1
|
Filho EM, Araujo GN, Machado GP, Padilla L, de Paula JET, Botelho AC, Campos CM, Quesada FLH, Alcantara M, Santiago R, de Los Santos FD, Oliveira MD, Ribeiro MH, Perez L, Pinto ME, Côrtes LA, Piccaro P, Brilakis ES, Quadros AS. Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions. Catheter Cardiovasc Interv 2024; 103:539-547. [PMID: 38431912 DOI: 10.1002/ccd.30987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 11/25/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications. AIM Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use. RESULTS From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in the GCE group were older and had more comorbidities. The median J-CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78-2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41-2.41, p = 0.986), in-hospital death (OR: 1.39, 95% CI: 0.54-3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52-2.19, p = 0.850) were similar in both groups. CONCLUSION In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.
Collapse
Affiliation(s)
| | - Gustavo N Araujo
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Instituto de Cardiologia de Santa Catarina, São José, Brazil
| | | | - Lucio Padilla
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Félix D de Los Santos
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Centro Medico ABC, Mexico City, Mexico
| | - Marcos D Oliveira
- Hospital São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Marcelo H Ribeiro
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Hospital SOS Cardio, Florianópolis, Brazil
| | - Luiz Perez
- Hospital Clinico Regional Dr Guillermo Grant Benavente, Concepcion, Chile
| | | | | | - Pedro Piccaro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | |
Collapse
|
2
|
Hailin D, Hongtu Q, Wenyong Z. Percutaneous coronary intervention for chronic total occlusion of the left circumflex branch in mirror dextrocardia: a case report. J Med Case Rep 2023; 17:486. [PMID: 37990278 PMCID: PMC10664485 DOI: 10.1186/s13256-023-04196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/02/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Mirror dextrocardia (MDC) is a condition in which the heart is located in a mirror-image position on the right side of the chest compared to the normal position in individuals with physiological variations. Patients with MDC and chronic total occlusion (CTO) of the left circumflex branch (LCX) are extremely rare in clinical practice. The treatment of MDC-CTO-LCX differs significantly from patients without mirror dextrocardia and the same condition in terms of instrument selection and procedural techniques. In this article, we report a successful case of interventional treatment in a patient with MDC-CTO-LCX. We summarize the anatomical and electrocardiographic variations in patients with MDC-CTO-LCX, and discuss the selection of interventional instruments and techniques that can be useful for interventionists as well as the diagnostic and therapeutic considerations that can be helpful for clinical physicians. CASE PRESENTATION A male Han Chinese patient, 51, was admitted, presenting recurrent chest pain for a year and recent onset of exertional fatigue over the past week.He reported episodes of chest pain following physical activities over the past year, lasting between 5 and 20 min.Despite these symptoms, the patient did not seek immediate medical attention, and the occurrence of his chest pain has progressively lessened within the year.A week prior, the patient developed exertional dyspnea after brief walks, though without any episodes of nocturnal paroxysmal dyspnea.Upon arrival at our hospital for evaluation, he was initially diagnosed with chronic coronary syndrome, previous inferior myocardial infarction, atrial arrhythmia, and classified under the New York Heart Association functional class III.Following his admission, a chest X-ray and coronary angiography were conducted.The results indicated mirror dextrocardia and total occlusion of the left circumflex branch. Percutaneous coronary intervention (PCI) was performed on the left circumflex branch. Subsequent angiography demonstrated optimal stent positioning without evidence of hematoma or dissection.Following the procedure, the patient's symptoms of chest pain and exertional dyspnea were resolved, which led to his subsequent discharge.A follow-up electrocardiogram, 10 months post-procedure, displayed a slow and regular atrial rhythm. CONCLUSIONS The incidence of dextrocardia is very low, and it may appear normal on an electrocardiogram; however, careful diagnosis is required when there is an abnormal direction of the P wave in limb leads. During the operation for chronic occlusive lesions of the right-sided coronary artery, the anomalous anatomical structure necessitates specific requirements for instrument selection and operative techniques. After revascularization of chronic occlusive vessels in dextrocardia, routine electrocardiographic examination may show false normalization, requiring caution in interpretation.
Collapse
Affiliation(s)
- Du Hailin
- Cardiovascular Department, Chengdu Qingbaijiang District People's Hospital, No.15, Fenghuang East 4th Road, Qingbaijiang District, Chengdu, 610399, Sichuan, China
| | - Qiao Hongtu
- Cardiovascular Department, Chengdu Qingbaijiang District People's Hospital, No.15, Fenghuang East 4th Road, Qingbaijiang District, Chengdu, 610399, Sichuan, China
| | - Zhang Wenyong
- Cardiovascular Department, Chengdu Qingbaijiang District People's Hospital, No.15, Fenghuang East 4th Road, Qingbaijiang District, Chengdu, 610399, Sichuan, China.
| |
Collapse
|
3
|
Illési Á, Debreceni IB, Fejes Z, Nagy B, Hodosi K, Kappelmayer J, Csanádi Z, Szük TI. Effect of invasive therapeutic coronary interventions on endothelial cell activation and thrombin generation in patients with chronic total coronary occlusion. Thromb Res 2022; 217:64-72. [PMID: 35908382 DOI: 10.1016/j.thromres.2022.07.010] [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: 04/24/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is commonly used treatment for chronic total occlusion (CTO). PCI can be performed in two different ways using wire escalation (WE) or subintimal dissection and reentry (DR) technique. During both procedures patients are treated with anticoagulants, however a substantial activation of coagulation cascade is expected, which may affect clinical outcome. OBJECTIVES Our aim was to compare the impact of WE and DR techniques regarding endothelial cell activation and thrombin formation. METHODS Fifty patients after CTO-PCI were enrolled into this study. Blood samples were obtained before PCI, at 48 h and 3-6 months after the intervention to measure soluble endothelium-specific markers and to investigate thrombin generation. RESULTS Twenty-nine patients were treated with WE, 21 received DR. In the DR group, soluble VCAM-1 (vascular cell adhesion molecule-1) and ICAM-1 (intercellular cell adhesion molecule-1) concentrations were gradually elevated and remained significantly increased at 3-6 months (p = 0.006 and p = 0.037, respectively) compared to pre-PCI. Furthermore, significant decrease in lagtime (p = 0.004) and time to peak (p = 0.002) with a substantial increment in peak thrombin (p = 0.001) were observed in these patients. In contrast, no significant alteration was found in the WE cohort. Clinical complications (myocardial infarction, stroke, thrombosis, revascularization) did not occur in the first 9 months of follow-up period in either group. CONCLUSION Although DR intervention induces more thrombin generation with a larger degree of endothelium activation compared to WE, this technique does not cause more clinical complications.
Collapse
Affiliation(s)
- Ádám Illési
- Department of Cardiology and Cardiac Surgery, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary; Doctoral School of Kálmán Laki, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary
| | - Ildikó Beke Debreceni
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary
| | - Zsolt Fejes
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary
| | - Béla Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary
| | - Katalin Hodosi
- Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary
| | - János Kappelmayer
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary
| | - Zoltán Csanádi
- Department of Cardiology and Cardiac Surgery, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary; Doctoral School of Kálmán Laki, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary
| | - Tibor István Szük
- Department of Cardiology and Cardiac Surgery, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary; Doctoral School of Kálmán Laki, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary.
| |
Collapse
|
4
|
Fujito H, Yoda S, Hatta T, Miyagawa M, Tanaka Y, Fukumoto K, Suzuki Y, Matsumoto N, Okumura Y. Prognostic value of the normalization of left ventricular mechanical dyssynchrony after revascularization in patients with coronary artery disease. Heart Vessels 2022; 37:1395-1410. [PMID: 35322282 DOI: 10.1007/s00380-022-02045-8] [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: 10/07/2021] [Accepted: 02/18/2022] [Indexed: 11/04/2022]
Abstract
There are no reports indicating a prognostic difference based on normalization of left ventricular (LV) mechanical dyssynchrony after revascularization in patients with coronary artery disease (CAD). We retrospectively investigated 596 patients who underwent rest 201Tl and stress 99mTc-tetrofosmin electrocardiogram-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging. All patients had significant stenosis with ≥ 75% narrowing of the coronary arterial diameter detected by coronary angiography performed after confirmation of ≥ 5% ischemia by the SPECT. Patients underwent revascularization and thereafter were re-evaluated by the SPECT during a chronic phase, and followed-up to confirm their prognosis for ≥ 1 year. The composite endpoint was the onset of major cardiac events (MCEs) consisting of cardiac death, non-fatal myocardial infarction (MI), unstable angina pectoris (UAP), and severe heart failure requiring hospitalization. The stress phase bandwidth (SPBW) was calculated by phase analysis with the Heart Risk View-F software and its normal upper limit was set to 38°. During the follow-up, 64 patients experienced MCEs: Cardiac death (n = 11), non-fatal MI (n = 5), UAP (n = 26), and severe heart failure (n = 22). The results of the multivariate analysis showed the ∆summed difference score %, ∆stress LV ejection fraction, and stress SPBW after revascularization to be independent predictors of MCEs. Additionally, the results of the multivariate logistic regression analysis showed the summed rest score%, summed difference score%, stress LV ejection fraction, and perfusion defects in the left circumflex artery region before revascularization to be independent predictors for normalized SPBW after revascularization. The prognosis of patients who normalized SPBW after revascularization was similar to that of patients with a normal SPBW before revascularization, while patients who did not normalize after revascularization had the worst prognosis. In conclusion, normalization of LV dyssynchrony after revascularization assessed with nuclear cardiology may help predict future MCEs and thus a useful indicator for predicting improved prognosis in patients with CAD.
Collapse
Affiliation(s)
- Hidesato Fujito
- Department of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan.
| | - Takumi Hatta
- Department of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Masatsugu Miyagawa
- Department of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Yudai Tanaka
- Department of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Katsunori Fukumoto
- Department of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Yasuo Okumura
- Department of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| |
Collapse
|
5
|
Nabi T, Rayees S, Khandy A, Manzoor S. Chronic Total Occlusion Anatomy and Characteristics of Coronary Collaterals and Angiographic Features Predicting the Success of Chronic Total Occlusion Intervention. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
6
|
Scotti A, Godino C, Munafò A, Pivato CA, Chiarito M, Fiore G, Di Maio S, Vergara P, Della Bella P, Carlino M, Margonato A, Colombo A. Cardiac and sudden death after chronic total occlusion percutaneous coronary intervention: Prognostic role of the target vessel. Catheter Cardiovasc Interv 2021; 97:E789-E800. [PMID: 33332744 DOI: 10.1002/ccd.29425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The role of the target vessel in percutaneous revascularization of chronic total occlusion (CTO) is unclear. OBJECTIVE We sought to assess the long-term results of percutaneous coronary intervention (PCI) for CTO lesions in each coronary artery and to investigate the impact of successful revascularization and previous myocardial infarction (MI) in the territory of the target vessel. METHODS AND RESULTS Cohort observational study on 1,124 patients who have undergone CTO PCI attempt: 371 on left anterior descending artery (LAD), 485 right coronary artery, and 268 left circumflex. Patients were further stratified by successfully revascularized and not-revascularized CTO (CTO-NR). Vessels affected by a previous MI were defined as infarct-related artery (IRA). The primary endpoint was cardiac death; the secondary endpoint was the combined rate of sudden cardiac-death and sustained ventricular-arrhythmias (SCD/SVAs). Propensity score-matching was performed to evaluate LAD versus NON-LAD CTO. Up to 12-year follow-up, the clinical benefit associated with successful PCI was consistent across the three groups. CTO-NR had the greatest association with cardiac death and SCD/SVAs in each coronary artery and in IRA-CTO patients. CONCLUSIONS Unsuccessful percutaneous CTO revascularization was associated with lower cardiac survival and freedom from SCD/SVAs, irrespective of the vessel treated. This result was mainly driven by patients with an IRA CTO.
Collapse
Affiliation(s)
- Andrea Scotti
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy.,Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Munafò
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo A Pivato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Cardio Center, Humanitas Research Hospital, Milan, Italy
| | - Mauro Chiarito
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Cardio Center, Humanitas Research Hospital, Milan, Italy
| | - Giorgio Fiore
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Silvana Di Maio
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Vergara
- Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
| | - Paolo Della Bella
- Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
| | - Mauro Carlino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| |
Collapse
|
7
|
Gong M, Peng H, Wu Z, Li W, Lv Y, Lv Y, Zheng Z, An T, Zhang J, Lv M, Li X, Gong H, Mao Y, Liu J. Angiographic Scoring System for Predicting Successful Percutaneous Coronary Intervention of In-Stent Chronic Total Occlusion. J Cardiovasc Transl Res 2021; 14:598-609. [PMID: 33409961 DOI: 10.1007/s12265-020-10090-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to develop a scoring model to predict the technical success of recanalizing via antegrade approach in-stent chronic total occlusion (IS-CTO) by percutaneous coronary intervention (PCI). We retrospectively collected data from 474 patients who underwent an uneasy IS-CTO PCI via antegrade approach from January 2015 to December 2018, consecutively. We selected clinical and angiographic factors and utilized a derivation and validation cohort (4:1 sampling ratio) analysis. Factors with strong correlations with technical failure, according to multivariable analysis, were assigned 1 point, and a scoring system with a 4-point maximum was established. The model was then validated with a validation cohort. The overall procedural success rate was 77.4%. On multivariable analysis, the factors that correlated with technical failure were proximal bending (beta coefficient [β] = 2.142), tortuosity (β = 2.622), stent under expansion (β = 3.052), and poor distal landing zone (β = 2.004). The IS-CTO score demonstrated good calibration and excellent predicting capacity in the derivation (receiver-operator characteristic [ROC] area = 0.973 and Hosmer-Lemeshow chi-squared = 5.252; p = 0.072) and validation (ROC area = 0.976 and Hosmer-Lemeshow chi-squared = 0.916; p = 0.632) cohorts. In the validation subset, the IS-CTO score demonstrated superior performance to the Japanese chronic total occlusion score (J-CTO) and PROGRESS CTO scores for predicting technical success (area under the a curve [AUC] 0.976 vs. 0.642 vs. 0.579, respectively; difference in AUC between the IS-CTO score and J-CTO score = 0.334, p < 0.01; difference in AUC between the IS-CTO score and PROGRESS score = 0.397, p < 0.01). Our results suggest that the IS-CTO score system is a helpful tool to predict the technical success of IS-CTO PCI via antegrade approach in china. Graphical Abstract.
Collapse
Affiliation(s)
- Minglian Gong
- Department of Cardiology, Dalian The Fifth People's Hospital, No. 890 Huanghe Road, Shahekou District, Dalian, 116021, Liaoning, China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Hongyu Peng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Zheng Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Wenzheng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Yun Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Yuan Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Ze Zheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Tao An
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science, Peking Union Medical College, National Center for Cardiovascular Disease, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jing Zhang
- Department of Cardiology, Dalian The Fifth People's Hospital, No. 890 Huanghe Road, Shahekou District, Dalian, 116021, Liaoning, China
| | - Mingrui Lv
- Department of Cardiology, Dalian The Fifth People's Hospital, No. 890 Huanghe Road, Shahekou District, Dalian, 116021, Liaoning, China
| | - Xin Li
- Department of Cardiology, Dalian The Fifth People's Hospital, No. 890 Huanghe Road, Shahekou District, Dalian, 116021, Liaoning, China
| | - Hangyu Gong
- Department of Cardiology, Dalian The Sixth People's Hospital, No.269 Luganghuibo Road, Ganjingzi District, Dalian, 116033, Liaoning, China
| | - Yi Mao
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science, Peking Union Medical College, National Center for Cardiovascular Disease, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Jinghua Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China.
| |
Collapse
|
8
|
Hirai T, Grantham JA. Indications and Patient Selection for Percutaneous Coronary Intervention of Chronic Total Occlusions. Interv Cardiol Clin 2021; 10:1-5. [PMID: 33223098 DOI: 10.1016/j.iccl.2020.09.002] [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] [Indexed: 06/11/2023]
Abstract
The most common indication for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is angina relief, which translates into improved physical function and quality of life. As the risk of the procedure is higher compared with non CTO PCI, it is important for operators to understand the current state of literature and have a detailed discussion with patients regarding risks and benefits prior to the procedure. This article discusses indications for the procedure and how to appropriately select patients for CTO PCI, in hopes of inspiring the reader to consistently offer this approach to indicated patients regardless of anatomic complexity.
Collapse
Affiliation(s)
- Taishi Hirai
- University of Missouri, One Hospital Drive, Columbia, MO 65212, USA.
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, 4330 Wornall Road, Kansas City, MO 64111, USA; University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA
| |
Collapse
|
9
|
Hagnäs MJ, Venuti G, Castellana C, Piedimonte G, Ferrarotto L, Mäkikallio T, Capodanno D, Tamburino C, La Manna A. Does the left circumflex coronary artery location impact on the success of chronic total occlusion recanalization? A single-center cohort study. SCAND CARDIOVASC J 2020; 55:106-108. [PMID: 33331181 DOI: 10.1080/14017431.2020.1852307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We sought to determine whether the chronic total occlusions (CTO) recanalization results differ between circumflex artery (CX) and other coronary arteries in our center. The study dataset encompassed 428 consecutive procedures. J-CTO score was highest in the right coronary artery (RCA) and lowest in CX lesions. After adjusting for the J-CTO score, age, body mass index, baseline creatinine, diabetes, dyslipidemia and hypertension the odds ratio for procedural success in CX compared to the other arteries was not statistically significant. We found no difference in success rates of recanalizing CTO in CX compared to other coronary arteries.
Collapse
Affiliation(s)
- Magnus J Hagnäs
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy.,Department of Internal Medicine, Heart smithy, Lapland Central Hospital, Rovaniemi, Finland
| | - Giuseppe Venuti
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Carmelo Castellana
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Giulio Piedimonte
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Luigi Ferrarotto
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Timo Mäkikallio
- Division of Cardiology, Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Davide Capodanno
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Alessio La Manna
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| |
Collapse
|
10
|
Neupane S, Gupta A, Basir M, Alaswad K. Chronic total occlusion percutaneous coronary interventions: identifying patients at risk of complications. Expert Rev Cardiovasc Ther 2020; 18:269-275. [DOI: 10.1080/14779072.2020.1760091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Saroj Neupane
- Department of Internal Medicine, WakeMed Hospital, Raleigh, NC, USA
| | - Ankur Gupta
- Division of Cardiology, Henry Ford Hospital/Wayne State University, Detroit, MI, USA
| | - Mir Basir
- Division of Cardiology, Henry Ford Hospital/Wayne State University, Detroit, MI, USA
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital/Wayne State University, Detroit, MI, USA
| |
Collapse
|
11
|
Left Main Coronary Artery Disease and Outcomes after Percutaneous Coronary Intervention for Chronic Total Occlusions. J Clin Med 2020; 9:jcm9040938. [PMID: 32235416 PMCID: PMC7231249 DOI: 10.3390/jcm9040938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/13/2020] [Accepted: 03/21/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Concomitant left main coronary artery (LMCA) disease in patients with chronic total occlusions (CTO) commonly results in referral for coronary artery bypass grafting, although the impact of LMCA in CTO patients remains largely unknown. Nevertheless, patient selection for percutaneous coronary intervention of CTOs (CTO-PCI) or alternative revascularization strategies should be based on precise evaluation of the coronary anatomy to anticipate those patients that most likely benefit from a procedure and not on strict adherence to perpetual clinical practice. Therefore, the aim of this study was to assess the impact of LMCA disease on long-term outcomes in patients undergoing percutaneous coronary intervention for CTO. Methods: We enrolled 3860 consecutive patients undergoing PCI for at least one CTO lesion and investigated the predictive value of concomitant LMCA disease. All-cause mortality was defined as the primary study endpoint. Results: We observed that LMCA disease is significantly associated with mortality. In the Cox regression analysis, we observed a crude hazard ratio (HR) 1.59 (95% confidence interval (CI) 1.23–2.04, p < 0.001) for patients with LMCA disease as compared to patients without. Results remained unchanged after bootstrap- or clinical confounder-based adjustment. Conclusion: LMCA disease is associated with excess mortality in CTO patients. Specifically, anatomical features such as CTO of the circumflex artery represent a high risk patient population.
Collapse
|
12
|
Does the effectiveness of recanalization of chronic occlusion depend on the location of the obstruction? ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:258-262. [PMID: 30302101 PMCID: PMC6173089 DOI: 10.5114/aic.2018.78328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/24/2018] [Indexed: 01/27/2023] Open
Abstract
Introduction In past studies, it has been questioned whether success of recanalization of chronic total occlusion (CTO) depends on the location of the occlusion - the circumflex artery (Cx) was considered as the most difficult to open. Aim To determine whether the effectiveness of recanalization of CTO depends on the location of the obstruction. Material and methods From January 2011 to January 2016, a single operator dedicated to chronic total occlusions performed in our center 357 procedures on 337 patients. Results Among 337 patients included in the study, 83.4% were male. Mean age was 62.8 ±9.3 years. Most of the patients had hypertension (86.4%) and hyperlipidemia (99.4%), and 28.8% of them had diabetes. The most frequently opened artery was the right coronary artery (RCA; 52.4%), followed by the left anterior descending artery (LAD; 29.4%), and last the Cx (18.2%). The mean J-CTO score was comparable between the three groups. The success rate of recanalization of CTO was similar for all arteries: 84.5% in the RCA, 81.9% in the LAD and 89.2% in the Cx (overall p = 0.437). Neither procedural complications nor adverse events depended on the location of the CTO. Conclusions Our study shows the same efficacy of CTO procedures of all epicardial arteries. We did not observe that effectiveness of recanalization of CTO depends on the location of the obstruction.
Collapse
|
13
|
Corrigan FE, Karmpaliotis D, Samady H, Lerakis S. Ostial right coronary chronic total occlusion: Transesophageal echocardiographic guidance for retrograde aortic re-entry. Catheter Cardiovasc Interv 2018; 91:1070-1073. [PMID: 29068132 DOI: 10.1002/ccd.27379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 08/12/2017] [Accepted: 09/17/2017] [Indexed: 11/08/2022]
Abstract
As antegrade options are limited, intervention upon the ostial right coronary artery (RCA) chronic total occlusion (CTO) warrants a retrograde approach. Landmarks for an aggressive approach are concerning as passage of stiff guidewires or electrocautery near the RCA ostium may result in wire passage into structures other than the aorta. We report the first use of transesophageal echocardiography (TEE) to assist retrograde passage of a guidewire into the aorta. For the ostial RCA CTO, TEE guidance may be considered to assist retrograde passage of aggressive guidewires into the aorta.
Collapse
Affiliation(s)
- Frank E Corrigan
- Division of Cardiology, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia
| | - Dimitrios Karmpaliotis
- Division of Cardiology, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia
| | - Stamatios Lerakis
- Division of Cardiology, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia
| |
Collapse
|
14
|
Tanabe M, Kodama K, Asada K, Kunitomo T. Lesion characteristics and procedural outcomes of re-attempted percutaneous coronary interventions for chronic total occlusion. Heart Vessels 2017; 33:573-582. [PMID: 29224054 DOI: 10.1007/s00380-017-1091-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 12/01/2017] [Indexed: 12/31/2022]
Abstract
This study was performed to investigate lesion characteristics and procedural outcomes of re-attempted percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Prior failure of percutaneous revascularization of CTO has been identified as an independent predictor of failure at subsequent attempts. However, procedural outcomes of re-attempted PCI for CTO have not been elucidated. We evaluated lesion characteristics and procedural outcomes in 310 consecutive patients undergoing CTO-PCI, and compared the results between re-attempted (n = 59) and initial procedures (n = 251). Overall, 266 CTO lesions (85.8%) were treated successfully. In addition, the technical success rate in the re-attempted CTO lesions was 69.5% (41 of 59), although this was lower than for initially attempted lesions (89.6%, 225 of 251; P = 0.0021). In the details of reasons of previous failures, treatment devices failed to cross even after guidewire cross and procedure discontinuation due to management of complications achieved higher rates of technical success compared to those with the inability of guidewire crossing in re-attempted CTO-PCI (87.5 and 85.7 vs. 65.9%, respectively). CTO lesions in which PCI was re-attempted had more complex features, including calcification, tortuous morphology, and long lesion length, whereas patient demographics were similar. Re-attempted CTO lesions required complex procedures, including the retrograde approach (55.9 vs. 13.9%, P < 0.001), longer fluoroscopic time, and larger radiation dose. Meanwhile, rates of complications and in-hospital MACCE were similarly low in both groups. The technical success rates of re-attempted CTO-PCI lesions were acceptable. Furthermore, CTO-PCIs in re-attempted lesions were as safe as initially attempted CTO-PCI. However, re-attempted CTO-PCI lesions showed features of high anatomical complexity that required more complex and longer procedures, including the retrograde approach, for successful interventional revascularization. Re-attempted CTO-PCI due to treatment devices failed to cross even after guidewire cross and procedure discontinuation due to management of complications in previous attempt had higher success rates that those with the inability of guidewire crossing.
Collapse
Affiliation(s)
- Masaki Tanabe
- Department of Cardiology, Kyoto Okamoto Memorial Hospital, 58 Sayama Nishinokuchi, Kumiyama, Kyoto, 611-0034, Japan.
| | - Kenji Kodama
- Department of Cardiology, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan
| | - Kohei Asada
- Division of Cardiology, Okamura Memorial Hospital, Shizuoka, Japan
| | - Takeo Kunitomo
- Department of Cardiology, Nagahama City Hospital, Nagahama, Shiga, Japan
| |
Collapse
|
15
|
Karmpaliotis D, Karatasakis A, Alaswad K, Jaffer FA, Yeh RW, Wyman RM, Lombardi WL, Grantham JA, Kandzari DE, Lembo NJ, Doing A, Patel M, Bahadorani JN, Moses JW, Kirtane AJ, Parikh M, Ali ZA, Kalra S, Nguyen-Trong PKJ, Danek BA, Karacsonyi J, Rangan BV, Roesle MK, Thompson CA, Banerjee S, Brilakis ES. Outcomes With the Use of the Retrograde Approach for Coronary Chronic Total Occlusion Interventions in a Contemporary Multicenter US Registry. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003434. [PMID: 27307562 DOI: 10.1161/circinterventions.115.003434] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to examine the efficacy and safety of chronic total occlusion percutaneous coronary intervention using the retrograde approach. METHODS AND RESULTS We compared the outcomes of the retrograde versus antegrade-only approach to chronic total occlusion percutaneous coronary intervention among 1301 procedures performed at 11 experienced US centers between 2012 and 2015. The mean age was 65.5±10 years, and 84% of the patients were men with a high prevalence of diabetes mellitus (45%) and previous coronary artery bypass graft surgery (34%). Overall technical and procedural success rates were 90% and 89%, respectively, and in-hospital major adverse cardiovascular events occurred in 31 patients (2.4%). The retrograde approach was used in 539 cases (41%), either as the initial strategy (46%) or after a failed antegrade attempt (54%). When compared with antegrade-only cases, retrograde cases were significantly more complex, both clinically (previous coronary artery bypass graft surgery prevalence, 48% versus 24%; P<0.001) and angiographically (mean Japan-chronic total occlusion score, 3.1±1.0 versus 2.1±1.2; P<0.001) and had lower technical success (85% versus 94%; P<0.001) and higher major adverse cardiovascular events (4.3% versus 1.1%; P<0.001) rates. On multivariable analysis, the presence of suitable collaterals, no smoking, no previous coronary artery bypass graft surgery, and left anterior descending artery target vessel were independently associated with technical success using the retrograde approach. CONCLUSIONS The retrograde approach is commonly used in contemporary chronic total occlusion percutaneous coronary intervention, especially among more challenging lesions and patients. Although associated with lower success and higher major adverse cardiovascular event rates in comparison to antegrade-only crossing, retrograde percutaneous coronary intervention remains critical for achieving overall high success rates.
Collapse
Affiliation(s)
- Dimitri Karmpaliotis
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Aris Karatasakis
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Khaldoon Alaswad
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Farouc A Jaffer
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Robert W Yeh
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - R Michael Wyman
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - William L Lombardi
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - J Aaron Grantham
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - David E Kandzari
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Nicholas J Lembo
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Anthony Doing
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Mitul Patel
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - John N Bahadorani
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Jeffrey W Moses
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Ajay J Kirtane
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Manish Parikh
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Ziad A Ali
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Sanjog Kalra
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Phuong-Khanh J Nguyen-Trong
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Barbara A Danek
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Judit Karacsonyi
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Bavana V Rangan
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Michele K Roesle
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Craig A Thompson
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Subhash Banerjee
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Emmanouil S Brilakis
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.).
| |
Collapse
|
16
|
Oguayo KN, Oguayo CC, Vallabhan R, Choi JW. Microcatheter balloon pinning technique to facilitate wiring of a left circumflex chronic total occlusion. Cardiovasc Ther 2017; 35. [PMID: 28750147 DOI: 10.1111/1755-5922.12290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/18/2017] [Accepted: 07/23/2017] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Coronary chronic total occlusions (CTOs) are commonly encountered during diagnostic angiograms. With recent advances, especially in experienced centers, success rates with CTO percutaneous coronary intervention (PCI) have approached 80% or higher. It is important to note that despite these advancements in techniques, CTOs remain difficult to treat. We present a case of a left circumflex artery (LCX) CTO that was successfully revascularized using a microcatheter balloon pinning technique that allowed additional wire support. CASE REPORT A 77-year-old woman status post-two-vessel coronary artery bypass graft surgery presented with new onset angina at rest and was found to have a patent graft to the left anterior descending artery, and an unrevascularized proximal LCX CTO. PCI was attempted with a microcatheter using an antegrade approach. This approach was unsuccessful due to the lack of support and the left circumflex angle. As a result, we used a balloon to pin the microcatheter to the wall of the left main to allow for successful wiring of the LCX. A stent was successfully deployed in the LCX, and the patient was discharged from the hospital 2 days later. At follow-up, the patient was asymptomatic and returned to her usual activity. DISCUSSION After conducting a thorough literature search, it appears that this is the first case that a microcatheter has been pinned with a balloon. We believe that in LCX CTOs that require support, the microcatheter pinning technique can provide adequate support in wiring CTO's. LCX CTOs can be very difficult to treat, we present a case of a LCX CTO that required the use of the microcatheter balloon pinning technique to allow additional wire support for successful wiring and ultimately treatment.
Collapse
Affiliation(s)
- Kevin N Oguayo
- Division of Cardiology, Department of Internal Medicine, Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Chris C Oguayo
- Department of Internal Medicine, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Ravi Vallabhan
- Division of Cardiology, Department of Internal Medicine, Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - James W Choi
- Division of Cardiology, Department of Internal Medicine, Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| |
Collapse
|
17
|
|
18
|
Further validation of the hybrid algorithm for CTO PCI; difficult lesions, same success. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:328-331. [DOI: 10.1016/j.carrev.2017.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/02/2017] [Accepted: 02/15/2017] [Indexed: 11/21/2022]
|
19
|
Leibundgut G, Kaspar M. Chronic Total Occlusions. Interv Cardiol 2017. [DOI: 10.5772/68067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
20
|
Ellis SG, Burke MN, Murad MB, Graham JJ, Badawi R, Toma C, Meltser H, Nair R, Buller C, Whitlow PL. Predictors of Successful Hybrid-Approach Chronic Total Coronary Artery Occlusion Stenting. JACC Cardiovasc Interv 2017; 10:1089-1098. [DOI: 10.1016/j.jcin.2017.03.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/22/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
|
21
|
Fang HY, Wu CJ, Fang CY, Lee WC. Influence about the flow of distal branch after intervention of the right coronary artery chronic total occlusion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:411-417. [PMID: 28366607 DOI: 10.1016/j.carrev.2017.03.018] [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: 03/04/2017] [Accepted: 03/16/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Limited data are available for the clinical outcomes after the recanalization of right coronary artery (RCA) chronic total occlusion (CTO). The study aims to assess the clinical outcomes in the antegrade flow of the distal branch after successful RCA CTO percutaneous coronary intervention (PCI). METHODS Between January 2002 and December 2012, 538 patients who underwent RCA CTO PCI were enrolled. The clinical outcomes as myocardial infarction (MI), target vessel revascularization, cardiac death, major adverse cardiac events, and all-cause mortality, were compared to the antegrade flow of distal branch after successful RCA CTO PCI. RESULTS The CTOs were located in proximal segments (57.6%), mid segments (27.5%) and distal segments (14.9%). The average Syntax score was 18.4±9.6 and 47.8% patients had a Syntax score greater than 27.5. A total of 62.8% patients had final thrombolysis of myocardial infarction (TIMI)-3 flow of distal branch, 16.9% patients had final TIMI-3 flow of only one major branch, 11.3% patients had TIMI-1-2 flow, and 8.9% patients had no antegrade flow. The incidence of periprocedural MI was lower in both side branches were preserved (13.9% vs. 23.0% and 18.8%, p=0.01). The clinical outcomes were similar between the groups with and without good antegrade flow of distal side branch. End stage renal disease (ESRD) and left ventricular ejection fraction (LVEF) <40% predicted three-year cardiac death. CONCLUSIONS There is no significant difference of clinical outcomes when distal side branches of RCA are recanalized successfully. ESRD and LVEF <40% were the predictors for three-year cardiac death.
Collapse
Affiliation(s)
- Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| |
Collapse
|
22
|
Martinez-Parachini JR, Karatasakis A, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Bahadorani J, Doing A, Nguyen-Trong PK, Danek BA, Karacsonyi J, Alame A, Rangan BV, Thompson CA, Banerjee S, Brilakis ES. Impact of diabetes mellitus on acute outcomes of percutaneous coronary intervention in chronic total occlusions: insights from a US multicentre registry. Diabet Med 2017; 34:558-562. [PMID: 27743404 PMCID: PMC5352496 DOI: 10.1111/dme.13272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 12/24/2022]
Abstract
AIM To examine the impact of diabetes mellitus on procedural outcomes of patients who underwent percutaneous coronary intervention for chronic total occlusion. METHODS We assessed the impact of diabetes mellitus on the outcomes of percutaneous coronary intervention for chronic total occlusion among 1308 people who underwent such procedures at 11 US centres between 2012 and 2015. RESULTS The participants' mean ± sd age was 66 ± 10 years, 84% of the participants were men and 44.6% had diabetes. As compared with participants without diabetes, participants with diabetes were more likely to have undergone coronary artery bypass graft surgery (38 vs 31%; P = 0.006), and to have had previous heart failure (35 vs 22%; P = 0.0001) and peripheral arterial disease (19 vs 13%; P = 0.002). They also had a higher BMI (31 ± 6 kg/m2 vs 29 ± 6 kg/m2 ; P = 0.001), similar Japanese chronic total occlusion scores (2.6 ± 1.2 vs 2.5 ± 1.2; P = 0.82) and similar final successful crossing technique: antegrade wire escalation (46 vs 47%; P = 0.66), retrograde (30 vs 28%; P = 0.66) and antegrade dissection re-entry (24 vs 25%; P = 0.66). Technical (91 vs 90%; P = 0.80) and procedural (89 vs 89%; P = 0.93) success was similar in the two groups, as was the incidence of major adverse cardiac events (2.2 vs 2.5%; P = 0.61). CONCLUSIONS In a contemporary cohort of people undergoing percutaneous coronary intervention for chronic total occlusion, nearly one in two (45%) had diabetes mellitus. Procedural success and complication rates were similar in people with and without diabetes.
Collapse
Affiliation(s)
| | - A Karatasakis
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | | | - K Alaswad
- Henry Ford Hospital, Detroit, MI, USA
| | - F A Jaffer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - R W Yeh
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - M Patel
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA, USA
| | - J Bahadorani
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA, USA
| | - A Doing
- Medical Center of the Rockies, Loveland, CO, USA
| | - P-K Nguyen-Trong
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | - B A Danek
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | - J Karacsonyi
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | - A Alame
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | - B V Rangan
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | | | - S Banerjee
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | - E S Brilakis
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
- Minneapolis Heart Institute, Minneapolis, MN, USA
| |
Collapse
|
23
|
Karatasakis A, Danek BA, Karmpaliotis D, Alaswad K, Vo M, Carlino M, Patel MP, Rinfret S, Brilakis ES. Approach to CTO Intervention: Overview of Techniques. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:1. [PMID: 28105600 DOI: 10.1007/s11936-017-0501-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OPINION STATEMENT Successful percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) has been associated with significant clinical benefits, but remains technically demanding. Failure to cross the CTO with a guidewire is the most common cause of CTO PCI failure. CTO crossing can be achieved in the antegrade or retrograde direction and can be accomplished by maintaining true lumen position throughout or via subintimal dissection/reentry techniques. A procedural plan should be created prior to the procedure through careful angiographic review of four key parameters: (a) morphology of the proximal occlusion cap; (b) length of the occlusion; (c) quality of the distal vessel and presence of bifurcation at the distal cap; and (d) suitability of collateral circulation for retrograde crossing. Dual coronary injection is recommended in all cases with contralateral collaterals for detailed characterization of the lesion. If one approach fails to progress, a quick transition to the next approach is encouraged to maximize efficacy and efficiency. Procedural complications, including vessel perforation, may occur more frequently in CTO as compared with non-CTO PCI; hence, availability of necessary equipment and expertise in treating such complications are essential.
Collapse
Affiliation(s)
- Aris Karatasakis
- University of Texas Southwestern Medical Center, Dallas, TX, USA.,VA North Texas Health Care System, Dallas, TX, USA
| | - Barbara Anna Danek
- University of Texas Southwestern Medical Center, Dallas, TX, USA.,VA North Texas Health Care System, Dallas, TX, USA
| | | | | | - Minh Vo
- Mazankowski Heart Institute, Edmonton, AB, Canada
| | | | - Mitul P Patel
- VA San Diego Healthcare System/University of California San Diego, La Jolla, CA, USA
| | | | - Emmanouil S Brilakis
- University of Texas Southwestern Medical Center, Dallas, TX, USA. .,VA North Texas Health Care System, Dallas, TX, USA. .,Minneapolis Heart Institute, 920 E 28th Street #300, Minneapolis, MN, 55407, USA.
| |
Collapse
|
24
|
Di Mario C, Sorini Dini C. Conquering CTO revascularisation: the summit is near with 90% of the ascent behind us. EUROINTERVENTION 2016; 12:e1319-e1321. [PMID: 27934607 DOI: 10.4244/eijv12i11a218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
25
|
Karatasakis A, Danek BA, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Bahadorani JN, Lombardi WL, Wyman RM, Grantham JA, Kandzari DE, Lembo NJ, Doing AH, Toma C, Moses JW, Kirtane AJ, Parikh MA, Ali ZA, Garcia S, Kalsaria P, Karacsonyi J, Alame AJ, Thompson CA, Banerjee S, Brilakis ES. Comparison of various scores for predicting success of chronic total occlusion percutaneous coronary intervention. Int J Cardiol 2016; 224:50-56. [DOI: 10.1016/j.ijcard.2016.08.317] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
|
26
|
Christopoulos G, Kandzari DE, Yeh RW, Jaffer FA, Karmpaliotis D, Wyman MR, Alaswad K, Lombardi W, Grantham JA, Moses J, Christakopoulos G, Tarar MNJ, Rangan BV, Lembo N, Garcia S, Cipher D, Thompson CA, Banerjee S, Brilakis ES. Development and Validation of a Novel Scoring System for Predicting Technical Success of Chronic Total Occlusion Percutaneous Coronary Interventions: The PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Score. JACC Cardiovasc Interv 2016; 9:1-9. [PMID: 26762904 DOI: 10.1016/j.jcin.2015.09.022] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/10/2015] [Accepted: 09/10/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This study sought to develop a novel parsimonious score for predicting technical success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) performed using the hybrid approach. BACKGROUND Predicting technical success of CTO PCI can facilitate clinical decision making and procedural planning. METHODS We analyzed clinical and angiographic parameters from 781 CTO PCIs included in PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) using a derivation and validation cohort (2:1 sampling ratio). Variables with strong association with technical success in multivariable analysis were assigned 1 point, and a 4-point score was developed from summing all points. The PROGRESS CTO score was subsequently compared with the J-CTO (Multicenter Chronic Total Occlusion Registry in Japan) score in the validation cohort. RESULTS Technical success was 92.9%. On multivariable analysis, factors associated with technical success included proximal cap ambiguity (beta coefficient [b] = 0.88), moderate/severe tortuosity (b = 1.18), circumflex artery CTO (b = 0.99), and absence of "interventional" collaterals (b = 0.88). The resulting score demonstrated good calibration and discriminatory capacity in the derivation (Hosmer-Lemeshow chi-square = 2.633; p = 0.268, and receiver-operator characteristic [ROC] area = 0.778) and validation (Hosmer-Lemeshow chi-square = 5.333; p = 0.070, and ROC area = 0.720) subset. In the validation cohort, the PROGRESS CTO and J-CTO scores performed similarly in predicting technical success (ROC area 0.720 vs. 0.746, area under the curve difference = 0.026, 95% confidence interval = -0.093 to 0.144). CONCLUSIONS The PROGRESS CTO score is a novel useful tool for estimating technical success in CTO PCI performed using the hybrid approach.
Collapse
Affiliation(s)
- Georgios Christopoulos
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Robert W Yeh
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | - Georgios Christakopoulos
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Muhammad Nauman J Tarar
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bavana V Rangan
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Daisha Cipher
- College of Health Innovation, University of Texas at Arlington, Arlington, Texas
| | | | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emmanouil S Brilakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
27
|
Danek BA, Karatasakis A, Karmpaliotis D, Alaswad K, Yeh RW, Jaffer FA, Patel MP, Mahmud E, Lombardi WL, Wyman MR, Grantham JA, Doing A, Kandzari DE, Lembo NJ, Garcia S, Toma C, Moses JW, Kirtane AJ, Parikh MA, Ali ZA, Karacsonyi J, Rangan BV, Thompson CA, Banerjee S, Brilakis ES. Development and Validation of a Scoring System for Predicting Periprocedural Complications During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Complications Score. J Am Heart Assoc 2016; 5:e004272. [PMID: 27729332 PMCID: PMC5121521 DOI: 10.1161/jaha.116.004272] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 09/13/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND High success rates are achievable for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using the hybrid approach, but periprocedural complications remain of concern. Although scores estimating success and efficiency in CTO PCI have been developed, there is currently no available score for estimation of the risk for periprocedural complications. We sought to develop a scoring tool for prediction of periprocedural complications during CTO PCI. METHODS AND RESULTS We analyzed data from 1569 CTO PCIs in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) using a derivation and validation sampling ratio of 2:1. Variables independently associated with periprocedural complications in multivariable analysis in the derivation set were assigned points based on their respective odds ratios. Forty-four (2.8%) patients experienced complications. Three factors were independent predictors of complications and were included in the score: patient age >65 years, +3 points (odds ratio, OR=4.85, CI 1.82-16.77); lesion length ≥23 mm, +2 points (OR=3.22, CI 1.08-13.89); and use of the retrograde approach +1 point (OR=2.41, CI 1.04-6.05). The resulting score showed good calibration and discriminatory capacity in the derivation (Hosmer-Lemeshow χ2 6.271, P=0.281, receiver-operating characteristic [ROC] area=0.758) and validation (Hosmer-Lemeshow χ2 4.551, P=0.473, ROC area=0.793) sets. Score values of 0 to 2, 3 to 4, and ≥5 were defined as low, intermediate, and high risk of complications (derivation cohort 0.4%, 1.8%, 6.5%, P<0.001; validation cohort 0.0%, 2.5%, 6.8%, P<0.001). CONCLUSIONS The PROGRESS CTO complication score is a useful tool for prediction of periprocedural complications in CTO PCI. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.
Collapse
Affiliation(s)
- Barbara Anna Danek
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
| | - Aris Karatasakis
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
| | | | | | - Robert W Yeh
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Farouc A Jaffer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Mitul P Patel
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA
| | - Ehtisham Mahmud
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA
| | | | | | | | | | | | | | - Santiago Garcia
- Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, MN
| | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | | | | - Judit Karacsonyi
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
| | - Bavana V Rangan
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
| | | | - Subhash Banerjee
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
| | | |
Collapse
|
28
|
Karacsonyi J, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Bahadorani J, Doing A, Ali ZA, Karatasakis A, Danek BA, Rangan BV, Alame AJ, Banerjee S, Brilakis ES. Prevalence, indications and management of balloon uncrossable chronic total occlusions: Insights from a contemporary multicenter US registry. Catheter Cardiovasc Interv 2016; 90:12-20. [DOI: 10.1002/ccd.26780] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/21/2016] [Accepted: 08/15/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Judit Karacsonyi
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged; Szeged Hungary
| | | | | | - Farouc A. Jaffer
- Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Robert W. Yeh
- Beth Israel Deaconess Medical Center, Boston; Massachusetts
| | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego; San Diego California
| | - John Bahadorani
- VA San Diego Healthcare System and University of California San Diego; San Diego California
| | | | | | - Aris Karatasakis
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Barbara A. Danek
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Bavana V. Rangan
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Aya J. Alame
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Subhash Banerjee
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Emmanouil S. Brilakis
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
- Minnepolis Heart Institute; Minneapolis Minnesota
| |
Collapse
|
29
|
Karacsonyi J, Alaswad K, Jaffer FA, Yeh RW, Patel M, Bahadorani J, Karatasakis A, Danek BA, Doing A, Grantham JA, Karmpaliotis D, Moses JW, Kirtane A, Parikh M, Ali Z, Lombardi WL, Kandzari DE, Lembo N, Garcia S, Wyman MR, Alame A, Nguyen-Trong PKJ, Resendes E, Kalsaria P, Rangan BV, Ungi I, Thompson CA, Banerjee S, Brilakis ES. Use of Intravascular Imaging During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry. J Am Heart Assoc 2016; 5:JAHA.116.003890. [PMID: 27543800 PMCID: PMC5015304 DOI: 10.1161/jaha.116.003890] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intravascular imaging can facilitate chronic total occlusion (CTO) percutaneous coronary intervention. METHODS AND RESULTS We examined the frequency of use and outcomes of intravascular imaging among 619 CTO percutaneous coronary interventions performed between 2012 and 2015 at 7 US centers. Mean age was 65.4±10 years and 85% of the patients were men. Intravascular imaging was used in 38%: intravascular ultrasound in 36%, optical coherence tomography in 3%, and both in 1.45%. Intravascular imaging was used for stent sizing (26.3%), stent optimization (38.0%), and CTO crossing (35.7%, antegrade in 27.9%, and retrograde in 7.8%). Intravascular imaging to facilitate crossing was used more frequently in lesions with proximal cap ambiguity (49% versus 26%, P<0.0001) and with retrograde as compared with antegrade-only cases (67% versus 31%, P<0.0001). Despite higher complexity (Japanese CTO score: 2.86±1.19 versus 2.43±1.19, P=0.001), cases in which imaging was used for crossing had similar technical and procedural success (92.8% versus 89.6%, P=0.302 and 90.1% versus 88.3%, P=0.588, respectively) and similar incidence of major cardiac adverse events (2.7% versus 3.2%, P=0.772). Use of intravascular imaging was associated with longer procedure (192 minutes [interquartile range 130, 255] versus 131 minutes [90, 192], P<0.0001) and fluoroscopy (71 minutes [44, 93] versus 39 minutes [25, 69], P<0.0001) time. CONCLUSIONS Intravascular imaging is frequently performed during CTO percutaneous coronary intervention both for crossing and for stent selection/optimization. Despite its use in more complex lesion subsets, intravascular imaging was associated with similar rates of technical and procedural success for CTO percutaneous coronary intervention. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.
Collapse
Affiliation(s)
- Judit Karacsonyi
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary
| | | | - Farouc A Jaffer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA
| | - John Bahadorani
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA
| | - Aris Karatasakis
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
| | - Barbara A Danek
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
| | | | | | | | | | | | | | - Ziad Ali
- Columbia University, New York, NY
| | | | | | | | - Santiago Garcia
- Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, MN
| | | | - Aya Alame
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
| | | | - Erica Resendes
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
| | - Pratik Kalsaria
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
| | - Bavana V Rangan
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
| | - Imre Ungi
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary
| | | | - Subhash Banerjee
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
| | | |
Collapse
|
30
|
Karatasakis A, Tarar MNJ, Karmpaliotis D, Alaswad K, Yeh RW, Jaffer FA, Wyman RM, Lombardi WL, Grantham JA, Kandzari DE, Lembo NJ, Moses JW, Kirtane AJ, Parikh M, Garcia S, Doing A, Pershad A, Shah A, Patel M, Bahadorani J, Shoultz CA, Danek BA, Thompson CA, Banerjee S, Brilakis ES. Guidewire and microcatheter utilization patterns during antegrade wire escalation in chronic total occlusion percutaneous coronary intervention: Insights from a contemporary multicenter registry. Catheter Cardiovasc Interv 2016; 89:E90-E98. [PMID: 27184465 DOI: 10.1002/ccd.26568] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/10/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVES We sought to describe contemporary guidewire and microcatheter utilization for antegrade wire escalation (AWE) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND Equipment utilization for AWE has been variable and evolving over time. METHODS We examined device utilization during 694 AWE attempts in 679 patients performed at 15 experienced US centers between May 2012 and April 2015. RESULTS Mean age was 65.6 ± 9.7 years, and 85% of the patients were men. Successful wiring occurred in 436 AWE attempts (63%). Final technical and procedural success was 91% and 89%, respectively. The mean number of guidewire types used for AWE was 2.2 ± 1.4. The most frequently used guidewire types were the Pilot 200 (Abbott Vascular, 56% of AWE procedures), Fielder XT (Asahi Intecc, 45%), and the Confianza Pro 12 (Asahi Intecc, 28%). The same guidewires were the ones that most commonly crossed the occlusion: Pilot 200 (36% of successful AWE crossings), Fielder XT (20%), and Confianza Pro 12 (11%). A microcatheter or over-the-wire balloon was used for 81% of AWE attempts; the Corsair microcatheter (Asahi Intecc) was the most commonly used (44%). No significant association was found between guidewire type and incidence of major adverse cardiac events (MACE). CONCLUSIONS Our contemporary, multicenter CTO PCI registry demonstrates that the most commonly used wires for AWE are polymer-jacketed guidewires. "Stiff" and polymer-jacketed guidewires appear to provide high crossing rates without an increase in MACE or perforation, and may thus be considered for upfront use. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Aris Karatasakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Muhammad Nauman J Tarar
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Farouc A Jaffer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | - Santiago Garcia
- Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, Minnesota
| | | | - Ashish Pershad
- Banner Good Samaritan Cavanagh Heart Clinic, Phoenix, Arizona
| | | | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego, San Diego, California
| | - John Bahadorani
- VA San Diego Healthcare System and University of California San Diego, San Diego, California
| | | | - Barbara A Danek
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Subhash Banerjee
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emmanouil S Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
31
|
Wilson WM, Walsh SJ, Yan AT, Hanratty CG, Bagnall AJ, Egred M, Smith E, Oldroyd KG, McEntegart M, Irving J, Strange J, Douglas H, Spratt JC. Hybrid approach improves success of chronic total occlusion angioplasty. Heart 2016; 102:1486-93. [DOI: 10.1136/heartjnl-2015-308891] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/16/2016] [Indexed: 11/04/2022] Open
|
32
|
Brilakis ES, Burke MN. Chronic Total Occlusion Percutaneous Coronary Intervention: Bridging the Gap. JACC Cardiovasc Interv 2016; 9:923-5. [PMID: 27085574 DOI: 10.1016/j.jcin.2016.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Emmanouil S Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.
| | - M Nicholas Burke
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota
| |
Collapse
|
33
|
Danek BA, Karatasakis A, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel MP, Bahadorani J, Lombardi WL, Wyman RM, Grantham JA, Kandzari DE, Lembo NJ, Doing AH, Toma C, Moses JW, Kirtane AJ, Ali ZA, Parikh M, Garcia S, Nguyen-Trong PK, Karacsonyi J, Alame AJ, Kalsaria P, Thompson C, Banerjee S, Brilakis ES. Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary US Multicenter Registry. Can J Cardiol 2016; 32:1433-1439. [PMID: 27476986 DOI: 10.1016/j.cjca.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/12/2016] [Accepted: 04/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We sought to determine the effect of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012 and 2016 at 11 experienced US centres. RESULTS Mean patient age was 66 ± 10 years and 85.6% of the patients were men. Overall technical and procedural success rates were 90.1% and 87.5%, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ± 62 months and 12 months (interquartile range, 3-64 months), respectively. Patients were stratified into tertiles according to lesion age (3-5, 5-36.3, and > 36.3 months). Older lesion age was associated with older patient age (68 ± 8 vs 65 ± 10 vs 64 ± 11 years; P = 0.009), previous coronary artery bypass grafting (62% vs 42% vs 30%; P < 0.001), and moderate/severe calcification (75% vs 53% vs 59%; P = 0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8% vs 89.6% vs 93.0%; P = 0.37) or procedural (86.3% vs 87.4% vs 89.0%; P = 0.80) success, or the incidence of MACE (3.1% vs 3.0% vs 6.3%; P = 0.31) for older vs younger occlusions. CONCLUSIONS Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/re-entry. Older CTOs can be recanalized with high technical and procedural success and acceptable MACE rates. Lesion age appears unlikely to be a significant determinant of CTO PCI success.
Collapse
Affiliation(s)
- Barbara A Danek
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aris Karatasakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mitul P Patel
- VA San Diego Healthcare System and University of California San Diego, La Jolla, California, USA
| | - John Bahadorani
- VA San Diego Healthcare System and University of California San Diego, La Jolla, California, USA
| | | | | | | | | | | | | | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Ziad A Ali
- Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Santiago Garcia
- Minneapolis VA Health Care System and University of Minnesota, Minneapolis, Minnesota, USA
| | - Phuong-Khanh Nguyen-Trong
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Judit Karacsonyi
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aya J Alame
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pratik Kalsaria
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emmanouil S Brilakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| |
Collapse
|
34
|
Karacsonyi J, Karatasakis A, Karmpaliotis D, Alaswad K, Yeh RW, Jaffer FA, Wyman MR, Lombardi WL, Grantham JA, Kandzari DE, Lembo N, Moses JW, Kirtane AJ, Parikh MA, Green P, Finn M, Garcia S, Doing A, Patel M, Bahadorani J, Martinez Parachini JR, Resendes E, Rangan BV, Ungi I, Thompson CA, Banerjee S, Brilakis ES. Effect of Previous Failure on Subsequent Procedural Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention (from a Contemporary Multicenter Registry). Am J Cardiol 2016; 117:1267-71. [PMID: 26899493 DOI: 10.1016/j.amjcard.2016.01.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 12/18/2022]
Abstract
We sought to examine the impact of previous failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical and angiographic characteristics and procedural outcomes of 1,213 consecutive patients who underwent 1,232 CTO PCIs from 2012 to 2015 at 12 US centers. Mean age was 65 ± 10 years, and 84.8% of patients were men. A previously failed attempt had been performed in 215 patients (17.5%). As compared with patients without previous CTO PCI failure, patients with previous failure had higher Multicenter CTO Registry in Japan CTO score (2.40 ± 1.13 vs 3.28 ± 1.29, p <0.0001) and were more likely to have in-stent restenosis (10.5% vs 28.4%, p <0.0001) and to undergo recanalization attempts using the retrograde approach (41% vs 50%, p = 0.011). Technical (90% vs 88%, p = 0.390) and procedural (89% vs 86%, p = 0.184) success were similar in the 2 study groups; however, median procedure time (125 vs 142 minutes, p = 0.026) and fluoroscopy time (45 vs 55 minutes, p = 0.015) were longer in the previous failure group. In conclusion, a previously failed CTO PCI attempt is associated with higher angiographic complexity, longer procedural duration, and fluoroscopy time, but not with the success and complication rates of subsequent CTO PCI attempts.
Collapse
Affiliation(s)
- Judit Karacsonyi
- Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Aris Karatasakis
- Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dimitri Karmpaliotis
- Division of Cardiology, Department of Medicine, Columbia University, New York, New York
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Robert W Yeh
- Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Farouc A Jaffer
- Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael R Wyman
- Department of Cardiology, Torrance Memorial Medical Center, Torrance, California
| | | | - J Aaron Grantham
- Department of Cardiology, Mid America Heart Institute, Kansas City, Missouri
| | - David E Kandzari
- Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Nicholas Lembo
- Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Jeffrey W Moses
- Division of Cardiology, Department of Medicine, Columbia University, New York, New York
| | - Ajay J Kirtane
- Division of Cardiology, Department of Medicine, Columbia University, New York, New York
| | - Manish A Parikh
- Division of Cardiology, Department of Medicine, Columbia University, New York, New York
| | - Philip Green
- Division of Cardiology, Department of Medicine, Columbia University, New York, New York
| | - Matthew Finn
- Division of Cardiology, Department of Medicine, Columbia University, New York, New York
| | - Santiago Garcia
- Department of Medicine, Minneapolis Veterans Affairs Health Care System, University of Minnesota, Minneapolis, Minnesota
| | - Anthony Doing
- Department of Cardiology, Medical Center of the Rockies, Loveland, Colorado
| | - Mitul Patel
- Department of Cardiology, Veterans Affairs San Diego Health Care System, University of California San Diego, San Diego, California
| | - John Bahadorani
- Department of Cardiology, Veterans Affairs San Diego Health Care System, University of California San Diego, San Diego, California
| | | | - Erica Resendes
- Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bavana V Rangan
- Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Imre Ungi
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | | | - Subhash Banerjee
- Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emmanouil S Brilakis
- Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
35
|
Christopoulos G, Wyman RM, Alaswad K, Karmpaliotis D, Lombardi W, Grantham JA, Yeh RW, Jaffer FA, Cipher DJ, Rangan BV, Christakopoulos GE, Kypreos MA, Lembo N, Kandzari D, Garcia S, Thompson CA, Banerjee S, Brilakis ES. Clinical Utility of the Japan-Chronic Total Occlusion Score in Coronary Chronic Total Occlusion Interventions: Results from a Multicenter Registry. Circ Cardiovasc Interv 2016; 8:e002171. [PMID: 26162857 DOI: 10.1161/circinterventions.114.002171] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The performance of the Japan-chronic total occlusion (J-CTO) score in predicting success and efficiency of CTO percutaneous coronary intervention has received limited study. METHODS AND RESULTS We examined the records of 650 consecutive patients who underwent CTO percutaneous coronary intervention between 2011 and 2014 at 6 experienced centers in the United States. Six hundred and fifty-seven lesions were classified as easy (J-CTO=0), intermediate (J-CTO=1), difficult (J-CTO=2), and very difficult (J-CTO≥3). The impact of the J-CTO score on technical success and procedure time was evaluated with univariable logistic and linear regression, respectively. The performance of the logistic regression model was assessed with the Hosmer-Lemeshow statistic and receiver operator characteristic curves. Antegrade wiring techniques were used more frequently in easy lesions (97%) than very difficult lesions (58%), whereas the retrograde approach became more frequent with increased lesion difficulty (41% for very difficult lesions versus 13% for easy lesions). The logistic regression model for technical success demonstrated satisfactory calibration and discrimination (P for Hosmer-Lemeshow =0.743 and area under curve =0.705). The J-CTO score was associated with a 2-fold increase in the odds of technical failure (odds ratio 2.04, 95% confidence interval 1.52-2.80, P<0.001). Procedure time increased by ≈20 minutes for every 1-point increase of the J-CTO score (regression coefficient 22.33, 95% confidence interval 17.45-27.22, P<0.001). CONCLUSIONS J-CTO score was strongly associated with final success and efficiency in this study, supporting its expanded use in CTO interventions. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.
Collapse
Affiliation(s)
- Georgios Christopoulos
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - R Michael Wyman
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Khaldoon Alaswad
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Dimitri Karmpaliotis
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - William Lombardi
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - J Aaron Grantham
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Robert W Yeh
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Farouc A Jaffer
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Daisha J Cipher
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Bavana V Rangan
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Georgios E Christakopoulos
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Megan A Kypreos
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Nicholas Lembo
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - David Kandzari
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Santiago Garcia
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Craig A Thompson
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Subhash Banerjee
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Emmanouil S Brilakis
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
| |
Collapse
|
36
|
Danek BA, Karatasakis A, Karmpaliotis D, Alaswad K, Yeh RW, Jaffer FA, Patel M, Bahadorani J, Lombardi WL, Wyman MR, Grantham JA, Doing A, Moses JW, Kirtane A, Parikh M, Ali ZA, Kalra S, Kandzari DE, Lembo N, Garcia S, Rangan BV, Thompson CA, Banerjee S, Brilakis ES. Use of antegrade dissection re-entry in coronary chronic total occlusion percutaneous coronary intervention in a contemporary multicenter registry. Int J Cardiol 2016; 214:428-37. [PMID: 27088405 DOI: 10.1016/j.ijcard.2016.03.215] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND We assessed efficacy and safety of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using antegrade dissection re-entry (ADR). METHODS We examined outcomes of ADR among 1313 CTO PCIs performed at 11 US centers between 2012-2015. RESULTS 84.1% of patients were men. Prevalence of prior coronary artery bypass graft surgery was 34.3%. Overall technical and procedural success were 90.1% and 88.7%, respectively. In-hospital major adverse cardiovascular events (MACE) occurred in 31 patients (2.4%). ADR was used in 458 cases (34.9%), and was the first strategy in 169 cases (12.9%). ADR cases were angiographically more complex than non-ADR cases (mean J-CTO score: 2.8±1.2 vs. 2.4±1.2, p<0.001). ADR was performed using the CrossBoss catheter in 246 of 458 (53.7%) and the Stingray system in 251 ADR cases (54.8%). Compared with non-ADR cases, ADR cases had lower technical (86.9% vs. 91.8%, p=0.005) and procedural success (85.0% vs. 90.7%, p=0.002), but similar risk for MACE (2.9% vs. 2.2%, p=0.42). ADR was associated with longer procedure and fluoroscopy time, and higher patient air kerma dose and contrast volume (all p<0.001). After excluding retrograde cases, ADR and antegrade wire escalation (AWE) had similar technical success (92.7% vs. 94.2%, p=0.43), procedural success (91.8% vs. 94.1%, p=0.23), and MACE (2.1% vs. 0.6%, p=0.12). CONCLUSIONS ADR is used relatively frequently in contemporary CTO PCI, especially for challenging lesions and after failure of other strategies. ADR is associated with similar success rates and risk for complications as compared with AWE, and is important for achieving high procedural success.
Collapse
Affiliation(s)
- Barbara Anna Danek
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States
| | - Aris Karatasakis
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States
| | | | | | - Robert W Yeh
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Farouc A Jaffer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA, United States
| | - John Bahadorani
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA, United States
| | | | - Michael R Wyman
- Torrance Memorial Medical Center, Torrance, CA, United States
| | | | - Anthony Doing
- Medical Center of the Rockies, Loveland, CO, United States
| | | | - Ajay Kirtane
- Columbia University, New York, NY, United States
| | | | - Ziad A Ali
- Columbia University, New York, NY, United States
| | - Sanjog Kalra
- Columbia University, New York, NY, United States
| | | | | | - Santiago Garcia
- Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, MN, United States
| | - Bavana V Rangan
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States
| | | | - Subhash Banerjee
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States
| | - Emmanouil S Brilakis
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States.
| |
Collapse
|
37
|
Brilakis ES, Nicholson WJ. Expanding options for retrograde recanalisation of right coronary artery chronic total occlusions. EUROINTERVENTION 2016; 11:e1214-7. [PMID: 26865438 DOI: 10.4244/eijv11i11a241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Emmanouil S Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | |
Collapse
|
38
|
Amsavelu S, Carlino M, Brilakis ES. Carlino to the rescue: Use of intralesion contrast injection for bailout antegrade and retrograde crossing of complex chronic total occlusions. Catheter Cardiovasc Interv 2016; 87:1118-1123. [PMID: 26833947 DOI: 10.1002/ccd.26418] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/12/2015] [Accepted: 12/31/2015] [Indexed: 12/19/2022]
Abstract
Percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTO) can be challenging. Although several crossing techniques are available, in some cases their application fails to cross the occlusion. Carlino et al. have pioneered the technique of hydraulic microdissection by contrast injection through a microcatheter inserted into the lesion. We report two CTO PCI cases in which the use of the Carlino technique enabled success after other crossing strategies failed to cross the occlusion. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Suwetha Amsavelu
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mauro Carlino
- Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Emmanouil S Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
39
|
Amsavelu S, Christakopoulos GE, Karatasakis A, Patel K, Rangan BV, Stetler J, Roesle M, Resendes E, Grodin J, Abdullah S, Banerjee S, Brilakis ES. Impact of Crossing Strategy on Intermediate-term Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention. Can J Cardiol 2016; 32:1239.e1-1239.e7. [PMID: 27006316 DOI: 10.1016/j.cjca.2016.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/11/2016] [Accepted: 01/29/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is ongoing controversy about the optimal crossing strategy selection for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), especially regarding the relative merits of antegrade dissection/re-entry and the retrograde approach. METHODS We retrospectively examined the clinical outcomes of 173 consecutive patients who underwent successful CTO PCI at our institution between January 2012 and March 2015. RESULTS The mean age was 65 ± 8 years, and 98% of the patients were men with a high prevalence of diabetes (60%), previous coronary artery bypass grafting (CABG) (31%), and previous PCI (54%). The successful CTO crossing strategy was antegrade wire escalation in 79 patients (45.5%), antegrade dissection/re-entry in 58 patients (33.5%), retrograde wire escalation in 11 patients (6.4%), and retrograde dissection and re-entry in 25 patients (14.5%). The retrograde approach was more commonly used in lesions with interventional collaterals (P < 0.0001), moderate/severe calcification (P = 0.02), blunt stump (P = 0.01), and a higher Japan Chronic Total Occlusion score (P = 0.0002). Use of dissection and re-entry (both antegrade and retrograde) was associated with bifurcation and the distal cap (P = 0.004), longer CTO occlusion length (P < 0.0001), and longer stent length (P < 0.0001). Median follow-up was 11 months. The 12-month incidence of death, myocardial infarction, and the composite of acute coronary syndrome/target lesion revascularization/target vessel revascularization was 2.5%, 4.9%, and 24.4%, respectively, and was similar with intimal and subintimal crossing strategies. CONCLUSIONS Antegrade dissection/re-entry and retrograde approaches are frequently used during CTO PCI and were associated with similarly favorable intermediate-term outcomes as antegrade wire escalation.
Collapse
Affiliation(s)
- Suwetha Amsavelu
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Georgios E Christakopoulos
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aris Karatasakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Krishna Patel
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bavana V Rangan
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey Stetler
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michele Roesle
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Erica Resendes
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jerrold Grodin
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shuaib Abdullah
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Subhash Banerjee
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emmanouil S Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| |
Collapse
|