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Tanaka K, Okamura A, Yoshikawa R, Tsuchikane E, Ishikawa M, Suzuki S, Nagai H, Sumiyoshi A, Kawahira M, Yamasaki T, Matsuda H, Iwamoto M, Watanabe S, Yamasaki K, Tanaka N, Koyama Y, Iwanaga Y, Watanabe H. Tip Detection-Antegrade Dissection and Re-Entry With New Puncture Wire in CTO Intervention: Revolution Through 3D-Wiring. JACC. ASIA 2024; 4:359-372. [PMID: 38765666 PMCID: PMC11099825 DOI: 10.1016/j.jacasi.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 05/22/2024]
Abstract
Background The authors devised the tip detection (TD) method and developed AnteOwl WR intravascular ultrasound to standardize intravascular ultrasound-based 3-dimensional wiring for intraplaque tracking in chronic total occlusion (CTO)-percutaneous coronary intervention (PCI). The TD method also allowed antegrade dissection and re-entry (ADR). Combining TD-ADR with Conquest Pro 12 Sharpened Tip (CP12ST) wire, a new ADR wire with the strongest penetration force developed to date, enabled re-entry anywhere except calcification sites. Objectives This study investigated the efficacy and feasibility of TD-ADR by comparison of procedural outcomes with Stingray-ADR in CTO-PCI. Methods Twenty-seven consecutive CTO cases treated by TD-ADR with CP12ST wire between August 2021 and April 2023 and 27 consecutive CTO cases treated by Stingray-ADR with Conquest 8-20 (CP20) wire between March 2018 and July 2021 were retrospectively enrolled as the TD-ADR by CP12ST wire group and Stingray-ADR by CP20 wire group, respectively, from 4 facilities that could share technical information on these procedures. Results The success rate of the ADR procedure was significantly improved (27 of 27 cases [100%] vs 18 of 27 cases [67%], respectively; P = 0.002) and total procedural time was significantly reduced (median procedural time: 145.0 [Q1-Q3: 118.0-240.0] minutes vs 185.0 [Q1-Q3: 159.5-248.0] minutes, respectively; P = 0.028) in the TD-ADR by CP12ST wire group compared to the Stingray-ADR by CP20 wire group. There were few in-hospital major adverse cardiac and cerebrovascular events or no complications in either group. Conclusions TD-ADR by CP12ST wire can standardize highly accurate ADR in CTO-PCI.
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Affiliation(s)
- Kota Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Atsunori Okamura
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | | | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan
| | - Masato Ishikawa
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | | | | | | | | | | | - Hiroaki Matsuda
- Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Japan
| | - Mutsumi Iwamoto
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Satoshi Watanabe
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Keita Yamasaki
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yasushi Koyama
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | | | - Heitaro Watanabe
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
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Kitani S, Tsuchikane E, Yamaki M, Igarashi Y. First successful implementation of subintimal transcatheter withdrawal technique in intravascular ultrasound-guided tip detection antegrade dissection and reentry: a case report. Eur Heart J Case Rep 2023; 7:ytad580. [PMID: 38046646 PMCID: PMC10691871 DOI: 10.1093/ehjcr/ytad580] [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: 06/28/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
Background Antegrade dissection and reentry (ADR) is an effective technique for wire passage in chronic total occlusion (CTO), and in recent years, the effectiveness of intravascular ultrasound (IVUS)-guided tip detection (TD)-ADR has been reported. However, the expansion of the subintimal space serves as a significant obstacle to the success of ADR, posing a limitation to the procedure. Case summary We present the first case of using IVUS-guided TD-ADR with the subintimal transcatheter withdrawal (STRAW) technique. The patient was a 68-year-old Asian female with effort angina pectoris and a CTO in the middle section of the right coronary artery (RCA). Two previous attempts at percutaneous coronary intervention (PCI) for the RCA at another hospital were unsuccessful. During the third attempt PCI, the antegrade wire migrated into the subintimal space. To address this, we performed IVUS-guided TD-ADR using the Conquest Pro 12 Sharpened Tip (CP12ST; Asahi Intecc, Aichi, Japan) wire. However, due to the expansion of the subintimal space, we were unable to puncture the true lumen. To reduce the subintimal space, we employed the STRAW technique, which allowed successful puncture of the true lumen using the CP12ST wire. Finally, stenting was performed, resulting in satisfactory antegrade blood flow. Discussion Intravascular ultrasound-guided TD provides accurate guidance for puncturing in ADR procedures, but the expansion of the subintimal space remains a significant challenge. The STRAW technique offers a solution by reducing the subintimal space and enabling successful puncture of the true lumen during IVUS-guided TD-ADR.
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Affiliation(s)
- Shunsuke Kitani
- Department of Cardiology, Sapporo Kosei General Hospital, Kita 3-jo Higashi 8-chome, Chuo-ku, Sapporo, Hokkaido 0600033, Japan
| | | | - Masaru Yamaki
- Department of Cardiology, Sapporo Kosei General Hospital, Kita 3-jo Higashi 8-chome, Chuo-ku, Sapporo, Hokkaido 0600033, Japan
| | - Yasumi Igarashi
- Department of Cardiology, Sapporo Kosei General Hospital, Kita 3-jo Higashi 8-chome, Chuo-ku, Sapporo, Hokkaido 0600033, Japan
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Niizeki T, Tsuchikane E, Konta T, Kishi K, Okada H, Ito Y, Oikawa Y, Yoshikawa R, Tanaka H. New Angiographic Difficulty Score for First-Attempt Chronic Total Occlusion in the 3 Major Coronary Arteries. JACC Cardiovasc Interv 2023; 16:2542-2551. [PMID: 37879806 DOI: 10.1016/j.jcin.2023.08.046] [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: 04/23/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is still challenging due to complex lesion morphology. Success rates may vary among the 3 major coronary arteries, influenced by clinical and angiographic characteristics. OBJECTIVES This study sought to evaluate the differences in the predictors of unsuccessful PCI in first-attempt CTO lesions of the 3 major coronary arteries compared with the J-CTO (Japanese CTO) score. METHODS This study assessed 6,408 first-attempt CTO patients from the Japanese CTO-PCI expert registry between January 2014 and December 2021, randomly assigned to derivation and validation sets. Difficulty scores for each artery were determined by assigning points to predictive unsuccessful factors. RESULTS The CTO lesions were distributed as follows: left anterior descending coronary artery: 2,245 (35%), left circumflex coronary artery: 1,131 (18%), and right coronary artery (RCA): 3,032 (47%). Regarding success rates, left circumflex coronary artery CTO had the lowest procedural success rate (90%) followed by RCA CTO (92%) and left anterior descending coronary artery CTO (94%). RCA CTO was significantly longer and more severely angulated, requiring more often the retrograde approach. A multivariate logistic analysis revealed that predictors of failed PCI were different in CTO lesions among the 3 major coronary arteries, respectively. Moreover, our difficulty score for RCA CTO was superior to the J-CTO score in predicting unsuccessful PCI. CONCLUSIONS Clinical and angiographic differences might explain the discrepancies of success rates in CTO lesions among the 3 major coronary arteries. Our novel difficulty score was comparable to the J-CTO score in predicting unsuccessful CTO-PCI with a superior discriminatory capacity.
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Affiliation(s)
- Takeshi Niizeki
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | | | - Tsuneo Konta
- Department of Public Health and Hygiene, Yamagata University School of Medicine, Yamagata, Japan
| | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshiaki Ito
- Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Kanagawa, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | | | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
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Komiyama H, Matsukage T. Debating the State-of-the-Art CTO PCI: Is There Still Room for Discussion? JACC Case Rep 2023; 19:101949. [PMID: 37593591 PMCID: PMC10429723 DOI: 10.1016/j.jaccas.2023.101949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Hidenori Komiyama
- Department of Cardiology, Saitama Medical University/Saitama Medical Center, Saitama, Japan
| | - Takashi Matsukage
- Department of Cardiology, Saitama Medical University/Saitama Medical Center, Saitama, Japan
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Tanaka K, Okamura A, Tsuchikane E, Matsuda H, Kawahira M, Sumiyoshi A, Watanabe S, Iwamoto M, Tanaka N, Koyama Y, Iwanaga Y, Watanabe H. New Antegrade Dissection Re-Entry Technique With Tip Detection Method and New Puncture Wire in CTO-PCI. JACC Cardiovasc Interv 2023; 16:1546-1548. [PMID: 37380241 DOI: 10.1016/j.jcin.2023.04.019] [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: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Kota Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Atsunori Okamura
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
| | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine, Toyohashi Heart Center Toyohashi, Japan
| | - Hiroaki Matsuda
- Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Japan
| | | | | | - Satoshi Watanabe
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Mutsumi Iwamoto
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yasushi Koyama
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | | | - Heitaro Watanabe
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
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