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Ricottini E, Coletti F, Nusca A, Cocco N, Corlianò A, Appetecchia A, Melfi R, Mangiacapra F, Gallo P, Rinaldi R, Grigioni F, Ussia GP. Coronary Chronic Total Occlusion Revascularization: When, Who and How? J Clin Med 2024; 13:1943. [PMID: 38610708 PMCID: PMC11012595 DOI: 10.3390/jcm13071943] [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: 02/27/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Coronary chronic total occlusions (CTO) are an increasingly frequent entity in clinical practice and represent a challenging percutaneous coronary intervention (PCI) scenario. Despite data from randomized trials that have not yet demonstrated a clear benefit of CTO recanalization, the widespread of CTO-PCI has substantially increased. The improvement in operators' techniques, equipment, and training programs has led to an improvement in the success rate and safety of these procedures, which will represent an important field of future development of PCI. The present review will summarize clinical outcomes and technical and safety issues of CTO revascularization with the aim to guide clinical daily cath-lab practice.
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Affiliation(s)
- Elisabetta Ricottini
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Federica Coletti
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Annunziata Nusca
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Nino Cocco
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Andrea Corlianò
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Alessandro Appetecchia
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Rosetta Melfi
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Fabio Mangiacapra
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Paolo Gallo
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Raffaele Rinaldi
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Francesco Grigioni
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Gian Paolo Ussia
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
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Drozd J, Kula W, Celiński R, Drozd M. Coronary wire entrapment and unraveling during CTO PCI - how to retrieve a filament from the aorta. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2024; 20:109-111. [PMID: 38616944 PMCID: PMC11008512 DOI: 10.5114/aic.2024.136395] [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: 01/14/2024] [Accepted: 01/27/2024] [Indexed: 04/16/2024] Open
Affiliation(s)
- Jakub Drozd
- Department of Cardiology, SP ZOZ MSWiA, Lublin, Poland
| | - Wojciech Kula
- Department of Cardiology, SP ZOZ MSWiA, Lublin, Poland
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Nathan A, Hashemzadeh M, Movahed MR. Percutaneous Coronary Intervention of Chronic Total Occlusion Associated with Higher Inpatient Mortality and Complications Compared With Non-CTO Lesions. Am J Med 2023; 136:994-999. [PMID: 37356643 DOI: 10.1016/j.amjmed.2023.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) in patients with chronic total occlusion is commonly performed despite unclear long-term benefits. The goal of this study was to evaluate the postprocedural outcome of patients with chronic total occlusion intervention. METHODS The National Inpatient Sample database, years 2016-2020, was studied using International Classification of Diseases, Tenth Revision codes. Patients with chronic total occlusion interventions were compared with patients without chronic total occlusion. We evaluated postprocedural mortality and complications. RESULTS PCI in patients with chronic total occlusion was associated with higher total inhospital mortality and all postprocedural complications. A weighted total of 10,059,269 patients underwent PCI, with 259,574 having chronic total occlusion. The chronic total occlusion group had a 3.17% mortality rate vs 2.57% of nonchronic total occlusion PCIs (odds ratio [OR] 1.24; 95% confidence interval [CI], 1.18-1.31; P < .001). Using multivariate analysis adjusting for basline charcteristics and high risk features such as age, sex, race, diabetes mellitus, chronic kidney disease, systolic heart failure, 3-vessel PCI, hypertension, chronic obstructive pulmonary disease, ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, prior PCI, history of coronary artery bypass graft, history of anemia, smoking status, atrial fibrillation/flutter, valvular heart disease, and , history of stroke, chronic total occlusion PCI remained significantly associated with higher total mortality (OR 1.07; 95% CI, 1.02-1.13; P = .02). Patients with chronic total occlusion compared with nonchronic total occlusion PCI had also higher rates of myocardial infarction (OR 2.85; 95% CI, 2.54-3.21; P < .001), coronary perforation (OR 6.01; 95% CI, 5.25-6.89; P < .001), tamponade (OR 3.36; 95% CI, 2.91-3.88; P < .001), contrast-induced nephropathy (OR 2.05; 95% CI, 1.45-2.90; P < .001), procedural bleeding (OR 3.57; 95% CI, 3.27-3.89; P < .001), and acute postprocedural respiratory failure (OR 2.07; 95% CI, 1.81-2.36; P < .001). All postprocedural complications were more than 3 times the nonchronic total occlusion patients (OR 3.45; 95% CI, 3.24-3.67; P < .001). CONCLUSION Using a large national inpatient database, PCI performed in patients with chronic total occlusion was associated with significantly much higher mortality and postprocedural complications compared with PCI in nonchronic total occlusion patients.
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Affiliation(s)
| | | | - Mohammad Reza Movahed
- University of Arizona College of Medicine-Phoenix; University of Arizona Sarver Heart Center, Tucson.
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Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Allana SS, Alaswad K, Basir MB, Krestyaninov O, Khelimskii D, Gorgulu S, Davies RE, Benton SM, Khatri JJ, Poommipanit P, Choi JW, Jaber WA, Rinfret S, Nicholson W, Al-Azizi KM, Potluri S, Aygul N, Altunkeser BB, Koutouzis M, Tsiafoutis I, Milkas A, ElGuindy AM, Abi Rafeh N, Goktekin O, Mastrodemos OC, Rangan BV, Sandoval Y, Burke MN, Brilakis ES. Incidence, mechanisms, treatment, and outcomes of donor vessel injury during percutaneous coronary interventions for chronic total occlusion. Catheter Cardiovasc Interv 2023; 102:585-593. [PMID: 37560823 DOI: 10.1002/ccd.30798] [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: 03/25/2023] [Revised: 06/22/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Donor vessel injury is a potentially life-threatening complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). AIMS Our goal was to examine the incidence, mechanisms, treatment, and outcomes of patients with donor vessel injury in a large multicenter CTO PCI registry. METHODS We analyzed the baseline clinical and angiographic characteristics, and procedural outcomes of 12,349 CTO PCIs performed between 2012 and 2022 at 44 centers. RESULTS The incidence of donor vessel injury was 0.35% (n = 43). The baseline clinical characteristics of patients with and without donor vessel injury were similar. Cases complicated by donor vessel injury were more complex with higher Japanese CTO score (2.9 ± 1.1 vs. 2.4 ± 1.3; p = 0.004) and lower procedural success rate (69.8% vs. 85.2%; p = 0.004). The retrograde approach was used more commonly in donor vessel injury cases (68.9% vs. 30.9%; p < 0.001). Most (53.5%) donor vessel injuries were guide catheter-induced, whereas 20.9% were due to donor vessel thrombosis. Of the 43 patients with donor vessel injury, 36 (83.7%) were treated with stenting and seven (16.3%) received a left ventricular assist device. The incidence of major adverse cardiovascular events (MACEs) was significantly higher in cases with donor vessel injury (23.3% vs. 2.0%; p < 0.001). Of the 43 patients with donor vessel injury, five patients (11.6%) experienced acute myocardial infarction and four patients (9.3%) died. CONCLUSIONS Donor vessel injury, occurred in 0.35% of CTO PCIs performed by experienced operators, was mainly due to guide catheter-induced dissection or thrombosis and was associated with lower procedural success and higher MACE.
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Affiliation(s)
- Spyridon Kostantinis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan, USA
| | - Mir B Basir
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan, USA
| | - Oleg Krestyaninov
- Department of Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Dmitrii Khelimskii
- Department of Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | - Rhian E Davies
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | - Stewart M Benton
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | | | - Paul Poommipanit
- Department of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Wissam A Jaber
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Stephane Rinfret
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - William Nicholson
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Karim M Al-Azizi
- Department of Cardiology, The Heart Hospital - Plano, Plano, Texas, USA
| | - Srinivasa Potluri
- Department of Cardiology, The Heart Hospital - Plano, Plano, Texas, USA
| | - Nazif Aygul
- Department of Cardiology, Selcuk University Medical Faculty, Konya, Turkey
| | | | - Michael Koutouzis
- Department of Cardiology, Red Cross Hospital of Athens, Athens, Greece
| | | | - Anastasios Milkas
- Department of Cardiology, Athens Naval and Veterans Hospital, Athens, Greece
| | - 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, Los Angeles, USA
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Olga C Mastrodemos
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Simsek B, Tajti P, Carlino M, Ojeda S, Pan M, Rinfret S, Vemmou E, Kostantinis S, Nikolakopoulos I, Karacsonyi J, Rempakos A, Dens JA, Agostoni P, Alaswad K, Megaly M, Avran A, Choi JW, Jaffer FA, Doshi D, Karmpaliotis D, Khatri JJ, Knaapen P, La Manna A, Spratt JC, Tanabe M, Walsh S, Mastrodemos OC, Allana S, Rangan BV, Goktekin O, Gorgulu S, Poommipanit P, Kearney KE, Lombardi WL, Grantham JA, Mashayekhi K, Brilakis ES, Azzalini L. External validation of the PROGRESS-CTO perforation risk score: Individual patient data pooled analysis of three registries. Catheter Cardiovasc Interv 2023; 101:326-332. [PMID: 36617391 DOI: 10.1002/ccd.30551] [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: 11/02/2022] [Revised: 01/05/2023] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Coronary artery perforation is one of the most feared and common complications of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS To assess the usefulness of the recently developed PROGRESS-CTO (NCT02061436) perforation risk score in independent cohorts. Individual patient-level data pooled analysis of three registries was performed. RESULTS Of the 4566 patients who underwent CTO PCI at 25 centers, 196 (4.2%) had coronary artery perforation. Patients with perforations were older (69 ± 10 vs. 65 ± 10, p < 0.001), more likely to be women (19% vs. 13%, p = 0.009), more likely to have a history of prior coronary artery bypass graft (34% vs. 20%, p < 0.001), and unfavorable angiographic characteristics such as blunt stump (62% vs. 48%, p < 0.001), proximal cap ambiguity (52% vs. 34%, p < 0.001), and moderate-severe calcification (60% vs. 49%, p = 0.002). Technical success was lower in patients with perforations (73% vs. 88%, p < 0.001). The area under the receiver operating characteristic curve of the PROGRESS-CTO perforation risk model was 0.76 (95% confidence interval [CI], 0.72-0.79), with good calibration (Hosmer-Lemeshow p = 0.97). We found that the CTO PCI perforation risk increased with higher PROGRESS-CTO perforation scores: 0.3% (score 0), 2.3% (score 1), 3.1% (score 2), 5.5% (score 3), 7.5% (score 4), 14.6% (score 5). CONCLUSION Given the good discriminative performance, calibration, and the ease of calculation, the PROGRESS-CTO perforation score may facilitate assessment of the risk of perforation in patients undergoing CTO PCI.
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Affiliation(s)
- Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Peter Tajti
- The Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Soledad Ojeda
- Division of Interventional Cardiology, Reina Sofia Hospital, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Manuel Pan
- Division of Interventional Cardiology, Reina Sofia Hospital, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Stephane Rinfret
- Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Evangelia Vemmou
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Ilias Nikolakopoulos
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Joseph A Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | | | - Michael Megaly
- Division of Cardiology, Willis Knighton Heart Institute, Shreveport, Louisiana, USA
| | - Alexandre Avran
- Department of Interventional Cardiology, Clinique Pasteur, Essey-lès-Nancy, Toulouse, France
| | - James W Choi
- Division of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Farouc A Jaffer
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Darshan Doshi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - James C Spratt
- St. George's University Healthcare NHS Trust, London, UK
| | - Masaki Tanabe
- Department of Cardiology, Nozaki Tokushukai Hospital, Osaka, Japan
| | | | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Salman Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Omer Goktekin
- Division of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Sevket Gorgulu
- Division of Cardiology, Biruni University School of Medicine, Istanbul, Turkey
| | | | - Kathleen E Kearney
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - William L Lombardi
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Department for Internal Medicine and Cardiology, Heart center Lahr, Lahr, Germany
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Lorenzo Azzalini
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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Di Mario C, Mashayekhi KA, Garbo R, Pyxaras SA, Ciardetti N, Werner GS. Recanalisation of coronary chronic total occlusions. EUROINTERVENTION 2022; 18:535-561. [PMID: 36134683 DOI: 10.4244/eij-d-21-01117] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators in this demanding, rapidly evolving field of interventional cardiology.
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Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Kambis A Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Roberto Garbo
- GVM Care & Research, Maria Pia Hospital, Turin, Italy
| | | | - Niccolò Ciardetti
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Gerald S Werner
- Department of Cardiology, Klinikum Darmstadt GmbH, Darmstadt, Germany
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Simsek B, Kostantinis S, Karacsonyi J, Hall A, Rangan BV, Croce KJ, Azzalini L, McEntegart M, Shishehbor M, Egred M, Mastrodemos OC, Sorajja P, Banerjee S, Lombardi W, Sandoval Y, Brilakis ES. International percutaneous coronary intervention complication survey. Catheter Cardiovasc Interv 2022; 99:1733-1740. [PMID: 35349771 DOI: 10.1002/ccd.30173] [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: 02/08/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the perceptions of interventional cardiologists (IC) regarding the frequency, impact, and management strategies of percutaneous coronary intervention (PCI) complications. BACKGROUND The perceptions and management strategies of ICs of PCI complications have received limited study. METHODS Online survey on PCI complications: 46 questions were distributed via email lists and Twitter to ICs. RESULTS Of 11,663 contacts, 821 responded (7% response rate): 60% were from the United States and the median age was 46-50 years. Annual PCI case numbers were <100 (26%), 100-199 (37%), 200-299 (21%), and ≥300 (16%); 42% do not perform structural interventions, others reported performing <40 (30%), or >100 (11%) structural cases annually. On a scale of 0-10, participating ICs were highly concerned about potential complications with a median score of 7.2 (interquartile range: 5.0-8.7). The most feared complication was death (39%), followed by coronary perforation (26%) and stroke (9%). Covered stents were never deployed by 21%, and 32% deployed at least one during the past year; 79% have never used fat to seal perforations; 64% have never used coils for perforations. Complications were attributed to higher patient/angiographic complexity by 68% and seen as opportunities for improvement by 70%; 97% of participants were interested in learning more about the management of PCI complications. The most useful learning methods were meetings (66%), webinars (48%), YouTube (32%), and Twitter (29%). CONCLUSION ICs who participated in the survey are highly concerned about complications. Following complication management algorithms and having access to more experienced operators might alleviate stress and optimize patient outcomes.
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Affiliation(s)
- Bahadir Simsek
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Allison Hall
- Eastern Health, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Bavana V Rangan
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Kevin J Croce
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Mehdi Shishehbor
- Division of Cardiovascular Medicine, Department of Interventional Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Olga C Mastrodemos
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Subhash Banerjee
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Cardiology, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
| | - William Lombardi
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Yader Sandoval
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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8
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Shi Y, He S, Luo J, Jian W, Shen X, Liu J. Lesion characteristics and procedural complications of chronic total occlusion percutaneous coronary intervention in patients with prior bypass surgery: A meta-analysis. Clin Cardiol 2022; 45:18-30. [PMID: 34989435 PMCID: PMC8799042 DOI: 10.1002/clc.23766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 11/07/2022] Open
Abstract
Coronary artery bypass graft (CABG) accelerates the prevalence of native coronary chronic total occlusion (CTO), and this kind of CTO shows extensive challenging and complex atherosclerotic pathology. As a result, the procedural success rate of percutaneous coronary intervention (PCI) is inferior to another kind of lesions. The present meta-analysis aims to compare the lesion characteristics and procedural complications of CTO-PCI in patients with or without prior CABG. A total of 8 studies, comprising of 13439 patients, published from inception to August 2021 were included in this meta-analysis. Results were pooled using random effects model and are presented as odds ratio (OR) with 95% confidence intervals (95% CIs). From the 13439 patients enrolled, 3349 (24.9%) patients had previous CABG and 10090 (75.1%) formed the control group in our analysis. For the clinical characteristic, compared to the non-CABG patients, prior CABG patients were older (OR, 3.98; 95% CI, 3.19-4.78; p < .001; I2 = 72%), had more male (OR, 1.30; 95% CI, 1.14-1.49; p < .001; I2 = 6%), diabetes mellitus (OR, 1.54; 95% CI, 1.36-1.73; p < .001; I2 = 37%), dyslipidemia (OR, 1.89; 95% CI, 1.33-2.69; p < .001; I2 = 81%), hypertension (OR, 1.88; 95% CI, 1.46-2.41; p < .001; I2 = 71%), previous myocardial infarction (OR, 1.94; 95% CI, 1.48-2.56; p < .001; I2 = 85%), and previous PCI (OR, 1.74; 95% CI, 1.52-1.98; p < .001; I2 = 22%). Non-CABG patents had more current smoker (OR, .45; 95% CI, 0.27-0.74; p < .001; I2 = 91%). BMI (OR, -0.01; 95% CI, -0.07-0.06; p = .85; I2 = 36%) were similar in both groups. For lesions location, the right coronary artery (RCA) was predominant target vessel in both groups (50.5% vs 48.7%; p=.49), although, the left circumflex (LCX) was more frequently CTO in the prior CABG group (27.3% vs 18.9%; p<.01), while left anterior descending artery (LAD) in non-CABG ones (16.0% vs 29.1%; p<0.01). For lesions characteristics, prior CABG patients had more blunt stump (OR, 1.71; 95% CI, 1.46-2.00; p < .001; I2 = 40%), proximal cap ambiguity (OR, 1.45; 95% CI, 1.28-1.64; p < .001; I2 = 0.0%), severe calcifications (OR, 2.91; 95% CI, 2.19-3.86; p < .001; I2 = 83%), more bending (OR, 3.07; 95% CI, 2.61-3.62; p < .001; I2 = 0%), lesion length > 20 mm (OR, 1.59; 95% CI, 1.10-2.29; p = .01; I2 = 83%), inadequate distal landing zone (OR, 1.95; 95% CI, 1.75-2.18; p<.001; I2 = 0.0%), distal cap at bifurcation (OR, 1.65; 95% CI, 1.46-1.88; p < .001; I2 = 0.0%), and higher J-CTO score (SMD, 0.52; 95% CI, 0.42-0.63; p < .001; I2 = 65%). But side branch at proximal entry (OR, 0.88; 95% CI, 0.72-1.07; p = .21; I2 = 45%), in-stent CTO (OR, 0.99; 95% CI, 0.86-1.14; p = .88; I2 = 0.0%), lack of interventional collaterals (OR, 0.80; 95% CI, 0.55-1.15; p = .23; I2 = 78%), and previously failed attempt (OR, 0.73; 95% CI, 0.48-1.11; p = .14; I2 = 89%) were similar in both groups. For complication, prior CABG patients had more perforation with need for intervention (OR, 1.91; 95% CI, 1.36-2.69; p < 0.001; I2 = 34%), contrast-induced nephropathy (OR, 3.40; 95% CI, 1.31-8.78; p = .01; I2 = 0.0%). Non-CABG patents had more tamponade (OR, 0.25; 95% CI, 0.09-0.72; p = .01; I2 = 0.0%), and the major bleeding complication (OR, 1.18; 95% CI, 0.57-2.44; p = .65; I2 = 0%) were no significant difference in both groups. In conclusion, Patients with prior CABG undergoing CTO-PCI have more complex lesion characteristics, though procedural complication rates were comparable.
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Affiliation(s)
- Yuchen Shi
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina
| | - Songyuan He
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina
| | - Jesse Luo
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina
| | - Wen Jian
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina
| | - Xueqian Shen
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina
| | - Jinghua Liu
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina
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Avula V, Karacsonyi J, Hammadah M, Brilakis ES. Venoarterial extracorporeal membrane oxygenation for life-threatening complications of percutaneous coronary and structural heart interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:308-311. [PMID: 34844867 DOI: 10.1016/j.carrev.2021.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022]
Abstract
Percutaneous coronary or structural heart interventions may lead to complications, such as perforation and acute vessel closure that may in turn lead to cardiac arrest or cardiogenic shock. Moreover, acute coronary syndrome patients presenting with cardiogenic shock can be challenging to treat due to hemodynamic instability. In such cases, venoarterial extracorporeal membrane oxygenation (V-A ECMO) can provide hemodynamic stabilization and oxygenation allowing successful treatment of the complication or culprit lesion in acute coronary syndrome patients. We present 3 cases illustrating successful emergent use of V-A ECMO in the cardiac catheterization laboratory in the setting of acute left main dissection during a chronic total occlusion intervention, cardiogenic shock in the setting of non-ST segment elevation myocardial infarction and multivessel coronary artery disease, and aortic annular rupture during transcatheter aortic valve replacement.
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Affiliation(s)
- Vennela Avula
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Muhammad Hammadah
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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10
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Azzalini L, Moroni F, Santiago R. Subintimal shift at the bifurcation: A cause of side branch occlusion in chronic total occlusion intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:298-301. [PMID: 34215558 DOI: 10.1016/j.carrev.2021.06.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/03/2022]
Abstract
Bifurcation lesions are frequently found in chronic total occlusion (CTO) percutaneous coronary intervention and are associated with lower procedural success and higher rates of complications, including side branch loss. In this report, we describe a poorly understood mechanism for side branch loss in CTO PCI: subintimal shift. This involves the extension of a dissection plane caused by subintimal (extraplaque) crossing in the main branch at the level of the side branch ostium, causing exclusion of the latter upon vessel preparation or stent placement. Subintimal shift (as compared to carina shift in non-CTO bifurcation intervention) appears to be under-recognized, and CTO operators should be aware that, from a technical standpoint, ballooning of the side branch is unlikely to restore and maintain flow, and a two-stent strategy is indicated to preserve the bifurcation.
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Affiliation(s)
- Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Richmond, VA, USA; Virginia Commonwealth University, Richmond, VA, USA.
| | - Francesco Moroni
- Division of Cardiology, VCU Health Pauley Heart Center, Richmond, VA, USA; Virginia Commonwealth University, Richmond, VA, USA; Università Vita-Salute San Raffaele, Milan, Italy
| | - Ricardo Santiago
- PCI Cardiology Group, Bayamon Heart and Lung Institute, Bayamon, PR, USA; PCI Cardiology Group, Manatí Cardiovascular Interventional Institute, Manatí, PR, USA
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11
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Knaapen P, Henriques JP, Nap A, Arslan F. Percutaneous coronary intervention for chronic total coronary occlusion: Do. Or do not. There is no try. Neth Heart J 2020; 29:1-3. [PMID: 33320303 PMCID: PMC7782592 DOI: 10.1007/s12471-020-01531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- P Knaapen
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - J P Henriques
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - A Nap
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - F Arslan
- Department of Cardiology, Vivantes Klinikum am Urban, Berlin, Germany
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