENTION 2019; 15:198-208. [DOI: 10.4244/eij-d-18-00826] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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34
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Hall AB, Brilakis ES. Hybrid 2.0: Subintimal plaque modification for facilitation of future success in chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv 2019; 93:199-201. [DOI: 10.1002/ccd.28088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 12/29/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Allison B. Hall
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis Minnesota
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