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Zhao Y, Wang P, Zheng Z, Ma Q, Shi Y, Liu J. Efficacy and safety of drug-coated balloons in chronic total coronary occlusion recanalization: a systematic review and meta-analysis. BMC Cardiovasc Disord 2024; 24:324. [PMID: 38918738 PMCID: PMC11200994 DOI: 10.1186/s12872-024-03993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 06/20/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND With advancements in chronic total coronary occlusion (CTO) recanalization techniques and concepts, the success rate of recanalization has been steadily increasing. However, the current data are too limited to draw any reliable conclusions about the efficacy and safety of drug-coated balloons (DCBs) in CTO percutaneous coronary intervention (PCI). Herein, we conducted a meta-analysis to confirm the efficacy of DCB in CTO PCI. METHODS We systematically searched PubMed, Web of Science and Embase from inception to July 25, 2023. The primary outcome was major advent cardiovascular events (MACE), including cardiac death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). The follow-up angiographic endpoints were late lumen enlargement (LLE), reocclusion and restenosis. RESULTS Five studies with a total of 511 patients were included in the meta-analysis. Across studies, patients were predominantly male (72.9-85.7%) and over fifty years old. The summary estimate rate of MACE was 13.0% (95% CI 10.1%-15.9%, I2 = 0%, p = 0.428). The summary estimate rates of cardiac death and MI were 2.2% (95% CI 0.7%-3.7%, I2 = 0%, p = 0.873) and 1.2% (95% CI -0.2-2.6%, I2 = 13.7%, p = 0.314), respectively. Finally, the pooled incidences of TLR and TVR were 10.1% (95% CI 5.7%-14.5%, I2 = 51.7%, p = 0.082) and 7.1% (95% CI 3.0%-11.2%, I2 = 57.6%, p = 0.070), respectively. Finally, the summary estimate rates of LLE, reocclusion and restenosis were 59.4% (95% CI 53.5-65.3%, I2 = 0%, p = 0.742), 3.3% (95% CI 1.1-5.4%, I2 = 0%, p = 0.865) and 17.5% (95% CI 12.9-22.0%, I2 = 0%, p = 0.623), respectively. CONCLUSION Accordingly, DCB has the potential to be used as a treatment for CTO in suitable patients.
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Affiliation(s)
- Yuhao Zhao
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Ping Wang
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Ze Zheng
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Qin Ma
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yuchen Shi
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
| | - Jinghua Liu
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
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Le Y, Wang R, Xing H, Chen H, Song X, He Y. Pericoronary adipose tissue attenuation predicts outcome of percutaneous intervention for chronic total occlusion. Clin Radiol 2024; 79:e232-e238. [PMID: 38087681 DOI: 10.1016/j.crad.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/25/2023] [Accepted: 10/10/2023] [Indexed: 01/02/2024]
Abstract
AIM To investigate the association between pericoronary adipose tissue (PCAT) attenuation (PCATA) and outcomes of chronic total occlusion (CTO) after percutaneous coronary intervention (PCI), and to establish a clinical model that can be easily generalised to predict the outcomes of PCI-CTO. MATERIALS AND METHODS Between September 2015 and September 2019, patients from two centres were enrolled retrospectively. The primary endpoint was a procedural success (defined as achieving residual stenosis of <30% and a grade 3 thrombolysis in myocardial infarction [TIMI] flow). The new predictive model was generated by factors that were determined by multivariate analysis. The PCATA of CTO (PCATA-CTO) score was developed by assigning 1 point for each independent predictor, and then summing all points accrued. In addition, the predictive efficacy and interobserver and intraobserver agreement of PCATA-CTO and other scoring systems based on coronary computed tomography angiography (CCTA) were compared. RESULTS A total of 201 patients (mean age 58.9 ± 10.8 years, 85% male) were enrolled. The PCI success was achieved in 76% of the lesions. PCAT was higher in the PCI success group (-72.44 ± 10.45HU versus -76.76 ± 10.54 HU, p<0.05). Multivariable analysis yielded severe calcification, lesion length ≥15 mm, and perivascular fat attenuation index (FAI) ≤-69.5HU as independent negative predictors for procedural success. The area under the receiver operating characteristic curves for the PCATA-CTO score was 0.72. Comparing the PCATA-CTO score with other predictive scores, the PCATA-CTO score showed the highest interobserver (kappa = 0.74) and intraobserver agreement (kappa = 0.90, all p<0.01). CONCLUSION FAI ≤-69.5HU is an independent negative predictor of procedural success. The PCATA-CTO score improved the reliability of the prediction model. Its potential for clinical implementation requires evaluation.
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Affiliation(s)
- Y Le
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - R Wang
- Department of Radiology, Affiliated Hospital, Chengde Medical University, Hebei 067020, China
| | - H Xing
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - H Chen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - X Song
- Department of Radiology, Affiliated Hospital, Chengde Medical University, Hebei 067020, China.
| | - Y He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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Wang X, Yang X, Lu W, Pan L, Han Z, Pan S, Shan Y, Wang X, Zheng X, Li R, Zhu Y, Qin P, Shi Q, Zhou S, Zhang W, Guo S, Zhang P, Qin X, Sun G, Qin Z, Huang Z, Qiu C. Long-term outcomes of less drug-eluting stents by the use of drug-coated balloons in de novo coronary chronic total occlusion intervention: A multicenter observational study. Front Cardiovasc Med 2023; 10:1045859. [PMID: 36937919 PMCID: PMC10022494 DOI: 10.3389/fcvm.2023.1045859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Data on drug-coated balloons (DCB) for de novo coronary chronic total occlusion (CTO) are limited. We aimed to investigate the long-term outcomes of substitution of drug-eluting stents (DES) by DCB. Methods We compared the outcomes of less DES strategy (DCB alone or combined with DES) and DES-only strategy in treating de novo coronary CTO in this prospective, observational, multicenter study. The primary endpoints were major adverse cardiovascular events (MACE), target vessel revascularization, myocardial infarction, and death during 3-year follow-up. The secondary endpoints were late lumen loss (LLL) and restenosis until 1-year after operation. Results Of the 591 eligible patients consecutively enrolled between January 2015 and December 2019, 281 (290 lesions) were treated with DCB (DCB-only or combined with DES) and 310 (319 lesions) with DES only. In the DCB group, 147 (50.7%) lesions were treated using DCB-only, and the bailout stenting rate was relatively low (3.1%). The average stent length per lesion in the DCB group was significantly shorter compared with the DES-only group (21.5 ± 25.5 mm vs. 54.5 ± 26.0 mm, p < 0.001). A total of 112 patients in the DCB group and 71 patients in the DES-only group (38.6% vs. 22.3%, p < 0.001) completed angiographic follow-up until 1-year, and LLL was much less in the DCB group (-0.08 ± 0.65 mm vs. 0.35 ± 0.62 mm, p < 0.001). There were no significant differences in restenosis occurrence between the two groups (20.5% vs. 19.7%, p > 0.999). The Kaplan-Meier estimates of MACE at 3-year (11.8% vs. 12.0%, log-rank p = 0.688) was similar between the groups. Conclusion Percutaneous coronary intervention with DCB is a potential "stent-less" therapy for de novo CTO lesions with satisfactory long-term clinical results compared to the DES-only approach.
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Affiliation(s)
- Xi Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinyue Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjie Lu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Pan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanying Han
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sancong Pan
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Yingguang Shan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xule Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaolin Zheng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ran Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongjian Zhu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng Qin
- Department of Geriatric Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiangwei Shi
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuai Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wencai Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sen Guo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peisheng Zhang
- Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaofei Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoju Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongsheng Qin
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Zhenwen Huang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunguang Qiu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Chunguang Qiu,
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Qiao X, Zhang WJ, Guo WF, Li Y, Liang XY, Wang ZL. Comparison of Clinical Outcomes Between Second-and First-Generation Drug-Eluting Stents in Patients With Chronic Total Occlusion Lesion: A Meta-Analysis. Front Cardiovasc Med 2021; 8:598046. [PMID: 33959639 PMCID: PMC8096061 DOI: 10.3389/fcvm.2021.598046] [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: 08/23/2020] [Accepted: 03/22/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives: The second-generation drug-eluting stents have been used to treat chronic total occlusion lesion. However, there is limited evidence of the clinical outcomes that whether the second-generation drug-eluting stents is superior to first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The study aimed to compare the differences in clinical outcomes between the two generations drug-eluting stents in patients with those by a meta-analysis. Methods: PubMed, Embase, the Cochrane library and Web of science databases were systemically searched before March, 2021. Randomized controlled trials and observational studies were included to compare the second-generation drug-eluting stents with the first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The clinical outcomes were major adverse cardiac events (MACE), target vessel revascularization, myocardial infarction, all-cause death. Fixed effects models were used to calculate the odds ratio (OR) and 95% confidence interval (CI) of each clinical outcome. Sensitivity analysis was performed to detect potential sources of heterogeneity. Subgroup analyses were used to assess the differential effects. Results: The meta-analysis included eight studies involving 4,583 patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. Pooled analysis showed that the incidence of MACE (OR = 0.68, 95%CI 0.54–0.85, P = 0.0008), target vessel revascularization (OR = 0.70, 95%CI 0.54–0.91, P = 0.007), and myocardial infarction (OR = 0.58, 95%CI 0.37–0.93, P = 0.02) were lower in the second-generation drug-eluting stents compared with the first-generation ones. However, there was not difference in all-cause deaths between two drug-eluting stents (OR = 0.67, 95%CI 0.45–1.01, P = 0.05). Conclusions: The second-generation drug-eluting stents are associated with lower MACE, target vessel revascularization, and myocardial infarction compared with the first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The results of this study can provide a reference for the selection of stents in patients with chronic total occlusion lesion. Further randomized controlled trials are needed to verify that the second-generation drug-eluting stents is superior to the first-generation ones in patients with chronic total occlusion (Registered by PROSPERO, CRD42020158406).
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Affiliation(s)
- Xuan Qiao
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Wen-Jiao Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Wen-Fen Guo
- Department of Cardiology, Baiyin Third People's Hospital, Baiyin, China
| | - Yan Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xi-Ying Liang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Zhi-Lu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
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Reddy SA. Knuckle wire technique in percutaneous coronary intervention of chronic total occlusion: Knuckle wire technique. ASIAINTERVENTION 2020; 6:91-101. [PMID: 34912993 PMCID: PMC8525720 DOI: 10.4244/aij-d-19-00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/10/2020] [Indexed: 02/02/2024]
Abstract
In percutaneous coronary intervention, the knuckle wire technique is one of the approaches to cross the long and ambiguous course of the occluded segment. However, this technique is generally used as a last alternative, when all other techniques fail. Although knuckle wiring expedites chronic total occlusion crossing, it can also complicate the percutaneous coronary intervention strategy irreversibly. Therefore, understanding the various aspects of the knuckle wire technique is a prerequisite in a chronic total occlusion setting. The authors herein intend to describe in detail the knuckle wire technique and its safe and effective approach in various chronic total occlusion wiring strategies, while befitting to the scope of a mainstream interventionist.
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Affiliation(s)
- Sharath A. Reddy
- Department of Cardiology, Medicover Hospitals, Madhapur, Hyderabad, Telangana, India
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Wang Y, Zhao HW, Wang CF, Fan CY, Zhang XJ, Zhu Y, Luo DF, Yu GN, Hou AJ, Luan B. Efficacy and safety of bivalirudin during percutaneous coronary intervention in high‐bleeding‐risk elderly patients with chronic total occlusion: A prospective randomized controlled trial. Catheter Cardiovasc Interv 2019; 93:825-831. [PMID: 30724035 DOI: 10.1002/ccd.28087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 12/29/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Yong Wang
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Hong-Wei Zhao
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Cheng-Fu Wang
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Chun-Yu Fan
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Xiao-Jiao Zhang
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Yu Zhu
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - De-Feng Luo
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Guo-Ning Yu
- Department of Science and Education, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Ai-Jie Hou
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Bo Luan
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
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Chen Y, Zheng X, Jin H, Deng S, Ren D, Greiser A, Fu C, Gao H, Zeng M. Role of Myocardial Extracellular Volume Fraction Measured with Magnetic Resonance Imaging in the Prediction of Left Ventricular Functional Outcome after Revascularization of Chronic Total Occlusion of Coronary Arteries. Korean J Radiol 2018; 20:83-93. [PMID: 30627024 PMCID: PMC6315067 DOI: 10.3348/kjr.2018.0069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/11/2018] [Indexed: 01/18/2023] Open
Abstract
Objective The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). Materials and Methods Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. Results In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77–0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = −0.61, p < 0.001) and changes in EF (β = −0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17–0.85; p = 0.019). Conclusion Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.
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Affiliation(s)
- Yinyin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xinde Zheng
- Department of Radiology, Zhongshan Hospital, Fudan University; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Shengming Deng
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Daoyuan Ren
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Caixia Fu
- Siemens Shenzhen Magnetic Resonance (C.F.), Shenzhen, China
| | - Hongxiang Gao
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
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Abdelmoneim I, Sadek A, Mosaad MA, Yassin I, Radwan Y, Shokry K, Magdy A, Elsherbeny MY, Abushouk AI. Diagnostic accuracy of multi-slice computed tomography in identifying lesion characteristics in coronary total occlusion. Int J Cardiovasc Imaging 2018; 34:1813-1818. [PMID: 29948635 DOI: 10.1007/s10554-018-1392-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
We performed this study to compare the sensitivity and specificity of multi-slice computed tomography (MSCT) to coronary angiography (CA) in detecting coronary total occlusion (CTO) lesion characteristics. Moreover, we analyzed the association between these characteristics and the risk of revascularization failure. Fifty patients with confirmed CTO diagnosis were tried for revascularization using the antegrade (all 50) or retrograde (in failed nine antegrade interventions) approaches. Each patient underwent CA and MSCT before the intervention and data from both modalities were compared using the SPSS software. Successful revascularization occurred in 36 (72%) and 6 (66.7%) patients of the antegrade and retrograde groups, respectively. Compared to CA, MSCT exhibited high sensitivity in detecting CTO segment calcification (100%), size of the affected vessel (100%, area under the curve [AUC] = 0.82), distal filling of the affected segment (97.7%) and side-branching at the CTO segment (93.3%). However, it had lower sensitivity in detecting collaterals (75%) and the length of the affected segment (87.5%, AUC = 0.77). According to MSCT data, increased occlusion length > 18 mm (p = 0.01), atherosclerotic vessel wall (p = 0.02), small distal vessel size ≤ 2.75 mm (p = 0.002), proximal side-branching (p = 0.01) and calcification of the proximal cap (p = 0.007) or distal stump (p = 0.01) were associated with an increased risk of revascularization failure. MSCT exhibited high sensitivity in identifying several CTO lesion characteristics, such as lesional calcification and size of the affected vessel. However, further research is needed to improve the diagnostic accuracy of this modality and define the predictors of revascularization failure in CTO patients.
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Affiliation(s)
- Islam Abdelmoneim
- Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ayman Sadek
- Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Ibrahim Yassin
- Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Yasser Radwan
- Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Khalid Shokry
- Specialized Heart Center, Kobri El-Kobba Military Hospital, Cairo, Egypt
| | - Ahmed Magdy
- Specialized Heart Center, Kobri El-Kobba Military Hospital, Cairo, Egypt
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9
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Li C, Xu R, Shen Y, Dai Y, Zhang F, Ma J, Ge L, Qian J, Ge J. Bivalirudin in percutaneous coronary intervention for chronic total occlusion: A single-center pilot study. Catheter Cardiovasc Interv 2017; 91:679-685. [PMID: 28766879 DOI: 10.1002/ccd.27181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 05/12/2017] [Accepted: 06/08/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Chenguang Li
- Department of Cardiology; Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases; Shanghai 200032 China
| | - Rende Xu
- Department of Cardiology; Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases; Shanghai 200032 China
| | - Yi Shen
- Department of Geriatrics; Zhongshan Hospital, Fudan University; Shanghai 200032 China
| | - Yuxiang Dai
- Department of Cardiology; Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases; Shanghai 200032 China
| | - Feng Zhang
- Department of Cardiology; Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases; Shanghai 200032 China
| | - Jianying Ma
- Department of Cardiology; Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases; Shanghai 200032 China
| | - Lei Ge
- Department of Cardiology; Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases; Shanghai 200032 China
| | - Juying Qian
- Department of Cardiology; Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases; Shanghai 200032 China
| | - Junbo Ge
- Department of Cardiology; Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases; Shanghai 200032 China
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Karalis I, Andreou C, Montero Cabezas JM, Schalij MJ. Microcatheters: A valuable tool in the presence of a challenging coronary anatomy in the setting of acute coronary interventions. Case report and mini review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:48-51. [PMID: 28262476 DOI: 10.1016/j.carrev.2017.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 11/17/2022]
Abstract
Popularity of microcatheters (MCs) is growing among interventional cardiologists, especially when complex coronary anatomy is involved. However, MCs are still considered by many as a niche tool and their value in common clinical practice and in the setting of acute coronary interventions has not been fully appreciated. This case report highlights the decisive role of MC use in the successful completion of a primary percutaneous coronary intervention. Characteristics and indications of the most commonly used MC are briefly discussed.
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Affiliation(s)
- Ioannis Karalis
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Constantinos Andreou
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Werner GS, Glaser P, Coenen A, Moehlis H, Tischer KH, Koch M, Klingenbeck R. Reduction of radiation exposure during complex interventions for chronic total coronary occlusions: Implementing low dose radiation protocols without affecting procedural success rates. Catheter Cardiovasc Interv 2017; 89:1005-1012. [DOI: 10.1002/ccd.26886] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/29/2016] [Accepted: 11/20/2016] [Indexed: 01/14/2023]
Affiliation(s)
- Gerald S. Werner
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Peggy Glaser
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Anja Coenen
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Hiller Moehlis
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Karl-Heinz Tischer
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Matthias Koch
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Reinhold Klingenbeck
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
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12
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Christopoulos G, Kotsia AP, Rangan BV, Vo M, Alaswad K, Karmpaliotis D, Banerjee S, Brilakis ES. “Subintimal external crush” technique for a “balloon uncrossable” chronic total occlusion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:63-65. [DOI: 10.1016/j.carrev.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 11/25/2022]
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13
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Maeremans J, Knaapen P, Stuijfzand WJ, Kayaert P, Pereira B, Barbato E, Dens J. Antegrade wire escalation for chronic total occlusions in coronary arteries. J Cardiovasc Med (Hagerstown) 2016; 17:680-6. [DOI: 10.2459/jcm.0000000000000340] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Chen YY, Ren DY, Zeng MS, Yang S, Yun H, Fu CX, Ge JB, Jin H, Qian JY, Zhang WG. Myocardial extracellular volume fraction measurement in chronic total coronary occlusion: Association with myocardial injury, angiographic collateral flow, and functional recovery. J Magn Reson Imaging 2016; 44:972-82. [PMID: 27008315 DOI: 10.1002/jmri.25235] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/28/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yin-yin Chen
- Department of Radiology; Zhongshan Hospital; Fudan University; Department of Medical Imaging; Shanghai Medical school; Fudan University and Shanghai Institute of Medical Imaging; Shanghai China
| | - Dao-yuan Ren
- Department of Cardiology; Zhongshan Hospital; Fudan University and Shanghai Institute of Cardiovascular Diseases; Shanghai China
| | - Meng-su Zeng
- Department of Radiology; Zhongshan Hospital; Fudan University; Department of Medical Imaging; Shanghai Medical school; Fudan University and Shanghai Institute of Medical Imaging; Shanghai China
| | - Shan Yang
- Department of Radiology; Zhongshan Hospital; Fudan University; Department of Medical Imaging; Shanghai Medical school; Fudan University and Shanghai Institute of Medical Imaging; Shanghai China
| | - Hong Yun
- Department of Radiology; Zhongshan Hospital; Fudan University; Department of Medical Imaging; Shanghai Medical school; Fudan University and Shanghai Institute of Medical Imaging; Shanghai China
| | - Cai-xia Fu
- Siemens Shenzhen Magnetic Resonance; Shenzhen China
| | - Jun-bo Ge
- Department of Cardiology; Zhongshan Hospital; Fudan University and Shanghai Institute of Cardiovascular Diseases; Shanghai China
| | - Hang Jin
- Department of Radiology; Zhongshan Hospital; Fudan University; Department of Medical Imaging; Shanghai Medical school; Fudan University and Shanghai Institute of Medical Imaging; Shanghai China
| | - Ju-ying Qian
- Department of Cardiology; Zhongshan Hospital; Fudan University and Shanghai Institute of Cardiovascular Diseases; Shanghai China
| | - Wei-guo Zhang
- Department of Radiology; The First Affiliated Hospital of Soochow University; Suzhou Jiangsu China
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15
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Park YH, Kim YK, Seo DJ, Seo YH, Lee CS, Song IG, Yang DJ, Kim KH, Park HW, Kim WH, Bae JH. Analysis of Plaque Composition in Coronary Chronic Total Occlusion Lesion Using Virtual Histology-Intravascular Ultrasound. Korean Circ J 2016; 46:33-40. [PMID: 26798383 PMCID: PMC4720847 DOI: 10.4070/kcj.2016.46.1.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/08/2015] [Accepted: 06/30/2015] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives Success rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have recently been reported to range from 80% to 90%. A better understanding of the pathologic characteristics of the CTO lesion may helpful to improving CTO PCI success rates. We evaluated the CTO lesion in patients with stable angina (SA) by virtual histology-intravascular ultrasound (VH-IVUS). Subjects and Methods The study population consisted of 149 consecutive patients with SA underwent VH-IVUS examination. We analyzed demographic and VH-IVUS findings in 22 CTO patients (17 males; mean, 62.3 years old) compared with 127 non-CTO patients (82 males; mean, 61.3 years old). Results A significantly lower ejection fraction (57.6±13.0% vs. 65.4±8.8%, p=0.007) was detected in the CTO group compared with the non-CTO group. Reference vessel lumen area of the proximal and distal segment was significantly less in CTO group than in non-CTO group. The lesion length of the CTO group was significantly longer than those of the non-CTO group (24.4±9.6 mm vs. 17.2±7.4 mm, p<0.001). Total atheroma volume (224±159 mm3 vs. 143±86 mm3, p=0.006) and percent atheroma volume (63.2±9.6% vs. 55.8±8.5%, p=0.011) of the CTO group were also significantly greater than those of non-CTO group. However, the lesion length adjusted plaque composition of the CTO group was not significantly different compared with that of the non-CTO group. Conclusion CTO lesions had a longer lesion length and greater plaque burden than the non-CTO lesion in patients with SA. However, lesion length adjusted plaque composition showed similar between the two groups. These results support that plaque characteristics of CTO lesions are similar to non-CTO lesions in patients with SA.
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Affiliation(s)
- Yo-Han Park
- Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Yong-Kyun Kim
- Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Duck-Jun Seo
- Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Young-Hoon Seo
- Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Chung-Seop Lee
- Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - In-Geol Song
- Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Dong-Ju Yang
- Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Ki-Hong Kim
- Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Hyun-Woong Park
- Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Wan-Ho Kim
- Cardiology, Andong Sungso Hospital, Andong, Korea
| | - Jang-Ho Bae
- Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
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16
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Synetos A, Toutouzas K, Latsios G, Kaitozis O, Trantalis G, Drakopoulou M, Papaioannou S, Tsiamis E, Bompotis G, Tousoulis D. Retrograde externalization of a Floppy RotaWire in a chronic total occlusion. Int J Cardiol 2015; 201:160-1. [PMID: 26298365 DOI: 10.1016/j.ijcard.2015.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/01/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Andreas Synetos
- First Department of Cardiology, Athens Medical School, Athens, Greece.
| | | | - George Latsios
- First Department of Cardiology, Athens Medical School, Athens, Greece
| | - Odysseas Kaitozis
- First Department of Cardiology, Athens Medical School, Athens, Greece
| | - George Trantalis
- First Department of Cardiology, Athens Medical School, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, Athens Medical School, Athens, Greece
| | | | | | - Georgios Bompotis
- First Department of Cardiology, Athens Medical School, Athens, Greece
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17
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Dash D, Li L. Intravascular Ultrasound Guided Percutaneous Coronary Intervention for Chronic Total Occlusion. Curr Cardiol Rev 2015; 11:323-317. [PMID: 26354514 PMCID: PMC4774637 DOI: 10.2174/1573403x11666150909105827] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/04/2015] [Indexed: 01/09/2023] Open
Abstract
Chronic total occlusion (CTO), a fascinating and dynamic niche in the realm of coronary artery disease, represents a major technical challenge for interventional cardiologists despite evolution of better guidewires, devices, experience and techniques. Effective wiring technique is the corner stone to success of percutaneous coronary intervention (PCI) in CTO. As a guide for guidewire crossing in CTO, coronary angiography is limited. On the other hand, intravascular ultrasound (IVUS) enhances the ability to identify coronary anatomy, the exact location of the guidewires within an artery, discriminating a true lumen from the false lumen before guidewire crossing. Some angiographic features have been suggested to be predictive of procedural failure, including blunt stump with a side branch at the site of occlusion. Novel use of IVUS can recognize the optimal entry point and evaluate if a guidewire properly penetrates the proximal cap of CTO.
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Affiliation(s)
- Debabrata Dash
- S. L Raheja (A Fortis Associate) Hospital Raheja Rugnalaya Marg Mahim (West), Mumbai, 400016 India
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18
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Rangan BV, Kotsia A, Christopoulos G, Spratt J, Rinfret S, Banerjee S, Brilakis ES. The Hybrid Approach to Intervention of Chronic Total Occlusions. Curr Cardiol Rev 2015; 11:299-304. [PMID: 26354507 PMCID: PMC4774633 DOI: 10.2174/1573403x11666150909113026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/04/2015] [Indexed: 11/24/2022] Open
Abstract
The “hybrid” approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to provide guidance on optimal crossing strategy selection. Dual angiography remains the cornerstone of clinical decision making in CTO PCI. Four angiographic parameters are assessed: (a) morphology of the proximal cap (clear-cut or ambiguous); (b) oc-clusion length;
(c) distal vessel size and presence of bifurcations beyond the distal cap; and (d) location and suitability of a retrograde con-duit (collateral channels or bypass grafts) for retrograde access. Antegrade wire escalation is favored for short
(<20 mm) occlusions, usually escalating rapidly from a soft tapered-tip polymer-jacketed guidewire to a stiff
polymer-jacketed or tapered-tip guidewire. Antegrade dissection/re-entry is favored in long (≥20 mm long) occlusions, try-ing to minimize the dissection length by re-entering into the distal true lumen immediately after the occlusion. Primary retro-grade approach is preferred for lesions with an ambiguous proximal cap, poor distal target, good interventional collaterals, and heavy calcification, as well as chronic kidney disease. The “hybrid” approach advocates early change between strategies to enable CTO crossing in the most efficacious, efficient, and safe way. Several early studies are demonstrating high success and low complication rates with use of the “hybrid” approach, supporting its expanding use in CTO PCI.
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Affiliation(s)
| | | | | | | | | | | | - Emmanouil S Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
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19
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Barbato E, Barton PJ, Bartunek J, Huber S, Ibanez B, Judge DP, Lara-Pezzi E, Stolen CM, Taylor A, Hall JL. Review and Updates in Regenerative and Personalized Medicine, Preclinical Animal Models, and Clinical Care in Cardiovascular Medicine. J Cardiovasc Transl Res 2015; 8:466-74. [DOI: 10.1007/s12265-015-9657-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 12/22/2022]
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20
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Chen YY, Zhang WG, Yang S, Yun H, Deng SM, Fu CX, Zeng MS, Jin H, Guo L. Extracellular volume fraction in coronary chronic total occlusion patients. Int J Cardiovasc Imaging 2015; 31:1211-21. [DOI: 10.1007/s10554-015-0680-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/13/2015] [Indexed: 11/24/2022]
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21
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Complete Versus Incomplete Coronary Revascularization of Patients With Multivessel Coronary Artery Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:366. [DOI: 10.1007/s11936-015-0366-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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22
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van Houwelingen KG, Sen H, Lam MK, Tandjung K, Löwik MM, de Man FH, Louwerenburg JHW, Stoel MG, Hartmann M, Linssen GC, Doggen CJ, von Birgelen C. Three-year clinical outcome after treatment of chronic total occlusions with second-generation drug-eluting stents in the TWENTE trial. Catheter Cardiovasc Interv 2014; 85:E76-82. [DOI: 10.1002/ccd.25713] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/27/2014] [Accepted: 10/18/2014] [Indexed: 11/05/2022]
Affiliation(s)
- K. Gert van Houwelingen
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede the Netherlands
| | - Hanim Sen
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede the Netherlands
| | - Ming Kai Lam
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede the Netherlands
| | - Kenneth Tandjung
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede the Netherlands
| | - Marije M. Löwik
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede the Netherlands
| | - Frits H.A.F. de Man
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede the Netherlands
| | - J. Hans W. Louwerenburg
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede the Netherlands
| | - Martin G. Stoel
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede the Netherlands
| | - Marc Hartmann
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede the Netherlands
| | - Gerard C.M. Linssen
- Department of Cardiology; Ziekenhuisgroep Twente, Almelo and Hengelo; the Netherlands
| | - Carine J. Doggen
- Health Technology and Services Research; MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente; Enschede the Netherlands
| | - Clemens von Birgelen
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede the Netherlands
- Health Technology and Services Research; MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente; Enschede the Netherlands
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