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Di Mario C, Mashayekhi KA, Garbo R, Pyxaras SA, Ciardetti N, Werner GS. Recanalisation of coronary chronic total occlusions. EUROINTERVENTION 2022; 18:535-561. [PMID: 36134683 DOI: 10.4244/eij-d-21-01117] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators in this demanding, rapidly evolving field of interventional cardiology.
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Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Kambis A Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Roberto Garbo
- GVM Care & Research, Maria Pia Hospital, Turin, Italy
| | | | - Niccolò Ciardetti
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Gerald S Werner
- Department of Cardiology, Klinikum Darmstadt GmbH, Darmstadt, Germany
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Kandzari DE, Karmpaliotis D, Kini AS, Moses JW, Tummala PE, Grantham JA, Orr C, Lombardi W, Nicholson WJ, Lembo NJ, Popma JJ, Wang J, Zhao W, McGreevy R. Late-term safety and effectiveness of everolimus-eluting stents in chronic total coronary occlusion revascularization: Final 4-year results from the evaluation of the XIENCE coronary stent, Performance, and Technique in Chronic Total Occlusions (EXPERT CTO) multicenter trial. Catheter Cardiovasc Interv 2019; 94:509-515. [PMID: 31444897 DOI: 10.1002/ccd.28436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/10/2019] [Accepted: 07/27/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Limited study has detailed the late-term safety and efficacy of chronic total coronary occlusion (CTO) revascularization among multiple centers applying modern techniques and with newer-generation drug-eluting stents. METHODS Among 20 centers, 222 patients enrolled in the XIENCE coronary stent, performance, and technique (EXPERT) CTO trial underwent CTO percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES). Through planned 4-year follow-up, the primary composite endpoint of major adverse cardiac events (MACE; death, myocardial infarction [MI] and target lesion revascularization) and rates of individual component endpoints and stent thrombosis were determined. RESULTS Demographic, lesion, and procedural characteristics included prior bypass surgery, 9.9%; diabetes, 40.1%; lesion length, 36.1 ± 18.5 mm; and stent length, 51.7 ± 27.2 mm. By 4 years, MACE rates were 31.6 and 22.4% by the pre-specified ARC and per-protocol definitions, respectively. Clinically-indicated target lesion revascularization at 4 years was 11.3%. In landmark analyses of events beyond the first year of revascularization, the annualized rates of target vessel-related MI and clinically-indicated target lesion revascularization were 0.53 and 1.3%, respectively. Through 4 years, the cumulative definite/probable stent thrombosis rate was 1.7% with no events occurring beyond the initial year of index revascularization. CONCLUSIONS In a multicenter registration trial representing contemporary technique and EES, these results demonstrate sustained long-term safety and effectiveness of EES in CTO percutaneous revascularization and can be used to inform shared decision making with patients being considered for CTO PCI relative to late safety and vessel patency.
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Affiliation(s)
| | - Dimitri Karmpaliotis
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | | | - Jeffrey W Moses
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | | | | | - Charles Orr
- St. Vincent's Heart Center, Indianapolis, Indiana
| | - William Lombardi
- PeaceHealth St. Joseph Medical Center, Cardiovascular Center, North Cascade Cardiology, Bellingham, WA
| | | | - Nicholas J Lembo
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | | | - Jin Wang
- Abbott Vascular, Inc., Santa Clara, California
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3
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Werner GS, Glaser P, Coenen A, Moehlis H, Tischer KH, Koch M, Klingenbeck R. Reduction of radiation exposure during complex interventions for chronic total coronary occlusions: Implementing low dose radiation protocols without affecting procedural success rates. Catheter Cardiovasc Interv 2017; 89:1005-1012. [DOI: 10.1002/ccd.26886] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/29/2016] [Accepted: 11/20/2016] [Indexed: 01/14/2023]
Affiliation(s)
- Gerald S. Werner
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Peggy Glaser
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Anja Coenen
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Hiller Moehlis
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Karl-Heinz Tischer
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Matthias Koch
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Reinhold Klingenbeck
- Medizinische Klinik I (Cardiology and Intensive care); Klinikum Darmstadt GmbH; Darmstadt Germany
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Isaaz K, Gerbay A, Terreaux J, Khamis H, Tammam K, Richard L, Cerisier A, Lamaud M, Da Costa A. Restenosis after percutaneous coronary intervention for coronary chronic total occlusion. The central role of an optimized immediate post-procedural angiographic result. Int J Cardiol 2016; 224:343-347. [PMID: 27681251 DOI: 10.1016/j.ijcard.2016.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/24/2016] [Accepted: 09/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Karl Isaaz
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France.
| | - Antoine Gerbay
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Jérémy Terreaux
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Hazem Khamis
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Khalid Tammam
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Laure Richard
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Alexis Cerisier
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Michel Lamaud
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Antoine Da Costa
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
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Ahn JH, Yang JH, Yu CW, Kim JS, Lee HJ, Choi RK, Kim TH, Jang HJ, Choi YJ, Roh YM, Shim WH, Song YB, Hahn JY, Choi JH, Lee SH, Gwon HC, Choi SH. First-Generation Versus Second-Generation Drug-Eluting Stents in Coronary Chronic Total Occlusions: Two-Year Results of a Multicenter Registry. PLoS One 2016; 11:e0157549. [PMID: 27314589 PMCID: PMC4912116 DOI: 10.1371/journal.pone.0157549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/01/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limited data are available regarding the long-term clinical outcomes of second-generation drug-eluting stents (DES) versus first-generation DES in patients with coronary chronic total occlusion (CTO) who undergo percutaneous coronary intervention (PCI). The aim of this study was to compare the clinical outcomes of second-generation DES with those of first-generation DES for the treatment of CTO. METHODS AND RESULTS Between March 2003 and February 2012, 1,006 consecutive patients with CTO who underwent successful PCI using either first-generation DES (n = 557) or second-generation DES (n = 449) were enrolled in a multicenter, observational registry. Propensity-score matching was also performed. The primary outcome was cardiac death over a 2-year follow-up period. No significant differences were observed between the two groups regarding the incidence of cardiac death (first-generation DES versus second-generation DES; 2.5% vs 2.0%; hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.37 to 1.98; p = 0.72) or major adverse cardiac events (MACE, 11.8% vs 11.4%; HR: 1.00; 95% CI: 0.67 to 1.50; p = 0.99). After propensity score matching, the incidences of cardiac death (HR: 0.86; 95% CI: 0.35 to 2.06; p = 0.86) and MACE (HR: 0.93; 95% CI: 0.63 to 1.37; p = 0.71) were still similar in both groups. Furthermore, no significant differences were observed between sirolimus-eluting, paclitaxel-eluting, zotarolimus-eluting, and everolimus-eluting stents regarding the incidence of cardiac death or MACE. CONCLUSION This study shows that the efficacy of second-generation DES is comparable to that of first-generation DES for treatment of CTO over 2 years of follow-up.
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Affiliation(s)
- Jong-Hwa Ahn
- Division of Cardiology, Department of Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Medicine, Cardiovascular Center, Anam Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Je Sang Kim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Hyun Jong Lee
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Rak Kyeong Choi
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Tae Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Ho Joon Jang
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Young Jin Choi
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Young Moo Roh
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Won-Heum Shim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Lee
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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Van den Branden BJL, Teeuwen K, Koolen JJ, van der Schaaf RJ, Henriques JPS, Tijssen JGP, Kelder JC, Vermeersch PHMJ, Rensing BJWM, Suttorp MJ. Primary Stenting of Totally Occluded Native Coronary Arteries III (PRISON III): a randomised comparison of sirolimus-eluting stent implantation with zotarolimus-eluting stent implantation for the treatment of total coronary occlusions. EUROINTERVENTION 2016; 9:841-53. [PMID: 23628457 DOI: 10.4244/eijv9i7a138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We investigated whether sirolimus-eluting stents (SES) are superior to next-generation zotarolimus-eluting stents (ZES) in treating patients with total coronary occlusions (TCO). METHODS AND RESULTS In a prospective, randomised trial we compared the SES with the zotarolimus-eluting stent (ZES; Endeavor or Resolute) after successful recanalisation of TCO. During the first phase of the trial, 51 patients were assigned to receive the SES and 46 patients to receive the Endeavor ZES. In the second phase we randomised 103 patients to the SES group and 104 patients to the Resolute ZES group. The primary endpoint was in-segment late lumen loss at eight-month follow-up. At eight months, patients in the SES group had less in-segment and in-stent late loss as compared to the Endeavor group: -0.13±0.3 mm vs. 0.27±0.6 mm (p=0.0002) and -0.13±0.5 mm vs. 0.54±0.5 mm (p<0.0001), respectively. In contrast, the SES and the Resolute ZES showed comparable amounts of in-segment (-0.03±0.7 mm vs. -0.10±0.7 mm, p=0.6) and in-stent (0.03±0.8 mm vs. 0.05±0.8 mm, p=0.9) late loss. CONCLUSIONS In the treatment of TCOs, the SES was associated with superior angiographic outcomes compared to the Endeavor ZES. On the other hand, the SES and the Resolute ZES showed comparable angiographic outcomes.
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Habara M, Tsuchikane E, Muramatsu T, Kashima Y, Okamura A, Mutoh M, Yamane M, Oida A, Oikawa Y, Hasegawa K. Comparison of percutaneous coronary intervention for chronic total occlusion outcome according to operator experience from the Japanese retrograde summit registry. Catheter Cardiovasc Interv 2015; 87:1027-35. [DOI: 10.1002/ccd.26354] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/30/2015] [Accepted: 11/15/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Maoto Habara
- Department of Cardiovascular Medicine; Toyohashi Heart Center; Aichi Japan
| | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine; Toyohashi Heart Center; Aichi Japan
| | - Toshiya Muramatsu
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Yoshifumi Kashima
- Division of Cardiology; Sapporo CardioVascular Clinic; Hokkaido Japan
| | - Atsunori Okamura
- Division of Cardiology; Sakurabashi-Watanabe Hospital; Osaka Japan
| | - Makoto Mutoh
- Division of Cardiology; Saitama Prefecture Cardiovascular and Respiratory Center; Saitama Japan
| | - Masahisa Yamane
- Cardiology Department; Saitama Sekishinkai Hospital; Saitama Japan
| | - Akitsugu Oida
- Department of Cardiology; Takase Clinic; Gunma Japan
| | - Yuji Oikawa
- Department of Cardiovascular; the Cardiovascular Institute; Tokyo Japan
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Lee MH, Lee JM, Kang SH, Yoon CH, Jang Y, Yu CW, Park HS, Lee SH, Hur SH, Kim MH, Rha SW, Gwon HC, Chae IH, Kim HS. Comparison of outcomes after percutaneous coronary intervention for chronic total occlusion using everolimus- versus sirolimus- versus paclitaxel-eluting stents (from the Korean National Registry of Chronic Total Occlusion Intervention). Am J Cardiol 2015; 116:195-203. [PMID: 26001819 DOI: 10.1016/j.amjcard.2015.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 12/01/2022]
Abstract
For the treatment of chronic total occlusion (CTO), the efficacy and safety of the everolimus-eluting stent (EES) remain less well defined. Also, there are limited data for the predictors of outcome after CTO intervention. The purpose of this study was to compare clinical outcomes of the EES with the first-generation drug-eluting stent (DES) in CTO intervention and to investigate the predictors of clinical outcome. The Korean National Registry of CTO Intervention is a retrospective cohort of 26 centers from the past 5 years. The primary end point was major adverse cardiovascular events (MACE) defined as a composite of cardiac death, nonfatal myocardial infarction, and target lesion revascularization. Of the 1,754 all-comer patients, 1,509 patients (EES 311, sirolimus-eluting stent [SES] 642, paclitaxel-eluting stent 556) were finally analyzed after excluding 245 patients (mixed DESs in 46 and follow-up loss in 199). In the inverse probability weighting-adjusted population, the 1-year MACE rate of the EES was comparable with that of the SES (5.8% vs 3.4%, p = 0.796) and the paclitaxel-eluting stent (5.8% vs 6.9%, p = 0.740). Each component of MACE was also comparable among the 3 stents. Importantly, the independent predictors of MACE were diabetes mellitus, previous congestive heart failure, and left circumflex CTO. In conclusion, for the first time in the largest CTO cohort, the EES showed good 1-year clinical outcomes that were comparable with the SES. Independent predictors of MACE after CTO intervention were clinical factors (diabetes and congestive heart failure) and lesion location.
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Affiliation(s)
- Min-Ho Lee
- Cardiovascular Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Joo M Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Si-Hyuck Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | | | - Yangsoo Jang
- Yonsei University Severance Hospital, Seoul, Korea
| | | | - Hun S Park
- Kyungpook National University Hospital, Daegu, Korea
| | - Seung-Hwan Lee
- Yonsei University Wonju Severance Hospital, Wonju, Korea
| | - Seung-Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Moo H Kim
- Dong-A University Medical Center, Busan, Korea
| | | | | | - In-Ho Chae
- Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
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Kandzari DE, Kini AS, Karmpaliotis D, Moses JW, Tummala PE, Grantham JA, Orr C, Lombardi W, Nicholson WJ, Lembo NJ, Popma JJ, Wang J, Larracas C, Rutledge DR. Safety and Effectiveness of Everolimus-Eluting Stents in Chronic Total Coronary Occlusion Revascularization. JACC Cardiovasc Interv 2015; 8:761-769. [DOI: 10.1016/j.jcin.2014.12.238] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/24/2014] [Accepted: 12/04/2014] [Indexed: 10/23/2022]
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Impact of lesion morphology on angiographic and clinical outcomes in patients with chronic total occlusion after recanalization with drug-eluting stents: a multislice computed tomography study. Eur Radiol 2015; 25:3084-92. [DOI: 10.1007/s00330-015-3706-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/23/2015] [Accepted: 03/04/2015] [Indexed: 01/07/2023]
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Werner GS, Coenen A, Tischer KH. Periprocedural ischaemia during recanalisation of chronic total coronary occlusions: the influence of the transcollateral retrograde approach. EUROINTERVENTION 2014; 10:799-805. [DOI: 10.4244/eijv10i7a139] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Galassi A, Grantham A, Kandzari D, Lombardi W, Moussa I, Thompson C, Werner G, Chambers C, Brilakis E. Percutaneous Treatment of Coronary Chronic Total Occlusions Part 1: Rationale and Outcomes. Interv Cardiol 2014; 9:195-200. [PMID: 29588802 DOI: 10.15420/icr.2014.9.3.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Coronary chronic total occlusions (CTOs) are commonly encountered in patients with coronary artery disease. Compared to patients without coronary CTOs, those with CTO have worse clinical outcomes and lower likelihood of complete coronary revascularisation. Successful CTO percutaneous coronary intervention (PCI) can significantly improve angina and improve left ventricular function. Although currently unproven, successful CTO PCI might also reduce the risk for arrhythmic events in patients with ischaemic cardiomyopathy, provide better tolerance of future acute coronary syndrome, and possibly improve survival. Evaluation by a heart team comprised of both interventional and non-interventional cardiologists and cardiac surgeons is important for determining the optimal revascularisation strategy in patients with coronary artery disease and CTOs. Ad hoc CTO PCI is generally not recommended, so as to allow sufficient time for (a) discussion with the patient about the indications, goals, risks, and alternatives to PCI; (b) careful procedural planning; and (c) contrast and radiation exposure minimisation. Use of drug-eluting stents is recommended for CTO PCI, given the lower rates of angiographic restenosis compared to bare metal stents.
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Affiliation(s)
| | - Aaron Grantham
- Saint Luke's Mid America Heart Institute and University of Missouri Kansas City, Missouri, US
| | | | | | | | | | | | - Charles Chambers
- Penn State University College of Medicine, Hershey, Pennsylvania, US
| | - Emmanouil Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, US
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Teeuwen K, Van den Branden BJL, Rahel BM, Laarman GJ, Tijssen JGP, Kelder JC, Slagboom T, Ten Berg JM, Suttorp MJ. Late catch-up in lumen diameter at five-year angiography in MACE-free patients treated with sirolimus-eluting stents in the Primary Stenting of Totally Occluded Native Coronary Arteries: a randomised comparison of bare metal stent implantation with sirolimus-eluting stent implantation for the treatment of total coronary occlusions (PRISON II). EUROINTERVENTION 2014; 9:212-9. [PMID: 23392450 DOI: 10.4244/eijv9i2a36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The present study was designed to examine the five-year angiographic follow-up of MACE-free patients enrolled in the PRISON II study. METHODS AND RESULTS In the PRISON II study a total of 200 patients were randomised to either bare metal stents (BMS) or sirolimus-eluting stents (SES) after successful recanalisation of total coronary occlusions (TCO). Patients free of MACE with available angiography at six months were approached for repeated angiography at five years. The primary endpoint was in-stent very late luminal loss (VLLL) at five years. The secondary endpoint was additional late luminal loss (ALLL) between six months and five years. At five years, repeated angiography was performed in 72 patients, 50/82 (61%) in the SES group and 22/58 (38%) in the BMS group. In-stent VLLL was lower in the SES group (0.19 mm ± 0.72 vs. 0.51 mm ± 0.71, p=0.09) compared to the BMS group and in-segment VLLL was comparable in both groups (0.01 mm±0.58 vs. 0.03 mm ± 0.73, p=0.89). Late catch-up in lumen diameter was observed in the SES group with a trend towards increased ALLL compared to the BMS group (in-stent, 0.35 mm ± 0.88 vs. 0.04 mm ± 0.81, p=0.16; in-segment, 0.20 mm ± 0.74 vs. -0.05 mm ± 0.73, p=0.19). CONCLUSIONS At five-year angiographic follow-up, late catch-up was observed after successful recanalisation of TCOs treated with SES. Despite a late catch-up, the angiographic results of SES were superior in-stent and similar in-segment compared to BMS.
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Affiliation(s)
- Koen Teeuwen
- Department of Interventional Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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Abstract
Successful recanalization and percutaneous revascularization of coronary arteries with chronic total occlusion (CTO) is one of the 'last frontiers' in coronary interventions. Conquering this obstacle will enable complete percutaneous revascularization in an increasing number of patients. The introduction within the last few years of enhanced guidewires combined with increasing operator experience and creative procedural techniques, such as the retrograde approach and the re-entry subintimal tracking technique (STAR), have significantly reduced the number of CTOs that should now be considered unapproachable. In addition, novel devices have been developed over recent years that may increase the success rate, as well as the safety, of the procedure. The Safe-Cross radiofrequency combines optical coherence reflectometry that warns the operator when the wire tip moves to within 1 mm of the outer vessel wall, combined with radiofrequency energy pulses to facilitate the passage. The CROSSER catheter mechanically vibrates against the face of the CTO at 20 kHz at a stroke depth of approximately 20 microm, creating a channel through the CTO. The most novel approach is the biologic one, in which proteolytic enzymes that digest the CTO cap to facilitate mechanical passage. The success rates for otherwise refractory CTOs will continue to improve with the development and validation of new imaging modalities and active energy source catheters.
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Affiliation(s)
- Giora Weisz
- Columbia University Medical Center, Center for Interventional Vascular Therapy, 161 Fort Washington Avenue, IP-5 Floor, New York, NY 10032, USA.
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Moreno R, García E, Teles R, Rumoroso JR, Cyrne Carvalho H, Goicolea FJ, Moreu J, Mauri J, Sabaté M, Mainar V, Patricio L, Valdés M, Fernández Vázquez F, Sánchez-Recalde A, Galeote G, Jimenez-Valero S, Almeida M, Lopez de Sa E, Calvo L, Plaza I, Lopez-Sendón JL, Martín JLR. Randomized comparison of sirolimus-eluting and everolimus-eluting coronary stents in the treatment of total coronary occlusions: results from the chronic coronary occlusion treated by everolimus-eluting stent randomized trial. Circ Cardiovasc Interv 2013; 6:21-8. [PMID: 23403384 DOI: 10.1161/circinterventions.112.000076] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients with coronary total occlusions are at especially high risk for restenosis and new revascularizations. Sirolimus-eluting stents dramatically improved the clinical outcome of this subset of patients in randomized trials, but other drug-eluting stents, mainly the everolimus-eluting stent (currently the most frequently used stent), have not yet been evaluated in patients with coronary total occlusions. The objective was to compare the second-generation everolimus-eluting stent with the first-generation sirolimus-eluting stent in patients with coronary total occlusions. METHODS AND RESULTS A total of 207 patients with coronary total occlusions and estimated time since occlusion >2 weeks were randomized to everolimus- or sirolimus-eluting stent. The primary end point was in-stent late loss at 9-month angiographic follow-up (noninferiority trial). Clinical follow-up was performed at 1 and 12 months. In-stent late loss at 9 months was 0.29±0.60 versus 0.13±0.69 mm in patients allocated to sirolimus- and everolimus-eluting stent, respectively. The observed difference in in-stent late loss between both groups was -0.16 mm (95% confidence interval, 0.04 to -0.36 mm; P for noninferiority <0.01). The rate of binary angiographic restenosis was 10.8% and 9.1% in patients allocated to sirolimus- and everolimus-eluting stent, respectively (P=0.709), whereas the rate of vessel reocclusion was 3.2% and 1.1%, respectively (P=0.339). At 12 months, the rate of major adverse events was 15.9% versus 11.1% with sirolimus- and everolimus-eluting stent, respectively (P=0.335), and probable or definitive stent thrombosis occurred in 3.0% and 0.0% of patients, respectively (P=0.075). CONCLUSIONS In patients with coronary total occlusions, everolimus-eluting stent is as effective as sirolimus-eluting stent. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00793221.
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Affiliation(s)
- Raul Moreno
- Hospital Universitario La Paz, 28046 Madrid, Spain.
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Valenti R, Vergara R, Migliorini A, Parodi G, Carrabba N, Cerisano G, Dovellini EV, Antoniucci D. Predictors of Reocclusion After Successful Drug-Eluting Stent–Supported Percutaneous Coronary Intervention of Chronic Total Occlusion. J Am Coll Cardiol 2013; 61:545-50. [PMID: 23273395 DOI: 10.1016/j.jacc.2012.10.036] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/28/2012] [Accepted: 10/23/2012] [Indexed: 01/16/2023]
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De Felice F, Fiorilli R, Parma A, Musto C, Nazzaro MS, Scappaticci M, Confessore P, Guerra E, Belloni F, Violini R. Five-year outcomes in patients with chronic total coronary occlusion treated with drug-eluting vs bare-metal stents: a case-control study. Can J Cardiol 2012; 29:945-50. [PMID: 23265094 DOI: 10.1016/j.cjca.2012.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 10/01/2012] [Accepted: 10/03/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Limited data exist on long-term safety and effectiveness of drug-eluting stents (DESs) in true chronic total coronary occlusion (CTO) settings. We evaluated 5-year clinical outcomes of patients with CTO treated successfully with DES vs bare-metal stent (BMS). METHODS We compared the 5-year clinical outcomes of 156 patients treated with DES implantation with outcomes of a historical cohort of 159 patients treated with BMS. Primary end point was freedom from major adverse cardiac events (MACEs; defined as death, myocardial infarction [MI], and target lesion revascularization [TLR]); secondary end points were freedom from target vessel failure (TVF; combination of target vessel revascularization, MI, and cardiac death) and TLR at 5 years. RESULTS After 5 years, the DES group had significantly superior event-free survival from MACE (84% vs 69%; log rank P < 0.001), TVF (71% vs 84%; P = 0.002), and TLR (77% vs 92%; P = 0.0001), compared with the BMS group. The Cox proportional hazards model identified BMS vs DES (adjusted hazard ratio [HR] = 3.37; 95% confidence interval [CI], 1.85-6.17; P = 0.001), final minimal lumen diameter (HR, 0.27; 95% CI, 0.14-0.52; P = 0.0001), and stent length (HR, 1.01; 95% CI, 1.00-1.03; P = 0.03) as independent predictors of MACE at 5-year follow-up. Twelve (7%) and 7 (4%) stent thromboses occurred in the DES and BMS groups (P = 0.23), respectively. CONCLUSIONS After 5 years, DESs were superior to BMSs in reducing MACE, TVF, and TLR in patients with CTO and should be the preferred strategy.
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Affiliation(s)
- Francesco De Felice
- UO Cardiologia Interventistica Azienda Ospedaliera S. Camillo Forlanini, Roma, Italy.
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Wöhrle J, Werner GS. Paclitaxel-coated balloon with bare-metal stenting in patients with chronic total occlusions in native coronary arteries. Catheter Cardiovasc Interv 2012; 81:793-9. [PMID: 22511572 DOI: 10.1002/ccd.24409] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 03/04/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We sought to evaluate the efficacy and safety of paclitaxel-coated balloon plus bare-metal stenting (BMS) in chronic total occlusions (CTOs). BACKGROUND Drug-eluting stent implantation after recanalization of CTOs is limited by the occurrence of restenosis and risk for late stent thromboses. METHODS In this prospective, bicenter trial we treated 48 patients after successful chronic total occlusion (CTO) recanalization in a native coronary artery with paclitaxel-coated balloon plus BMS. Patients were matched according to stent length, reference diameter, and diabetes mellitus with 48 patients treated with Taxus stent implantation. Dual antiplatelet therapy was prescribed for 6 months. Angiographic (clinical) follow-up was obtained after 6 (12) months. Primary endpoint was in-stent late lumen loss. RESULTS There was no difference in patient baseline characteristics or procedural results. Stent length was 59.7 ± 32.4 mm (16-151 mm) for paclitaxel-coated balloon plus BMS versus 56.2 ± 25.9 mm (16-132 mm) for Taxus stent. Late loss was statistically not different within the stent with 0.64 ± 0.69 mm versus 0.43 ± 0.64 mm (difference 0.20 mm, 95% confidence interval -0.07 to 0.47, P = 0.14) and at the occlusion site with 0.33 ± 0.69 mm versus 0.26 ± 0.70 mm, respectively. Restenosis rate was 27.7% compared with 20.8% (P = 0.44) and the combined clinical endpoint (cardiac death, myocardial infarction attributed to the target vessel, target lesion revascularization) was 14.6% versus 18.8% (P = 0.58), respectively. CONCLUSIONS In conclusion, for patients with complex CTOs in native coronary arteries the use of paclitaxel-coated balloon after bare-metal stenting was associated with similar clinical results and a nonsignificantly higher in-stent late loss compared with a matched population with paclitaxel-eluting stent implantation.
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Affiliation(s)
- Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, Ulm, Germany.
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Ino Y, Toyoda Y, Ishii S, Mizukoshi M, Kusuyama Y, Kubo T, Imanishi T, Akasaka T. Occlusion of left main coronary artery during percutaneous coronary intervention for chronic total occlusion of left circumflex artery with retrograde approach. Cardiovasc Interv Ther 2012; 28:81-6. [PMID: 22930371 DOI: 10.1007/s12928-012-0116-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 06/14/2012] [Indexed: 11/27/2022]
Abstract
The retrograde approach, a new technique of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), allows coronary interventionalists to improve the success rate. However, this technique occasionally has serious complications. We report a case with the occlusion of left main coronary artery (LMCA) during PCI for CTO in the proximal LCX with retrograde approach because of backward spiral dissection formed by retrograde wire. We could perform bail-out stenting for LMCA. In PCI for CTO in the proximal site of left coronary artery with retrograde approach, we should keep in mind a backward dissection to LMCA formed by retrograde wire.
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Affiliation(s)
- Yasushi Ino
- Division of Cardiology, Wakayama National Hospital, 1138 Wada, Mihama-cho, Hidaka-gun, Wakayama, Japan.
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Lee SP, Shin DH, Park KW, Kang HJ, Koo BK, Cho YS, Yeon TJ, Chae IH, Choi DJ, Kim HS. Angiographic patterns of restenosis after percutaneous intervention of chronic total occlusive lesions with drug-eluting stents. Int J Cardiol 2012; 156:180-5. [DOI: 10.1016/j.ijcard.2010.10.138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/23/2010] [Accepted: 10/31/2010] [Indexed: 11/27/2022]
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Van den Branden B, Rahel B, Laarman G, Slagboom T, Kelder J, ten Berg J, Suttorp M. Five-year clinical outcome after primary stenting of totally occluded native coronary arteries: a randomised comparison of bare metal stent implantation with sirolimus-eluting stent implantation for the treatment of total coronary occlusions (PRISON II study). EUROINTERVENTION 2012; 7:1189-96. [DOI: 10.4244/eijv7i10a190] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mehran R, Claessen BE, Godino C, Dangas GD, Obunai K, Kanwal S, Carlino M, Henriques JPS, Di Mario C, Kim YH, Park SJ, Stone GW, Leon MB, Moses JW, Colombo A. Long-term outcome of percutaneous coronary intervention for chronic total occlusions. JACC Cardiovasc Interv 2012; 4:952-61. [PMID: 21939934 DOI: 10.1016/j.jcin.2011.03.021] [Citation(s) in RCA: 219] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 03/04/2011] [Accepted: 03/16/2011] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). BACKGROUND Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO. METHODS We evaluated long-term clinical outcomes in 1,791 patients who underwent PCI of 1,852 CTO at 3 tertiary care centers in the United States, South Korea, and Italy between 1998 and 2007. Median follow-up was 2.9 years (interquartile range: 1.5 to 4.6 years). RESULTS Procedural success was obtained in 1,226 (68%) patients. Stents were implanted in 1,160 patients (95%); 396 patients (34%) received bare-metal stents (BMS), and 764 patients (66%) received drug-eluting stents (DES). After multivariable analysis, successful CTO PCI was an independent predictor of a lower cardiac mortality (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.21 to 0.75, p < 0.01) and reduced need for coronary artery bypass graft surgery (HR: 0.21, 95% CI: 0.13 to 0.40, p < 0.01); it also correlated with a strong trend toward lower all-cause mortality (HR: 0.63, 95% CI: 0.40 to 1.00, p = 0.05) at 5-year follow-up. Among patients who underwent stent implantation, treatment with DES rather than BMS resulted in less target vessel revascularization at long-term follow-up (17.2% vs. 31.1%, p < 0.01); definite/probable stent thrombosis rates were similar (DES 1.7%, BMS 2.3%, p = 0.58). Within the DES subgroup, patients treated with paclitaxel-eluting stents and sirolimus-eluting stents had similar clinical outcomes. CONCLUSIONS Successful CTO PCI is associated with reduced long-term cardiac mortality and need for coronary artery bypass graft surgery. Treatment of CTO with DES rather than BMS is associated with a significant reduction in target vessel revascularization with similar rates of stent thrombosis. Paclitaxel-eluting stents and sirolimus-eluting stents had similar long-term safety and efficacy outcomes.
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Affiliation(s)
- Roxana Mehran
- Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, New York 10029, USA.
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Galassi AR, Tomasello SD, Costanzo L, Campisano MB, Barrano G, Tamburino C. Long-Term Clinical and Angiographic Results of Sirolimus-Eluting Stent in Complex Coronary Chronic Total Occlusion Revascularization: The SECTOR Registry. J Interv Cardiol 2011; 24:426-36. [PMID: 22004600 DOI: 10.1111/j.1540-8183.2011.00648.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alfredo R Galassi
- Clinical Division of Cardiology, Department of Internal Medicine and Systemic Disease, Ferrarotto Hospital, ETNA Foundation, University of Catania, Via Antonello da Messina 75, Catania, Italy.
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Everolimus-eluting stents for treatment of chronic total coronary occlusions. Clin Res Cardiol 2011; 101:23-8. [PMID: 21938564 DOI: 10.1007/s00392-011-0359-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 09/02/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND After successful recanalization of a coronary chronic total occlusion (CTO) the risk for restenosis and subsequent need for repeat intervention is high. Everolimus-eluting stents (EESs) were associated with low rates of restenosis, reintervention and stent thrombosis in non-occluded lesions. We sought to determine the antiproliferative impact of the everolimus-eluting Xience V stent in CTOs. METHODS Fifty-three patients with a CTO in a native coronary artery were included. CTO was defined as a duration of occlusion ≥3 months and thrombolysis in myocardial infarction 0 flow. EESs were exclusively implanted to completely cover the occluded and adjacent stenotic segments. Dual antiplatelet therapy was prescribed for 6 months. Follow-up angiography was scheduled at 6 months. Clinical follow-up was done at 12 months. The primary endpoint was late loss at the initial occlusion site. Secondary clinical endpoint was a composite of cardiac death, myocardial infarction not clearly attributable to a non-target vessel and target lesion revascularization. RESULTS Mean occlusion length was 24 ± 17 mm, ranging from 4 to 74 mm. Mean stent length was 79 ± 36 mm, ranging from 18 to 158 mm. Reference diameter was 3.27 ± 0.58 mm. Late loss at the initial occlusion site was 0.22 ± 0.69 mm. There were six (11%) binary restenosis with a target lesion reintervention in three (6%) patients. There was no death, myocardial infarction or stent thrombosis within 12 months. CONCLUSION In patients with successful recanalization of complex CTOs the use of EESs results in a low angiographic late loss and restenosis rate without stent thrombosis throughout 12 months follow-up.
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Niccoli G, Leo A, Giubilato S, Cosentino N, Galassi AR, Minelli S, Porto I, Leone AM, Burzotta F, Trani C, Crea F. A meta-analysis of first-generation drug-eluting vs bare-metal stents for coronary chronic total occlusion: Effect of length of follow-up on clinical outcome. Int J Cardiol 2011; 150:351-4. [DOI: 10.1016/j.ijcard.2011.05.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 05/13/2011] [Indexed: 11/28/2022]
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Hakeem A, Karmali K, Larue SJ, Bhatti S, Chilakapati V, Samad Z, Roth Cline M, Cilingiroglu M, Leesar MA. Clinical presentation and outcomes of drug-eluting stent-associated coronary aneurysms. EUROINTERVENTION 2011; 7:487-96. [PMID: 21764668 DOI: 10.4244/eijv7i4a79] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Abdul Hakeem
- Division of Cardiovascular Medicine, University of Cincinnati Hospital, Cincinnati, OH, USA.
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28
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Werner GS. Outcomes following successful recanalization of chronic total coronary occlusions. Interv Cardiol 2011. [DOI: 10.2217/ica.11.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Werner GS, Schofer J, Sievert H, Kugler C, Reifart NJ. Multicentre experience with the BridgePoint devices to facilitate recanalisation of chronic total coronary occlusions through controlled subintimal re-entry. EUROINTERVENTION 2011; 7:192-200. [DOI: 10.4244/eijv7i2a33] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sohrabi B, Ghaffari S, Habibzadeh A, Chaichi P. Outcome of diabetic and non-diabetic patients undergoing successful percutaneous coronary intervention of chronic total occlusion. J Cardiovasc Thorac Res 2011; 3:45-8. [PMID: 24250951 DOI: 10.5681/jcvtr.2011.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 01/13/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Diabetes mellitus is associated with an increased risk of adverse clinical outcomes after percutaneous coronary intervention (PCI). The prognosis of patients with diabetes mellitus and chronic total occlusion (CTO) treated with PCI is poorly investigated. Current study evaluates outcome of successful PCI on CTO in patients with and without diabetes. METHODS One hundred and sixty three patients treated with successful PCI on CTO between January 2009 and March 2011 were prospectively identified from the PCI registry at the Madani Heart Center, Tabriz, Iran. Patients were followed for 15±3 months, were evaluated for the occurrence of major adverse cardiac events (MACE) comprising death, acute myocardial infarction, and need for repeat revascularization. RESULTS No differences were found in baseline clinical and procedural variables between patients with (n=34) and without diabetes (n=129), unless for hypertension (p=0.03). Hospitalization period after PCI in diabetics (3.26±0.61 days) and non-diabetics (2.86±0.52 days) was similar. In-hospital MACE occurred in 8 (23.5%) individuals of diabetics and 10 (7.8%) individuals of non-diabetics (p=0.02), among them revascularization was significantly higher in diabetics (20.6% vs. 7%, p=0.04). Follow-up events in diabetic and non-diabetic groups were 12 (35.3%) and 37 (28.5%), respectively (p was not significant). CONCLUSION In patients undergoing successful PCI on CTO, diabetes is associated with higher in-hospital adverse events; however diabetes does not affect long term outcomes in these patients.
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Affiliation(s)
- Bahram Sohrabi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
The present article discusses the current status of treatment strategies for chronic total occlusion (CTO) and the prospects offered by new therapies. The indication for revascularisation recognized in the current European guidelines includes the presence of typical symptoms and evidence of ischemia of over 10% of the total myocardium, while in patients with multiple vascular diseases the aim is complete revascularisation. Although the vast majority of patients with CTO fulfil these criteria, they are currently not receiving interventional treatment as frequently as expected. The reasons often given for this include the low success rates and high recurrence rates. However, both problems have been improved by drug-eluting stents (DES) on the one hand and by wire techniques and strategies on the other, such that results almost comparable with non-occluded coronary lesions can be achieved. While more advanced approaches like retrograde recanalization should be restricted to specialized centres, marked improvements can be achieved even without these special techniques by means of consistent further training and the application of modern techniques. Despite the aggressiveness of these approaches to pass through an occluded artery, the complication rate is not higher than with non-occluded lesions when the specific complications of recanalization are avoided in a careful approach. Further technical improvements are expected with the use of modern imaging techniques such as intravascular ultrasound and high-resolution CT imaging of coronary arteries.
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Lee SW, Lee JY, Park DW, Kim YH, Yun SC, Kim WJ, Suh J, Cho YH, Lee NH, Kang SJ, Lee CW, Park SW, Park SJ. Long-term clinical outcomes of successful versus unsuccessful revascularization with drug-eluting stents for true chronic total occlusion. Catheter Cardiovasc Interv 2011; 78:346-53. [PMID: 21452248 DOI: 10.1002/ccd.23019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 01/22/2011] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The aims of this study were to investigate the long-term clinical outcomes of patients with successful versus unsuccessful revascularization with drug-eluting stents (DES) for chronic total occlusion (CTO). BACKGROUND The benefits of successful revascularization of CTO remain unclear. METHODS Consecutive patients (n = 333) with "true" CTO, defined as Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 on angiography and duration ≥3 months, were divided into two groups, those with successful (CTO success group, n = 251) and unsuccessful (CTO failure group, n = 82) revascularization with DES for CTO lesions. The primary endpoint was defined as major adverse cardiac events (MACE) the composite of death, Q-wave myocardial infarction (MI), or target vessel revascularization (TVR). RESULTS The CTO success group was significantly younger, with a higher involvement of LAD, and lower incidences of renal failure, previous myocardial infarction, and previous coronary intervention than the CTO failure group. After a median follow up of 1,317 days (interquartile range, 1,059-1,590 days), there were no significant between-group differences in rate of MACE, both after crude analysis (9.4% vs. 11.8%, log-rank P = 0.16) and after adjustment (HR 1.17; 95% CI 0.47-2.88, P = 0.53). On multivariate analysis, major predictors of MACE were left ventricle ejection fraction (LVEF) <40% (HR 3.14; 95% CI 1.39-7.09, P = 0.005) and multiple CTO (HR 2.38; 95% CI 1.01-5.71, P = 0.049). CONCLUSIONS Long-term clinical outcomes were similar in the CTO success and failure groups. Multiple CTOs and LVEF <40% in CTO patients were independent predictors of MACE.
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Affiliation(s)
- Seung-Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Werner GS, Hochadel M, Zeymer U, Kerber S, Schumacher B, Grube E, Hauptmann KE, Brueck M, Zahn R, Senges J. Contemporary success and complication rates of percutaneous coronary intervention for chronic total coronary occlusions: results from the ALKK quality control registry of 2006. EUROINTERVENTION 2011; 6:361-6. [PMID: 20884415 DOI: 10.4244/eijv6i3a60] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Despite successful prevention of lesion recurrence by drug-eluting stents (DES), and the advancement in procedural techniques in the treatment of chronic total coronary occlusions (CTO), the number of CTOs treated by percutaneous coronary intervention (PCI) is still low as compared to their prevalence. This study aims to assess the outcome of PCI for CTOs in a contemporary survey of PCI in interventional centres in Germany. METHODS AND RESULTS The basis of this analysis is the 2006 quality assessment database of PCI conducted by the ALKK (working group of cardiology centres). Thirty-five centres contributed to this database, representing about 10% of all interventional centres of Germany. From a total of 20,502 patients, 8,882 patients with stable angina were selected. Of these 674 patients (7.6%) underwent PCI for a CTO. Their procedural characteristics and the hospital outcome were compared with patients treated for non-occlusive lesions. As compared to non-occlusive lesions, less patients underwent ad hoc PCI for a CTO. The fluoroscopy time was almost double of that in non-occlusive lesions, and contrast usage was significantly higher. The success rate was 60.1% as compared to 97.3% (p<0.001). Severe intraprocedural and in-hospital complications were similar for CTO and non-CTO lesions. Almost all patients with a CTO received a stent; DES were used in 53.4%, which was higher than the rate in non-CTO lesions (38.9%; p<0.001). CONCLUSIONS Although the success rate for PCI in CTOs is still well below that in non-occlusive lesions, this procedure is safe, encouraging its wider application. The low rate of DES use did not reflect the evidence for DES in CTOs.
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Ma J, Yang W, Singh M, Peng T, Fang N, Wei M. Meta-analysis of long-term outcomes of drug-eluting stent implantations for chronic total coronary occlusions. Heart Lung 2011; 40:e32-40. [PMID: 21419488 DOI: 10.1016/j.hrtlng.2010.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 07/04/2010] [Accepted: 07/17/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the treatment of chronic total occlusions (CTOs), some uncertainty exists regarding the effect of drug-eluting stents (DESs) compared with the effects of bare mental stents (BMSs). We reviewed outcomes of DES vs. BMS implantation for CTO lesions, to evaluate the risk-benefit ratio of DES implantation. METHODS Relevant studies of long-term clinical outcomes or angiographic outcomes of both BMS and DES implantation were examined. The primary endpoint comprised major adverse cardiovascular events (MACEs), including all-cause deaths, myocardial infarctions (MIs), and target lesion revascularizations (TLRs). A fixed-effect model and random-effect model were used to analyze the pooling results. RESULTS Ten studies were included according to the selection criteria. Eight were nonrandomized controlled trials, and two consisted of a randomized controlled comparison between DES and BMS implantation. No significant difference was evident for in-hospital MACE rates between the two groups (odds ratio [OR], 1.07; 95% confidence interval [CI], .53 to 2.13), but the long-term MACE rates in the DES group were significantly lower than in the BMS group (OR, .22; 95% CI, .13 to .38; P < .00001). The rates of stent restenosis and reocclusions were also significantly lower in the DES group (OR, .14; 95% CI, .09 to .20; and OR, .23; 95% CI, .12 to .41, respectively). CONCLUSION Implantation of the DES improves long-term angiographic and clinical outcomes compared with BMS in the treatment of CTO lesions.
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Affiliation(s)
- Jian Ma
- Division of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Saeed B, Kandzari DE, Agostoni P, Lombardi WL, Rangan BV, Banerjee S, Brilakis ES. Use of drug-eluting stents for chronic total occlusions: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2011; 77:315-32. [DOI: 10.1002/ccd.22690] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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HUANG PEIHSIU, YEUNG MICHAEL, LASALA JOHNM, COX DAVIDA, BOWMAN THOMASS, STARZYK RUTHM, DAWKINS KEITHD. Two-Year Clinical Outcomes with Paclitaxel-Eluting Coronary Stents in Patients with Chronic Total Occlusions: Analysis from the TAXUS ARRIVE Program. J Interv Cardiol 2011; 24:232-40. [DOI: 10.1111/j.1540-8183.2010.00622.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ogita M, Ako J, Sakakura K, Nakamura T, Funayama H, Sugawara Y, Kubo N, Momomura S. Distal Reference Segment Luminal Gain Following Percutaneous Coronary Intervention for Chronic Total Occlusion. Int Heart J 2011; 52:270-3. [DOI: 10.1536/ihj.52.270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Manabu Ogita
- Cardiovascular Division, Saitama Medical Center, Jichi Medical University
| | - Junya Ako
- Cardiovascular Division, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Cardiovascular Division, Saitama Medical Center, Jichi Medical University
| | - Tomohiro Nakamura
- Cardiovascular Division, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Funayama
- Cardiovascular Division, Saitama Medical Center, Jichi Medical University
| | - Yoshitaka Sugawara
- Cardiovascular Division, Saitama Medical Center, Jichi Medical University
| | - Norifumi Kubo
- Cardiovascular Division, Saitama Medical Center, Jichi Medical University
| | - Shinichi Momomura
- Cardiovascular Division, Saitama Medical Center, Jichi Medical University
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Beohar N, Meyers SN, Erdogan A, Harinstein ME, Pieper K, Gagnon S, Davidson CJ. Off-label use of drug-eluting versus bare metal stents: a lesion-specific systematic review of long-term outcomes. J Interv Cardiol 2010; 23:528-45. [PMID: 20735712 DOI: 10.1111/j.1540-8183.2010.00588.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review was to evaluate differences in lesion-specific outcomes with the "off-label" use of drug-eluting stents (DES) versus bare metal stents (BMS). METHODS MEDLINE, PubMed, the Cochrane databases, and other Web were searched for studies evaluating off-label use of DES and BMS with the same characteristics. Of 1,258 abstracts or manuscripts reviewed, 112 studies were included (total N = 23,438). Studies were excluded if patients received both types of stent or no stent; lesion type was unknown; lesion-specific outcomes for ≥6 months were unavailable; or <25 patients were enrolled. RESULTS Overall mortality at 6-12 months was approximately 3% for BMS and DES for off-label use. Increase in mortality was greater from 6-12 months to 2 years with BMS than with DES (3.3%-9.1%; 2.8%-4.1%); however, rates were similar at 3 years (BMS: 18.8%; DES:15.3%). Myocardial Infarction rates were similar for both types at 6-12 months (BMS: 6.5%; DES: 6.0%). Overall rates of stent thrombosis were 1.8% and 1.7% for BMS and DES, respectively. Similar or slightly lower rates of stent thrombosis were seen for most lesion types, except higher rates for small vessels for BMS (5.2%) and true bifurcation for DES (3.3%). Rates of target lesion revascularization (TLR) were 7.5% for BMS and 19.6% for DES at 6-12 months. At 2-years TLR remained lower than DES. When the combined group was compared to registry data alone, similar values were seen. CONCLUSIONS Rates of mortality, myocardial infarction (MI), and stent thrombosis were similar in patients receiving BMS or DES, while TLR rates were lower in DES patients.
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Affiliation(s)
- Nirat Beohar
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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Garg S, Serruys PW. Coronary Stents. J Am Coll Cardiol 2010; 56:S1-42. [PMID: 20797502 DOI: 10.1016/j.jacc.2010.06.007] [Citation(s) in RCA: 307] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/01/2010] [Accepted: 06/15/2010] [Indexed: 01/07/2023]
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Reifart N, Hauptmann KE, Rabe A, Enayat D, Giokoglu K. Short and long term comparison (24 months) of an alternative sirolimus-coated stent with bioabsorbable polymer and a bare metal stent of similar design in chronic coronary occlusions: the CORACTO trial. EUROINTERVENTION 2010; 6:356-60. [DOI: 10.4244/eijv6i3a59] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rubartelli P, Petronio AS, Guiducci V, Sganzerla P, Bolognese L, Galli M, Sheiban I, Chirillo F, Ramondo A, Bellotti S. Comparison of sirolimus-eluting and bare metal stent for treatment of patients with total coronary occlusions: results of the GISSOC II-GISE multicentre randomized trial. Eur Heart J 2010; 31:2014-20. [DOI: 10.1093/eurheartj/ehq199] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ciçek D, Pekdemir H, Kalay N, Binici S, Altay H, Müderrisoğlu H. Efficacy of sirolimus-eluting stents compared with paclitaxel-eluting stents in an unselected population with coronary artery disease: 24-month outcomes of patients in a prospective non-randomized registry in Southern Turkey. Int J Med Sci 2010; 7:191-6. [PMID: 20596361 PMCID: PMC2894220 DOI: 10.7150/ijms.7.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 06/04/2010] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The efficacy of drug-eluting stents has been shown in randomized trials, but some controversy exists regarding which stent sirolimus-eluting or paclitaxel-eluting is more effective in unselected Turkish patients. Therefore, we investigated the clinical outcomes of patients who were treated with one type of these drug-eluting stents in the real world. METHODS We created a registry and prospectively analyzed data on a consecutive series of all patients who presented to our institution with symptomatic coronary artery disease between February 2005 and March 2007 and who were treated with the sirolimus- or the paclitaxel-eluting stent. The follow-up period after stent implantation was approximately 24 months. The primary end point was a major cardiac event, and the secondary end point was stent thrombosis. Informed consent was obtained from all subjects, and the study protocol was approved by the local ethical committee. RESULTS In total, 204 patients were treated with either the sirolimus-eluting stent (n = 103) or the paclitaxel-eluting stent (n = 101). The lesions in the 2 arms of the study were treated similarly by conventional technique. At 24-month follow-up, patients who received the paclitaxel-eluting stent showed significantly higher rates of non-Q-wave myocardial infarction (1.9% vs 5.9%; P: .002), target vessel revascularization (1.9% vs 4.9%; P: .002), coronary artery bypass graft surgery (1.9% vs 6.9%; P: .001), and late stent thrombosis (1.9% vs 3.9%, P: .002). CONCLUSIONS Patients who received the sirolimus-eluting stent showed better clinical outcomes compared with those who had the paclitaxel-eluting-stent.
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Affiliation(s)
- Davran Ciçek
- Başkent University School of Medicine, Department of Cardiology, Antalya, Turkey.
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Leo A, Giubilato S, Bacà M, Montone RA, Niccoli G. Stent for chronic total coronary occlusions: benefits and drawbacks after the introduction of drug-eluting stents. Interv Cardiol 2010. [DOI: 10.2217/ica.10.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Moreno R, Garcia E, Teles R, Almeida M, Carvalho H, Sabate M, Martin-Reyes R, Rumoroso J, Galeote G, Goicolea F, Moreu J, Mainar V, Mauri J, Ferreira R, Valdes M, Perez de Prado A, Martin-Yuste V, Jimenez-Valero S, Sanchez-Recalde A, Calvo L, Lopez de Sa E, Macaya C, Lopez-Sendon JL. A randomised comparison between everolimus-eluting stent and sirolimus-eluting stent in chronic coronary total occlusions. Rationale and design of the CIBELES (non-acute Coronary occlusion treated by EveroLimus-Eluting Stent) trial. EUROINTERVENTION 2010; 6:112-116. [DOI: 10.4244/eijv6i1a17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Suzuki M, Takagi Y, Tsuchikane E. Percutaneous coronary intervention of chronic total occlusion in a left anterior descending coronary artery using an ipsilateral intraseptal bridging collateral tracking technique. Catheter Cardiovasc Interv 2010; 76:536-40. [DOI: 10.1002/ccd.22561] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Weisz G, Moses JW. Contemporary principles of coronary chronic total occlusion recanalization. Catheter Cardiovasc Interv 2010; 75 Suppl 1:S21-7. [PMID: 20333703 DOI: 10.1002/ccd.22382] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Giora Weisz
- Center for Interventional Vascular Therapy, New-York Presbyterian Hospital, Columbia University, and Cardiovascular Research Foundation, New York, New York 10032, USA.
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Bocksch W, Pomar F, Dziarmaga M, Tresukosol D, Ismail O, Janek B, Carlsson J, Simon JP. Clinical safety and efficacy of a novel thin-strut cobalt-chromium coronary stent system: results of the real world Coroflex Blue Registry. Catheter Cardiovasc Interv 2010; 75:78-85. [PMID: 19739262 DOI: 10.1002/ccd.22208] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this registry was to evaluate the clinical efficacy and safety of the Coroflex Blue cobalt-chromium stent in real-world practice. BACKGROUND The development of cobalt-chromium bare-metal stents (BMS) with thinner struts has lead to better deliverability and lower target-lesion revascularization rates compared with stainless steel BMS. METHODS The Coroflex Blue Registry was an international, prospective, multicenter registry enrolling patients with symptomatic ischemic heart disease attributable to single de novo or restenotic nonstented lesions of a single vessel amenable for percutaneous stenting. The primary end point was clinically driven target-lesion revascularisation (TLR) 6 months after enrolment, secondary endpoints were technical/procedural success, in-hospital outcome, definite stent thrombosis and major adverse cardiac events (death, myocardial infarction, or TLR) after 6 months. RESULTS The registry included 2,315 patients (mean age 64.3 +/- 11.1 years, 19.8% diabetes, 37.3% acute myocardial infarction). Although a complex lesion cohort with 60.3% Typ B(2)/C-lesions, the technical success rate was 99.1% and the procedural success rate 98.5%. The incidence of TLR after 6 months was 5.5% and the cumulative 6-month acute/subacute stent thrombosis rate was 1.6%. After 6 months cumulative event-free survival was 90.8% in all patients and 87% in patients with acute PCI for acute myocardial infarction. CONCLUSIONS This registry demonstrates the safety and efficacy of the Coroflex Blue cobalt-chromium stent platform in real-world practice. In the era of drug-eluting stents (DES), these results raise the serious question if the use of DES for primary prevention of restenosis and TLR is really justified.
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Affiliation(s)
- Wolfgang Bocksch
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
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Muramatsu T, Hirano K, Tsukahara R, Ito Y, Ishimori H, Nakano M, Sasao K, Sakai T, Araki M, Yamawaki M, Sasaki S, Moriyama A, Orita T, Takimura H, Sakamoto Y, Komatsu K. Long-term outcome of percutaneous transluminal coronary intervention for chronic total occlusion in the BMS era in Japan. Cardiovasc Interv Ther 2010; 25:78-84. [DOI: 10.1007/s12928-010-0016-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 01/15/2010] [Indexed: 11/30/2022]
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Lee SP, Kim SY, Park KW, Shin DH, Kang HJ, Koo BK, Suh JW, Cho YS, Yeon TJ, Chae IH, Choi DJ, Kim HS. Long-Term Clinical Outcome of Chronic Total Occlusive Lesions Treated With Drug-Eluting Stents: - Comparison of Sirolimus-Eluting and Paclitaxel-Eluting Stents -. Circ J 2010; 74:693-700. [DOI: 10.1253/circj.cj-09-0797] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Seung-Pyo Lee
- Cardiovascular Center, Seoul National University Hospital
| | - Song-Yi Kim
- Cardiovascular Center, Seoul National University Hospital
- Cardiovascular Center, Jeju National University Hospital
| | - Kyung-Woo Park
- Cardiovascular Center, Seoul National University Hospital
| | - Dong-Ho Shin
- Cardiovascular Center, Seoul National University Hospital
| | - Hyun-Jae Kang
- Cardiovascular Center, Seoul National University Hospital
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital
| | - Young-Seok Cho
- Cardiovascular Center, Seoul National University Bundang Hospital
| | - Tae-Jin Yeon
- Cardiovascular Center, Seoul National University Bundang Hospital
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital
| | - Dong-Ju Choi
- Cardiovascular Center, Seoul National University Bundang Hospital
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital
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Shen ZJ, GarcÃa-GarcÃa HM, Garg S, Onuma Y, Schenkeveld L, van Domburg RT, Serruys PW. Five-year clinical outcomes after coronary stenting of chronic total occlusion using sirolimus-eluting stents: Insights from the rapamycin-eluting stent evaluated at Rotterdam Cardiology Hospitalâ(Research) Registry. Catheter Cardiovasc Interv 2009; 74:979-86. [DOI: 10.1002/ccd.22230] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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