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Hirai K, Kawasaki T, Kishi K, Muramatsu T, Okada H, Oikawa Y, Yoshikawa R, Katoh H, Tsuchikane E, Tanaka H, Katoh O. Determinants of One-Year Outcome After Successful Percutaneous Coronary Intervention for Chronic Total Occlusion; Insight from Japanese CTO-PCI Expert Registry. Am J Cardiol 2024; 225:108-117. [PMID: 38885920 DOI: 10.1016/j.amjcard.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 05/30/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
Although outcomes have improved with new-generation drug-eluting stents, few reports have analyzed the risk factors associated with chronic outcomes of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI). This study aimed to investigate the independent risk factors for target lesion revascularization (TLR) and major adverse cardiac and cerebrovascular events (MACCEs) after CTO-PCI using Japanese multicenter data. A total of 3,666 patients, who underwent CTO-PCI and completed a 1-year follow-up, registered at the Japanese CTO-PCI Expert Registry from 2014 to 2019, were examined. The primary outcome was defined as TLR, and the secondary outcome was MACCEs at the 1-year follow-up. TLRs and MACCEs occurred in 175 (4.8%) and 524 (14.3%) patients, respectively. Multivariate logistic regression analysis demonstrated that in-stent occlusion (ISO) (odds ratio [OR] 2.604, 95% confidence interval [CI] 1.695 to 4.001), hemodialysis (OR 1.784, 95% CI 1.062 to 2.997), diabetes mellitus with insulin use (OR 1.741, 95% CI 1.060 to 2.861), moderate-to-severe calcification (OR 1.726, 95% CI 1.197 to 2.487), and the right coronary artery as the target vessel (OR 1.468, 95% CI 1.018 to 2.117) were significantly associated with TLR. Hemodialysis (OR 2.214, 95% CI 1.574 to 3.113), ISO (OR 1.499, 95% CI 1.127 to 1.993), arteriosclerosis obliterans (OR 1.414, 95% CI 1.074 to 1.863), and multivessel disease (OR 1.356, 95% CI 1.117 to 1.647) were significantly associated with MACCEs. One-year outcomes of new-generation drug-eluting stents for CTO-PCI were favorable, and ISO as a lesion factor and hemodialysis as a patient factor were strongly associated with TLR and MACCEs, respectively.
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Affiliation(s)
- Keisuke Hirai
- Department of Cardiology, Shin-Koga Hospital, Fukuoka, Japan.
| | | | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | | | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, the Cardiovascular Institute, Tokyo, Japan
| | | | - Harumi Katoh
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Okayama, Japan
| | | | - Hiroyuki Tanaka
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Osamu Katoh
- Department of Cardiology, Kusatsu Heart Center, Shiga, Japan
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Januszek R, Bryniarski L, Mashayekhi K, DI Mario C, Siłka W, Malinowski KP, Wańha W, Chyrchel M, Siudak Z. Annual operator volume and procedural outcomes of chronic total occlusions treated with percutaneous coronary interventions: analysis based on 14,899 patients. Minerva Cardiol Angiol 2024; 72:336-345. [PMID: 38482633 DOI: 10.23736/s2724-5683.23.06447-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
BACKGROUND Low operator and institutional volume is associated with poorer procedural and long-term clinical outcomes in patients treated with percutaneous coronary interventions (PCI). This study was aimed at evaluating the relationship between operator volume and procedural outcomes of patients treated with PCI for chronic total occlusion (CTO). METHODS Data were obtained from the national registry of percutaneous coronary interventions (ORPKI) collected from January 2014 to December 2020. The primary endpoint was a procedural success, defined as restoration of thrombolysis in myocardial infarction (TIMI) II/III flow without in-hospital cardiac death and myocardial infarction, whereas secondary endpoints included periprocedural complications. RESULTS Data of 14,899 CTO-PCIs were analyzed. The global procedural success was 66.1%. There was a direct relationship between the annual volume of CTO-PCIs per operator and the procedural success (OR: 1.006 [95% CI: 1.003-1.009]; P<0.001). The nonlinear relationships of annualized CTO-PCI volume per operator and adjusted outcome rates revealed that operators performing 40 CTO cases per year had the best procedural outcomes in terms of technical success (TIMI flow II/III after PCI), coronary artery perforation rate and any periprocedural complications rate (P<0.0001). Among the other factors associated with procedural success, the following can be noted: multi-vessel, left main coronary artery disease (as compared to single-vessel disease), the usage of rotablation as well as PCI within bifurcation. CONCLUSIONS High-volume CTO operators achieve greater procedural success with a lower frequency of periprocedural complications. Higher annual caseload might increase the overall quality of CTO-PCI.
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Affiliation(s)
- Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland -
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, Kraków, Poland -
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Carlo DI Mario
- Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Wojciech Siłka
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof P Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
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Blessing R, Keller K, Dimitriadis Z, Münzel T, Gori T, Hobohm L. Temporal trends of case-fatality in patients undergoing dual-injection coronary chronic total occlusion recanalization. Clin Res Cardiol 2024; 113:987-994. [PMID: 37695528 PMCID: PMC11219465 DOI: 10.1007/s00392-023-02298-x] [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: 04/16/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
AIMS Recently, interventional techniques and material to treat chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) have evolved significantly. Nevertheless, it is still unknown whether this progress improved treatment success and patients' outcome. In a nationwide sample, we sought to analyze trends of patients' characteristics, complications and in-hospital case-fatality of patients undergoing CTO revascularization in Germany. METHODS AND RESULTS We analyzed data on characteristics, treatments, and in-hospital outcomes for all coronary artery disease (CAD) patients (ICD-code I25) undergoing dual-injection CTO recanalization (OPS procedural code: 8-839.9) in Germany from 2009 to 2020. Overall, 4,998,457 inpatients aged ≥ 18 years with diagnosis of CAD were treated in German hospitals in this period. Among these, 52,879 patients (1.1%) underwent CTO recanalization. Annual number of CTO PCIs increased from 1263 in 2009 to 6435 in 2020 (β 3.48 [95% CI 3.44-3.52]; p < 0.001) in parallel with a significant decrease of case-fatality (2.2% in 2009 to 1.4% in 2020; β - 0.60 [95% CI - 0.82 to - 0.39]; p < 0.001). Overall, 754 (1.4%) patients with CTO recanalization died during the in-hospital stay and in-hospital case-fatality grew exponentially with age (β 0.82 [95% CI 0.73-0.90]; p < 0.001). Significant predictors of in-hospital case fatality with an OR > 3 were cancer, stroke, hemopericardium, acute renal failure, pulmonary embolism and shock. CONCLUSION Annual number of CTO procedures performed in Germany increased from 2009 to 2020 with a concomitant anti-proportional decrease in the case-fatality. Our findings may help to draw more attention to predictors of in-hospital case fatality in patients hospitalized for CTO recanalization.
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Affiliation(s)
- Recha Blessing
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55131, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Zisis Dimitriadis
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Frankfurt, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Berlin, Germany
| | - Tommaso Gori
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Berlin, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55131, Mainz, Germany.
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
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Tanaka H, Tsuchikane E, Kishi K, Okada H, Oikawa Y, Ito Y, Muramatsu T, Yoshikawa R, Kawasaki T, Okamura A, Sumitsuji S, Muto M, Katoh O. Retrograde Coronary Chronic Total Occlusion Intervention (JR-CTO) Score: From the Japanese CTO-PCI Expert Registry. JACC Cardiovasc Interv 2024; 17:1374-1384. [PMID: 38703149 DOI: 10.1016/j.jcin.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Despite the effectiveness of the retrograde approach for chronic total occlusion (CTO) lesions, there are no standardized tools to predict the success of retrograde percutaneous coronary intervention (PCI). OBJECTIVES The aim of this study was to develop a prediction tool to identify CTO lesions that will achieve successful retrograde PCI. METHODS This study evaluated data from 2,374 patients who underwent primary retrograde CTO-PCI and were enrolled in the Japanese CTO-PCI Expert Registry between January 2016 and December 2022 (NCT01889459). All observations were randomly assigned to the derivation and validation cohorts at a 2:1 ratio. The prediction score for guidewire failure in retrograde CTO-PCI was determined by assigning 1 point for each factor and summing all accrued points. RESULTS The JR-CTO score (moderate-severe calcification, tortuosity, Werner collateral connection grade ≤1, and nonseptal collateral channel) demonstrated a C-statistic for guidewire failure of 0.72 (95% CI: 0.67-0.76) and 0.71 (95% CI: 0.64-0.77) in the derivation and validation cohorts, respectively. Patients with lower scores had higher guidewire and technical success rates and decreased guidewire crossing time and procedural time (P < 0.01). CONCLUSIONS The JR-CTO (Japanese Retrograde Chronic Total Occlusion) score, a simple 4-item score that predicts successful guidewire crossing in patients undergoing retrograde CTO-PCI, has the potential to support clinical decision-making for the retrograde approach.
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Affiliation(s)
| | | | | | | | | | - Yoshiaki Ito
- Saiseikai Yokohama-City Eastern Hospital, Kanagawa, Japan
| | | | | | | | | | - Satoru Sumitsuji
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Makoto Muto
- Saitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan
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Mutlu D, Brilakis ES. The Role of Retrograde Crossing in Short Coronary Chronic Total Occlusions. Am J Cardiol 2024; 220:120-121. [PMID: 38583698 DOI: 10.1016/j.amjcard.2024.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Deniz Mutlu
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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Etriby KAE, Okasha NK, Zahran MES, Mohamed TR. Impact of successful antegrade and retrograde CTO PCI on short-term prognosis. Egypt Heart J 2024; 76:66. [PMID: 38816558 PMCID: PMC11139834 DOI: 10.1186/s43044-024-00501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/26/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) carries risk of complications and should be attempted when the anticipated benefits exceed the potential risks. The primary indication for CTO-PCI is symptom improvement. However, the impact of CTO-PCI on angina and subsequent incidence of major adverse cardiovascular event (MACE) rate remains controversial. Our aim was to study the impact of technically successful elective CTO-PCI on the procedural success rate and short-term MACE. The current study was a prospective cohort study that included a total of 80 patients who were referred to our center (Ain Shams University Hospitals) for elective CTO-PCI and underwent technically successful CTO-PCI. Data were collected on patient arrival to our department, and then, the patients were observed during hospital admission to record any In-Hospital MACE. These patients were then followed up for 6 months to record improvement or worsening of their symptoms and to assess occurrence of any MACE including hospitalization and undergoing symptom-driven coronary angiography. RESULTS The mean age of our patients was 56 ± 9.6 years, and 73 patients (91%) were men. Sixty-two patients (77.5%) were done via an antegrade approach, and 18 patients (22.5%) were done via a retrograde approach with an overall procedural success rate of 91.25% (antegrade 93.5%, retrograde 83.3%). The overall mean procedure time was 102 min, the mean contrast volume used was 371 ml, and the mean cumulative air kerma dose was 7.2 Gy. The retrograde group required longer procedure times, larger volumes of contrast and higher exposure to radiation. The overall in-hospital MACE was 8.75%. Sixty-five patients in our study (81.25%) showed an improvement in the grade of their exertional dyspnea or angina within the 6-month follow-up period. Thirteen patients in our study (16.25%) needed re-hospitalization within a 6-month period after PCI. The overall target lesion revascularization rate at 6 months was 8.75%. CONCLUSIONS Technically successful CTO PCI in a well-equipped center with highly qualified CTO operators resulted in high procedural success rates and low incidence of short-term MACE.
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Affiliation(s)
| | | | | | - Tarek Rashid Mohamed
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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7
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Ochiumi Y, Tsuchikane E, Kishi K, Okada H, Ito Y, Oikawa Y, Yoshikawa R, Okamura A, Tanaka H, Katoh O. The Characteristics of Primary Retrograde Approach Selection for Native Coronary Chronic Occlusion With Short Occlusion Length from the Japanese CTO-PCI Expert Registry. Am J Cardiol 2024; 218:113-120. [PMID: 38432339 DOI: 10.1016/j.amjcard.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/30/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Although the coronary chronic total occlusion (CTO) crossing algorithm has been published, the characteristics associated with the first strategy selection for short-length lesions <20 mm is still debatable. This study aimed to determine the characteristics associated with primary retrograde approach (PRA) for native CTO with short occlusion length in percutaneous coronary intervention (PCI). Between January 2014 and December 2021, we examined data on 4,088 lesions in the Japanese CTO-PCI Expert Registry with occlusion lengths <20 mm. Then, the characteristics for short-length CTO, which was performed by way of the PRA, were assessed. PRA was performed in 785 patients (19.2%). The guidewire success rate was 93.6%, and the technical success rate was 91.3%. Previous coronary artery bypass grafting, chronic kidney disease, and 6 lesion/anatomic characteristics (i.e., blunt stump, distal runoff <1 mm, CTO lesion tortuosity, reattempt procedures, ostial location, and the presence of collateral channel grade 2) were associated with PRA (p <0.05). Moreover, hemodialysis was an independent factor of unsuccessful anterograde guidewire crossing, along with distal runoff <1 mm, the existence of calcification, and CTO lesion tortuosity (all p <0.05). In clinical settings, these independent factors for PRA in short-length CTO can help in selecting the CTO-PCI strategy.
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Affiliation(s)
- Yusuke Ochiumi
- Department of Cardiology, Hiroshima Heart Center, Hiroshima, Japan
| | | | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshiaki Ito
- Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Kanagawa, Japan
| | - Yuji Oikawa
- Departmentof Cardiovascular Medicine, the Cardiovascular Institute, Tokyo, Japan
| | | | - Atsunori Okamura
- Division of Cardiology, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
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Alexandrou M, Rempakos A, Mutlu D, Ogaili AA, Choi JW, Poommipanit P, Alaswad K, Basir MB, Davies R, Benton S, Jaffer FA, Chandwaney RH, Kearney KE, ElGuindy AM, Rafeh NA, Goktekin O, Gorgulu S, Khatri JJ, Krestyaninov O, Khelimskii D, Rangan BV, Mastrodemos OC, Burke MN, Sandoval Y, Lombardi WL, Brilakis ES, Azzalini L. Comparative Analysis of Polymer Versus Non-Polymer Jacketed Wires in Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol 2024; 215:10-18. [PMID: 38224729 DOI: 10.1016/j.amjcard.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
There is significant variation in wire utilization patterns for chronic total occlusion (CTO) percutaneous coronary intervention. This study aimed to compare the outcomes of polymer-jacketed wires (PJWs) versus non-PJWs in anterograde procedures. We analyzed clinical and angiographic characteristics, and procedural outcomes of 7,575 anterograde CTO percutaneous coronary interventions that were performed at 47 centers between 2012 and 2023. Cases in which PJWs were exclusively used were classified in the PJW group, whereas cases where at least one non-PJW was employed were classified in the non-PJW group. Study end points were as follows: technical success, coronary perforation, major adverse cardiac event. PJWs were exclusively used in 3,481 cases (46.0%). These cases had lower prevalence of proximal cap ambiguity, blunt stump, and moderate/severe calcification. They also had lower Japanese CTO (J-CTO), Prospective Global Registry for the Study of Chronic Total Occlusion (PROGRESS-CTO), and PROGRESS-CTO complications scores, higher technical success (94.3% vs 85.7%, p <0.001), and lower perforation rates (2.2% vs 3.2%, p = 0.013). Major adverse cardiac event rates did not differ between groups (1.3% vs 1.5%, p = 0.53). Exclusive use of PJWs was independently associated with higher technical success in both the multivariable (odds ratio [OR] 2.66, 95% confidence interval [CI] 2.13 to 3.36, p <0.001) and inverse probability of treatment weight analysis (OR 2.43, 95% CI 2.04 to 2.89, p <0.001). Exclusive use of PJWs was associated with lower risk of perforation in the multivariable analysis (OR 0.69, 95% CI 0.49 to 0.95, p = 0.02), and showed a similar trend in the inverse probability of treatment weight analysis (OR 0.77, 95% CI 0.57 to 1.04, p = 0.09). Exclusive use of PJWs is associated with higher technical success and lower perforation risk in this non-randomized series of patients.
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Affiliation(s)
- Michaella Alexandrou
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Athanasios Rempakos
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Deniz Mutlu
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ahmed Al Ogaili
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Paul Poommipanit
- Section of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Mir Babar Basir
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Rhian Davies
- Department of Cardiology, WellSpan York Hospital, York, Pennsylvania
| | - Stewart Benton
- Department of Cardiology, WellSpan York Hospital, York, Pennsylvania
| | - Farouc A Jaffer
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Raj H Chandwaney
- Department of Invasive Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | - Nidal Abi Rafeh
- Department of Cardiology, North Oaks Health System, Hammond, Louisiana
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | | | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Dmitrii Khelimskii
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Bavana V Rangan
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Olga C Mastrodemos
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - M Nicholas Burke
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - William L Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Emmanouil S Brilakis
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
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Vadalà G, Galassi AR, Werner GS, Sianos G, Boudou N, Garbo R, Maniscalco L, Bufe A, Avran A, Gasparini GL, La Scala E, Ladwiniec A, Saghatelyan M, Goktekin O, Gorgulu S, Reifart N, Agostoni P, Rathore S, Ayoub M, Behnes M, Atmowihardjo I, Iannaccone M, Diletti R, Di Mario C, Mashayekhi K, Euro Cto Investigators OBOT. Contemporary outcomes of chronic total occlusion percutaneous coronary intervention in Europe: the ERCTO registry. EUROINTERVENTION 2024; 20:e185-e197. [PMID: 38343371 PMCID: PMC10836392 DOI: 10.4244/eij-d-23-00490] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/28/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Percutaneous coronary interventions (PCI) of chronic total occlusions (CTO) have reached high procedural success rates thanks to dedicated equipment, evolving techniques, and worldwide adoption of state-of-the-art crossing algorithms. AIMS We report the contemporary results of CTO PCIs performed by a large European community of experienced interventionalists. Furthermore, we investigated the impact of different risk factors for procedural major adverse cardiac and cerebrovascular events (MACCE) and trends of employment of specific devices like dual lumen microcatheters, guiding catheter extensions, intravascular ultrasound and calcium-modifying tools. METHODS We evaluated data from 8,673 CTO PCIs included in the European Registry of Chronic Total Occlusion (ERCTO) between January 2021 and October 2022. RESULTS The overall technical success rate was 89.1% and was higher in antegrade as compared with retrograde cases (92.8% vs 79.3%; p<0.001). Compared with antegrade procedures, retrograde procedures had a higher complexity of attempted lesions (Japanese CTO [J-CTO] score: 3.0±1.0 vs 1.9±1.2; p<0.001), a higher procedural and in-hospital MACCE rate (3.1% vs 1.2%; p<0.018) and a higher perforation rate with and without tamponade (1.5% vs 0.4% and 8.3% vs 2.1%, respectively; p<0.001). As compared with mid-volume operators, high-volume operators had a higher technical success rate in antegrade and retrograde procedures (93.4% vs 91.2% and 81.5% vs 69.0%, respectively; p<0.001), and had a lower MACCE rate (1.47% vs 2.41%; p<0.001) despite a higher mean complexity of the attempted lesions (J-CTO score: 2.42±1.28 vs 2.15±1.27; p<0.001). CONCLUSIONS The adoption of different recanalisation techniques, operator experience and the use of specific devices have contributed to a high procedural success rate despite the high complexity of the lesions documented in the ERCTO.
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Affiliation(s)
- Giuseppe Vadalà
- Division of Cardiology, University Hospital "P. Giaccone", Palermo, Italy
| | - Alfredo R Galassi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Gerald S Werner
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | | | | | - Roberto Garbo
- Maria Pia Hospital, GVM Care & Research, Turin, Italy
| | - Laura Maniscalco
- Division of Cardiology, University Hospital "P. Giaccone", Palermo, Italy
| | - Alexander Bufe
- Helios Klinikum Krefeld, University Witten/Herdecke, Witten, Germany
| | | | | | | | - Andrew Ladwiniec
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Meruzhan Saghatelyan
- Erebouni Medical Center, Yerevan, Armenia and Nork-Marash Medical Center (NMMC), Yerevan, Armenia
| | | | - Sevket Gorgulu
- Department of Cardiology, Acibadem University Istanbul, Istanbul, Turkey
| | | | | | - Sudhir Rathore
- Frimley Park Hospital, NHS Foundation Trust, Camberley, United Kingdom
| | - Mohamed Ayoub
- University Heart Center NRW, Bad Oeynhausen, Germany
| | | | - Iskander Atmowihardjo
- Department of Cardiology and Angiology, DRK Kliniken Berlin Köpenick, Berlin, Germany
| | | | - Roberto Diletti
- Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
| | - Carlo Di Mario
- Department of Clinical & Experimental Medicine, Structural Interventional Cardiology Division, Careggi University Hospital, Florence, Italy
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology, University Heart Center, University Freiburg, Freiburg, Germany
- Department of Internal Medicine and Cardiology, Heart Center Lahr, Lahr, Germany
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10
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Yamane M. Editorial: Old CTO technique in a new slice. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 59:53-54. [PMID: 37951757 DOI: 10.1016/j.carrev.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
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11
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Konstantinidis NV, Chevalier B, Hovasse T, Garot P, Benamer H, Unterseeh T, Champagne S, Sanguineti F, Neylon A, Moysiadis T, Avran A, Louvard Y, Lefèvre T. Interventions in chronic total occlusions with bifurcation lesions: incidence, treatment, and in-hospital outcome. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:980-990. [PMID: 37245654 DOI: 10.1016/j.rec.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/29/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION AND OBJECTIVES Coronary chronic total occlusions (CTO) involving bifurcation lesions are a challenging lesion subset that is understudied in the literature. This study analyzed the incidence, procedural strategy, in-hospital outcomes and complications of percutaneous coronary interventions (PCI) for bifurcation-CTO (BIF-CTO). METHODS We assessed data from 607 consecutive CTO patients treated at the Institut Cardiovasculaire Paris Sud (ICPS), Massy, France between January 2015 and February 2020. Procedural strategy, in-hospital outcomes and complication rates were compared between 2 patient subgroups: BIF-CTO (n=245=and non-BIF-CTO (n=362). RESULTS The mean patient age was 63.2±10.6 years; 79.6% were men. Bifurcation lesions were involved in 40.4% of the procedures. Overall lesion complexity was high (mean J-CTO score 2.30±1.16, mean PROGRESS-CTO score 1.37±0.94). The preferred bifurcation treatment strategy was a provisional approach (93.5%). BIF-CTO patients presented with higher lesion complexity, as assessed by J-CTO score (2.42±1.02 vs 2.21±1.23 in the non-BIF-CTO patients, P=.025) and PROGRESS-CTO score (1.60±0.95 vs 1.22±0.90 in the non-BIF-CTO patients, P<.001). Procedural success was 78.9% and was not affected by the presence of bifurcation lesions (80.4% in the BIF-CTO group, 77.8% in the non-BIF-CTO-CTO group, P=.447) or the bifurcation site (proximal BIF-CTO 76.9%, mid-BIF-CTO 83.8%, distal BIF-CTO 85%, P=.204). Complication rates were similar in BIF-CTO and non-BIF-CTO. CONCLUSIONS The incidence of bifurcation lesions is high in contemporary CTO PCI. Patients with BIF-CTO present with higher lesion complexity, with no impact on procedural success or complication rates when the predominant strategy is provisional stenting.
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Affiliation(s)
- Nikolaos V Konstantinidis
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France; Interventional Cardiology Department, St Luke's Hospital, Thessaloniki, Greece
| | - Bernard Chevalier
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Thomas Hovasse
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Philippe Garot
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Hakim Benamer
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Thierry Unterseeh
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Stephane Champagne
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Francesca Sanguineti
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Antoinette Neylon
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Theodoros Moysiadis
- Department of Computer Science, School of Sciences and Engineering, University of Nicosia, 2417, Nicosia, Cyprus
| | - Alexandre Avran
- Department of Cardiology, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Yves Louvard
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Thierry Lefèvre
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
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12
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Allana SS, Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Alexandrou M, Choi JW, Alaswad K, Krestyaninov O, Khelimskii D, Gorgulu S, Davies R, Benton S, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Azzalini L, Kearney K, Chandwaney R, Nicholson W, Jaber W, Rinfret S, Frizzell J, Patel T, Jefferson B, Aygul N, Rangan BV, Brilakis ES. The Retrograde Approach to Chronic Total Occlusion Percutaneous Coronary Interventions: Technical Analysis and Procedural Outcomes. JACC Cardiovasc Interv 2023; 16:2748-2762. [PMID: 38030360 DOI: 10.1016/j.jcin.2023.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with lower success and higher complication rates when compared with the antegrade approach. OBJECTIVES This study sought to assess contemporary techniques and outcomes of retrograde CTO PCI. METHODS We examined the baseline characteristics, procedural techniques and outcomes of 4,058 retrograde CTO PCIs performed at 44 centers between 2012 and 2023. Major adverse cardiac events (MACE) included any of the following in-hospital events: death, myocardial infarction, repeat target vessel revascularization, pericardiocentesis, cardiac surgery, and stroke. RESULTS The average J-CTO (Multicenter CTO Registry in Japan) score was 3.1 ± 1.1. Retrograde crossing was successful in 60.5% and lesion crossing in 81.6% of cases. The collaterals pathways successfully used were septals in 62.0%, saphenous vein grafts in 17.4%, and epicardials in 19.1%. The technical and procedural success rates were 78.7% and 76.6%, respectively. When retrograde crossing failed, technical success was achieved in 50.3% of cases using the antegrade approach. In-hospital MACE was 3.5%. The clinical coronary perforation rate was 5.8%. The incidence of in-hospital MACE with retrograde true lumen crossing, just marker antegrade crossing, conventional reverse controlled antegrade and retrograde tracking (CART), contemporary reverse CART, extended reverse CART, guide-extension reverse CART, and CART was 2.1%, 0.8%, 5.5%, 3.0%, 2.1%, 3.2%, and 4.1%, respectively; P = 0.01). CONCLUSIONS Retrograde CTO PCI is utilized in highly complex cases and yields moderate success rates with 5.8% perforation and 3.5% periprocedural MACE rates. Among retrograde crossing strategies, retrograde true lumen puncture was the safest. There is need for improvement of the efficacy and safety of retrograde CTO PCI.
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Affiliation(s)
- Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | | | | | - Dmitrii Khelimskii
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | | | | | | | | | | | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kathleen Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | | | | | - Taral Patel
- Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | - Brian Jefferson
- Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | | | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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13
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Ahn J, Yu H, Rha SW, Choi BG, Park S, Park EJ, Kang DO, Choi CU. Long-term clinical outcomes following successful percutaneous coronary intervention in patients with extremely long coronary chronic total occlusion lesions. Catheter Cardiovasc Interv 2023; 102:878-884. [PMID: 37681968 DOI: 10.1002/ccd.30829] [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: 07/10/2023] [Revised: 08/20/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Lesion length is related to worse clinical outcomes following percutaneous coronary intervention (PCI) for the treatment of chronic total occlusion (CTO). However, the data to confirm the association between extremely long lesions and clinical hard endpoints have been limited. Therefore, we investigated the impact of extremely long CTO lesions (≥50 mm, treated lesion length) on the long-term clinical outcomes following successful PCI. METHODS A total of 333 consecutive patients with CTO who underwent successful PCI with drug-eluting stents (DESs) were allocated to either the extremely long or the short CTO group according to their CTO lesion length. The 5-year clinical outcomes were compared between the two groups. The incidence of myocardial infarction, cardiac death (CD), revascularization, and major adverse cardiovascular events (MACE) was higher in the extremely long CTO group. The 5-year clinical outcomes were analyzed using the Cox hazard ratio (HR) model. RESULTS In the entire study population, the extremely long CTO lesion was an independent predictor for higher rate of revascularization, MACE, CD, or mortality. CONCLUSIONS In our study, CTO patients with extremely long lesions (≥50 mm) who underwent successful PCI were associated with a higher risk of worse long-term clinical outcomes, including hard clinical endpoints such as CD and mortality even in the DESs era.
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Affiliation(s)
- Jihun Ahn
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - HyeYon Yu
- School of Nursing, College of Medicine, Soonchunhyang University, Asan, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Eun Jin Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
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14
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Mohebbi B, Sadeghipour P, Zolfaghari R, Vadalà G, Khalilipur E, Zahedmehr A, Diana D, Maadani M, Shakerian F, Kiani R, Hosseini Z, Rashidinejad A, Rouzitalab M, Khalesi S, Toulabi V, Sucato V, Di Fazio L, Taherian M, Amiripouya S, Ashuri S, Bayatian A, Naderi S, Bakhshandeh H, Moosavi J, Abdi S, Firouzi A, Alemzadeh-Ansari MJ, Galassi AR. Outcomes of chronic total occlusion percutaneous coronary intervention from the RAIAN (RAjaie - Iran) registry. Indian Heart J 2023; 75:429-435. [PMID: 37866775 PMCID: PMC10774591 DOI: 10.1016/j.ihj.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 05/24/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE While most of the evidence in CTO interventions emerge from Western and Japanese studies, few data have been published up today from the Middle East. Objective of this study was to evaluate technical success rates and clinical outcomes of an Iranian population undergoing CTO PCI in a tertiary referral hospital. Moreover, we sought to evaluate the efficacy of our CTO teaching program. METHODS This is a retrospective single-center cohort study including 790 patients who underwent CTO PCI performed by operators with different volumes of CTOs PCI performed per year. According to PCI result, all patients have been divided into successful (n = 555, 70.3 %) and unsuccessful (n = 235, 29.7 %) groups. Study endpoints were Major Adverse Cardiovascular Events and Health Status Improvement evaluated using the Seattle Angina Questionnaire at one year. RESULTS A global success rate of 70 % for antegrade and 80 % for retrograde approach was shown despite the lack of some CTO-dedicated devices. During the enrollment period, the success rate increased significantly among operators with a lower number of CTO procedures per year. One-year MACE rate was similar in both successful and unsuccessful groups (13.5 % in successful and 10.6 % in unsuccessful group, p = 0.173). One year patients' health status improved significantly only in successful group. CONCLUSIONS No significant differences of in-hospital and one-year MACE were found between the successful and unsuccessful groups. Angina symptoms and quality of life significantly improved after successful CTO PCI. The RAIAN registry confirmed the importance of operator expertise for CTO PCI success.
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Affiliation(s)
- Bahram Mohebbi
- Cardiovascular Intervention Research Center, Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Zolfaghari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Giuseppe Vadalà
- Cardiology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) "G. D'Alessandro", Paolo Giaccone Hospital, University of Palermo, Italy.
| | - Ehsan Khalilipur
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Zahedmehr
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Davide Diana
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Mohsen Maadani
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Shakerian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Kiani
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahara Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Rashidinejad
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Rouzitalab
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Khalesi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Toulabi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vincenzo Sucato
- Cardiology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) "G. D'Alessandro", Paolo Giaccone Hospital, University of Palermo, Italy
| | - Luca Di Fazio
- Cardiology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) "G. D'Alessandro", Paolo Giaccone Hospital, University of Palermo, Italy
| | - Maisam Taherian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Amiripouya
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Ashuri
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ayatollah Bayatian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sajad Naderi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshandeh
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamal Moosavi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alfredo R Galassi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
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15
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Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Allana SS, Alexandrou M, Gorgulu S, Alaswad K, Basir MB, Davies RE, Benton SM, Krestyaninov O, Khelimskii D, Frizzell J, Ybarra LF, Bagur R, Reddy N, Kerrigan JL, Haddad EV, Love M, Elbarouni B, Soylu K, Yildirim U, Dattilo P, Azzalini L, Kearney K, Sadek Y, ElGuindy AM, Abi Rafeh N, Goktekin O, Mastrodemos OC, Rangan BV, Sandoval Y, Burke MN, Brilakis ES. Impact of calcium on the procedural techniques and outcomes of chronic total occlusion percutaneous coronary intervention. Int J Cardiol 2023; 390:131254. [PMID: 37562751 DOI: 10.1016/j.ijcard.2023.131254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Coronary calcification is common and increases the difficulty of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We examined the impact of calcium on procedural outcomes of 13,079 CTO PCIs performed in 12,799 patients at 46 US and non-US centers between 2012 and 2023. RESULTS Moderate or severe calcification was present in 46.6% of CTO lesions. Patients whose lesions were calcified were older and more likely to have had prior coronary artery bypass graft surgery. Calcified lesions were more complex with higher J-CTO score (3.0 ± 1.1 vs. 1.9 ± 1.2; p < 0.001) and lower technical (83.0% vs. 89.9%; p < 0.001) and procedural (81.0% vs. 89.1%; p < 0.001) success rates compared with mildly calcified or non-calcified CTO lesions. The retrograde approach was more commonly used among cases with moderate/severe calcification (40.3% vs. 23.5%; p < 0.001). Balloon angioplasty (76.6%) was the most common lesion preparation technique for calcified lesions, followed by rotational atherectomy (7.3%), laser atherectomy (3.4%) and, intravascular lithotripsy (3.4%). The incidence of major adverse cardiovascular events (MACE) was higher in cases with moderate or severe calcification (3.0% vs. 1.2%; p < 0.001), as was the incidence of perforation (6.5% vs. 3.4%; p < 0.001). On multivariable analysis, the presence of moderate/severe calcification was independently associated with lower technical success (odds ratio, OR = 0.73, 95% CI: 0.63-0.84) and higher MACE (OR = 2.33, 95% CI: 1.66-3.27). CONCLUSIONS Moderate/severe calcification was present in nearly half of CTO lesions, and was associated with higher utilization of the retrograde approach, lower technical and procedural success rates, and higher incidence of in-hospital MACE.
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Affiliation(s)
- Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | | | | | | | | | | | | | - Jarrod Frizzell
- The Christ Hospital, Ohio Heart and Vascular, Cincinnati, OH, USA
| | - Luiz F Ybarra
- London Health Sciences Center, Western University, London, ON, Canada
| | - Rodrigo Bagur
- London Health Sciences Center, Western University, London, ON, Canada
| | | | | | | | - Michael Love
- St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | | | - Korhan Soylu
- Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Ufuk Yildirim
- Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Philip Dattilo
- UC Health Medical Center of the Rockies, Loveland, CO, USA
| | | | | | | | | | | | | | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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16
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Niizeki T, Tsuchikane E, Konta T, Kishi K, Okada H, Ito Y, Oikawa Y, Yoshikawa R, Tanaka H. New Angiographic Difficulty Score for First-Attempt Chronic Total Occlusion in the 3 Major Coronary Arteries. JACC Cardiovasc Interv 2023; 16:2542-2551. [PMID: 37879806 DOI: 10.1016/j.jcin.2023.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is still challenging due to complex lesion morphology. Success rates may vary among the 3 major coronary arteries, influenced by clinical and angiographic characteristics. OBJECTIVES This study sought to evaluate the differences in the predictors of unsuccessful PCI in first-attempt CTO lesions of the 3 major coronary arteries compared with the J-CTO (Japanese CTO) score. METHODS This study assessed 6,408 first-attempt CTO patients from the Japanese CTO-PCI expert registry between January 2014 and December 2021, randomly assigned to derivation and validation sets. Difficulty scores for each artery were determined by assigning points to predictive unsuccessful factors. RESULTS The CTO lesions were distributed as follows: left anterior descending coronary artery: 2,245 (35%), left circumflex coronary artery: 1,131 (18%), and right coronary artery (RCA): 3,032 (47%). Regarding success rates, left circumflex coronary artery CTO had the lowest procedural success rate (90%) followed by RCA CTO (92%) and left anterior descending coronary artery CTO (94%). RCA CTO was significantly longer and more severely angulated, requiring more often the retrograde approach. A multivariate logistic analysis revealed that predictors of failed PCI were different in CTO lesions among the 3 major coronary arteries, respectively. Moreover, our difficulty score for RCA CTO was superior to the J-CTO score in predicting unsuccessful PCI. CONCLUSIONS Clinical and angiographic differences might explain the discrepancies of success rates in CTO lesions among the 3 major coronary arteries. Our novel difficulty score was comparable to the J-CTO score in predicting unsuccessful CTO-PCI with a superior discriminatory capacity.
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Affiliation(s)
- Takeshi Niizeki
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | | | - Tsuneo Konta
- Department of Public Health and Hygiene, Yamagata University School of Medicine, Yamagata, Japan
| | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshiaki Ito
- Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Kanagawa, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | | | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
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17
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Denby K, Young L, Ellis S, Khatri J. Antegrade wire escalation in chronic total occlusions: State of the art review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 55:88-95. [PMID: 37353443 DOI: 10.1016/j.carrev.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
Coronary chronic total occlusion percutaneous coronary intervention treatment algorithms have helped to standardize crossing strategy sequence to improve efficacy and efficiency of CTO interventions based on angiographic criteria. Unfortunately, advanced crossing techniques such as a retrograde and subintimal guidewire tracking and reentry that have accelerated procedural success in more difficult lesions are associated with higher major adverse cardiac event rates as compared with traditional antegrade and intimal guidewire tracking. In this regard, antegrade wire escalation (AWE) remains the most common CTO crossing strategy. In this state of the art review, we outline the techniques employed to maximize the clinical utility of AWE crossing strategy for both novice operators as well as those experienced with the advanced crossing strategies. For the less experienced operator, these techniques may provide a framework to treat more patients safely and effectively without the need to refer to a more advanced operator. Whereas these same techniques may be employed by an advanced operator to improve the technical success in procedures requiring more advanced crossing strategies.
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Affiliation(s)
- Kara Denby
- Interventional Cardiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America
| | - Laura Young
- Interventional Cardiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America
| | - Stephen Ellis
- Interventional Cardiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America
| | - Jaikirshan Khatri
- Interventional Cardiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America.
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Allana SS, Brilakis ES. Reply: Distal Target Vessel Characterization in CTO Vessels: Not Black or White. JACC Cardiovasc Interv 2023; 16:2188. [PMID: 37704307 DOI: 10.1016/j.jcin.2023.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023]
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19
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Karacsonyi J, Stanberry L, Simsek B, Kostantinis S, Allana SS, Rempakos A, Okeson B, Alaswad K, Basir MB, Jaffer F, Poommipanit P, Khatri J, Patel M, Mahmud E, Sheikh A, Wollmuth JR, Yeh RW, Chandwaney RH, ElGuindy AM, Abi Rafeh N, Schimmel DR, Benzuly K, Burke MN, Rangan BV, Mastrodemos OC, Sandoval Y, Ungi I, Brilakis ES. Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol 2023; 202:111-118. [PMID: 37429059 DOI: 10.1016/j.amjcard.2023.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 07/12/2023]
Abstract
Estimating the likelihood of urgent mechanical circulatory support (MCS) can facilitate procedural planning and clinical decision-making in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,784 CTO PCIs performed between 2012 and 2021 at 12 centers. The variable importance was estimated by a bootstrap applying a random forest algorithm to a propensity-matched sample (a ratio of 1:5 matching cases with controls on center). The identified variables were used to predict the risk of urgent MCS. The performance of the risk model was assessed in-sample and on 2,411 out-of-sample procedures that did not require urgent MCS. Urgent MCS was used in 62 (2.2%) of cases. Patients who required urgent MCS were older (70 [63 to 77] vs 66 [58 to 73] years, p = 0.003) compared with those who did not require urgent MCS. Technical (68% vs 87%, p <0.001) and procedural success (40% vs 85%, p <0.001) was lower in the urgent MCS group compared with cases that did not require urgent MCS. The risk model for urgent MCS use included retrograde crossing strategy, left ventricular ejection fraction, and lesion length. The resulting model demonstrated good calibration and discriminatory capacity with the area under the curve (95% confidence interval) of 0.79 (0.73 to 0.86) and specificity and sensitivity of 86% and 52%, respectively. In the out-of-sample set, the specificity of the model was 87%. The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention CTO MCS score can help estimate the risk of urgent MCS use during CTO PCI.
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Affiliation(s)
- Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Larissa Stanberry
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Salman S Allana
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Athanasios Rempakos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Brynn Okeson
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Mir B Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Farouc Jaffer
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul Poommipanit
- Department of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mitul Patel
- Cardiovascular Institute, VA San Diego Healthcare System and University of California San Diego, La Jolla, California
| | - Ehtisham Mahmud
- Cardiovascular Institute, VA San Diego Healthcare System and University of California San Diego, La Jolla, California
| | - Abdul Sheikh
- Interventional Cardiology Department, WellStar Health System, Marietta, Georgia
| | - Jason R Wollmuth
- Interventional Cardiology, Providence Heart Institute, Portland, Oregon
| | - Robert W Yeh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Raj H Chandwaney
- Interventional Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Nidal Abi Rafeh
- Department of Cardiology, North Oaks Health System, Hammond, Louisiana
| | - Daniel R Schimmel
- Cardiovascular Care, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Keith Benzuly
- Cardiovascular Care, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - M Nicholas Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bavana V Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Olga C Mastrodemos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Imre Ungi
- Division of Invasive Cardiology, Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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20
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Wu X, Wu M, Huang H, Liu Z, Cai J, Zhang Q, Huang H. Antegrade versus Retrograde Approach for Recanalization of Ostial or Stumpless Coronary Chronic Total Occlusion. Int J Gen Med 2023; 16:3995-4005. [PMID: 37674582 PMCID: PMC10479831 DOI: 10.2147/ijgm.s429956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
Purpose This research aimed to evaluate the procedural and in-hospital clinical outcomes of percutaneous coronary intervention (PCI) for ostial or stumpless chronic total occlusion (CTO) utilizing both the antegrade-only and retrograde approaches. Methods A comprehensive retrospective examination was conducted on the procedural and in-hospital clinical outcomes of 89 consecutive patients subjected to ostial or stumpless CTO PCI at our institution between April 2015 and October 2022. Results The antegrade-only technique demonstrated a superior technical success rate (92.0% vs 71.9%, p = 0.041) and procedural success rate (92.0% vs 68.8%, p = 0.022) in comparison to the retrograde approach (RA). The RA group presented a notably elevated Japanese-CTO (J-CTO) score relative to the antegrade-only approach group (2.45±0.73 vs 1.64±0.70, p < 0.001). The antegrade-only approach group manifested an increased frequency of microchannels at the proximal stump relative to the RA group (56.0% vs 10.9%, p < 0.001). In-hospital major adverse cardiac events (MACE) and in-hospital myocardial infarction (MI) were observed more prevalently in the RA group (18.8% vs 0, p = 0.003; 15.6% vs 0, p = 0.008; respectively). A J-CTO score below 2 and the manifestation of microchannels at the proximal stump were identified as predictors for successful antegrade-only approach PCI for ostial or stumpless CTO (OR: 2.79 [95% CI: 1.92-5.03, P =0.003]; OR: 2.89 [95% CI: 1.32-6.03, P =0.001]; respectively). Conclusion Relative to RA PCI for ostial or stumpless CTO, the antegrade-only approach is utilized for less complex CTO lesions and is associated with a diminished probability of in-hospital MACE.
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Affiliation(s)
- Xi Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Mingxing Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Haobo Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Zhe Liu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Jie Cai
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Qizhou Zhang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - He Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
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21
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Allana SS, Kostantinis S, Simsek B, Karacsonyi J, Rempakos A, Alaswad K, Krestyaninov O, Khelimskiid D, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Patel MP, Mahmud E, Koutouzis M, Tsiafoutis I, Gorgulu S, Elbarouni B, Nicholson W, Jaber W, Rinfret S, Rafeh NA, Goktekin O, ElGuindy AM, Sandoval Y, Burke MN, Rangan BV, Brilakis ES. Distal Target Vessel Quality and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:1490-1500. [PMID: 37380231 DOI: 10.1016/j.jcin.2023.03.007] [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: 11/27/2022] [Revised: 02/01/2023] [Accepted: 03/07/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Distal vessel quality is a key parameter in the global chronic total occlusion (CTO) crossing algorithm. OBJECTIVES The study sought to evaluate the association of distal vessel quality with the outcomes of CTO percutaneous coronary intervention. METHODS We examined the clinical and angiographic characteristics and procedural outcomes of 10,028 CTO percutaneous coronary interventions performed at 39 U.S. and non-U.S. centers between 2012 and 2022. A poor-quality distal vessel was defined as <2 mm diameter or with significant diffuse atherosclerotic disease. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. RESULTS A total of 33% of all CTO lesions had poor-quality distal vessel. When compared with good-quality distal vessels, CTO lesions with a poor-quality distal vessel had higher J-CTO (Japanese chronic total occlusion) scores (2.7 ± 1.1 vs 2.2 ± 1.3; P < 0.01), lower technical (79.9% vs 86.9%; P < 0.01) and procedural (78.0% vs 86.8%; P < 0.01) success, and higher incidence of MACE (2.5% vs 1.7%; P < 0.01) and perforation (6.4% vs 3.7%; P < 0.01). A poor-quality distal vessel was independently associated with technical failure and MACE. Poor-quality distal vessels were associated with higher use of the retrograde approach (25.2% vs 14.9%; P < 0.01) and higher air kerma radiation dose (2.4 [IQR: 1.3-4.0] Gy vs 2.0 [IQR: 1.1-3.5] Gy; P < 0.01). CONCLUSIONS A poor-quality distal vessel in CTO lesions is associated with higher lesion complexity, higher need for retrograde crossing, lower technical and procedural success, higher incidence of MACE and coronary perforation, and higher radiation dose.
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Affiliation(s)
- Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasois Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | - Dmitrii Khelimskiid
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | | | | | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | | | | | | | | | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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22
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Ebisawa S, Tanaka H, Muramatsu T, Kishi K, Oikawa Y, Muto M, Okada H, Kawasaki T, Yoshikawa R, Hamazaki Y, Tsuchikane E. Impact of minimum contrast media volumes during percutaneous coronary intervention for chronic total occlusion lesion. Heart Vessels 2023:10.1007/s00380-023-02270-9. [PMID: 37310464 DOI: 10.1007/s00380-023-02270-9] [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: 11/30/2022] [Accepted: 04/19/2023] [Indexed: 06/14/2023]
Abstract
Contrast media exposure is associated with contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Aim of this study is to assess the utility of minimum contrast media volume (CMV ≤ 50 mL) during CTO-PCI for CIN prevention in patients with chronic kidney disease (CKD). We extracted data from the Japanese CTO-PCI expert registry; 2863 patients with CKD who underwent CTO-PCI performed from 2014 to 2020 were divided into two groups: minimum CMV (n = 191) and non-minimum CMV groups (n = 2672). CIN was defined as an increased serum creatinine level of ≥ 25% and/or ≥ 0.5 mg/dL compared with baseline levels within 72 h of the procedure. In the minimum CMV group, the CIN incidence was lower than that in the non-minimum CMV group (1.0% vs. 4.1%; p = 0.03). Patient success rate was higher and complication rate was lower in the minimum CMV group than in the non-minimum CMV group (96.8% vs. 90.3%; p = 0.02 and 3.1% vs. 7.1%; p = 0.03). In the minimum CMV group, the primary retrograde approach was more frequent in the case of J-CTO = 1,2 and 3-5 groups compared to that in non-minimum CMV-PCI group (J-CTO = 0; 11% vs. 17.7%, p = 0.06; J-CTO = 1; 22% vs. 35.8%, p = 0.01; J-CTO = 2; 32.4% vs. 46.5%, p = 0.01; and J-CTO = 3-5; 44.7% vs. 80.0%, p = 0.02). Minimum CMV-PCI for CTO in CKD patients could reduce the incidence of CIN. The primary retrograde approach was observed to a greater extent in the minimum CMV group, especially in cases of difficult CTO.
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Affiliation(s)
- Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki-Shi, Okayama, 710-8602, Japan.
| | | | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | | | - Makoto Muto
- Division of Cardiology, Saitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | | | | | - Yuji Hamazaki
- Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Etsuo Tsuchikane
- Department of Cardiology, Toyohashi Heart Center, Aichi, Japan
- The Japanese CTO-PCI Expert Foundation, Okayama, Japan
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23
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Nakachi T, Yamane M, Kishi K, Muramatsu T, Okada H, Oikawa Y, Yoshikawa R, Kawasaki T, Tanaka H, Katoh O. Machine Learning for Prediction of Technical Results of Percutaneous Coronary Intervention for Chronic Total Occlusion. J Clin Med 2023; 12:jcm12103354. [PMID: 37240464 DOI: 10.3390/jcm12103354] [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: 04/20/2023] [Revised: 04/30/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: The probability of technical success in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) represents essential information for specifying the priority of PCI for treatment selection in patients with CTO. However, the predictabilities of existing scores based on conventional regression analysis remain modest, leaving room for improvements in model discrimination. Recently, machine learning (ML) techniques have emerged as highly effective methods for prediction and decision-making in various disciplines. We therefore investigated the predictability of ML models for technical results of CTO-PCI and compared their performances to the results from existing scores, including J-CTO, CL, and CASTLE scores. (2) Methods: This analysis used data from the Japanese CTO-PCI expert registry, which enrolled 8760 consecutive patients undergoing CTO-PCI. The performance of prediction models was assessed using the area under the receiver operating curve (ROC-AUC). (3) Results: Technical success was achieved in 7990 procedures, accounting for an overall success rate of 91.2%. The best ML model, extreme gradient boosting (XGBoost), outperformed the conventional prediction scores with ROC-AUC (XGBoost 0.760 [95% confidence interval {CI}: 0.740-0.780] vs. J-CTO 0.697 [95%CI: 0.675-0.719], CL 0.662 [95%CI: 0.639-0.684], CASTLE 0.659 [95%CI: 0.636-0.681]; p < 0.005 for all). The XGBoost model demonstrated acceptable concordance between the observed and predicted probabilities of CTO-PCI failure. Calcification was the leading predictor. (4) Conclusions: ML techniques provide accurate, specific information regarding the likelihood of success in CTO-PCI, which would help select the best treatment for individual patients with CTO.
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Affiliation(s)
- Tatsuya Nakachi
- Department of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10 Konandai, Konan-ku, Yokohama 234-0054, Japan
| | - Masahisa Yamane
- Cardiology Department, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama 350-1305, Japan
| | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, 103 Irinokuchi, Komatsushima-cho, Komatsushima, Tokushima 773-8502, Japan
| | - Toshiya Muramatsu
- Department of Cardiology, Tokyo Heart Center, 5-4-12 Kitashinagawa, Shinagawa-ku, Tokyo 141-0001, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu 430-8558, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-ku, Tokyo 106-0031, Japan
| | - Ryohei Yoshikawa
- Cardiology Center, Sanda City Hospital, 3-1-1 Keyakidai, Sanda, Hyogo 669-1321, Japan
| | - Tomohiro Kawasaki
- Department of Cardiology, Shin-Koga Hospital, 120 Tenjin-cho, Kurume, Fukuoka 830-8577, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Osamu Katoh
- Department of Cardiology, Kusatsu Heart Center, 407-1 Komaizawa-cho, Kusatsu, Shiga 525-0014, Japan
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Karacsonyi J, Alaswad K, Krestyaninov O, Karmpaliotis D, Kirtane A, Ali Z, McEntegart M, Masoumi A, Poomipanit P, Jaffer FA, Khatri J, Choi J, Patel M, Koutouzis M, Tsiafoutis I, Gorgulu S, Sheikh AM, Elbarouni B, Jaber W, ElGuindy A, Yeh R, Kostantinis S, Simsek B, Rangan B, Mastrodemos OC, Vemmou E, Nikolakopoulos I, Ungi I, Rafeh NA, Goktekin O, Burke MN, Brilakis ES, Sandoval Y. Single vs. multiple operators for chronic total occlusion percutaneous coronary interventions: From the PROGRESS-CTO Registry. Catheter Cardiovasc Interv 2023; 101:543-552. [PMID: 36695421 DOI: 10.1002/ccd.30564] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is limited data on the impact of a second attending operator on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) outcomes. METHODS We analyzed the association between multiple operators (MOs) (>1 attending operator) and procedural outcomes of 9296 CTO PCIs performed between 2012 and 2021 at 37 centers. RESULTS CTO PCI was performed by a single operator (SO) in 85% of the cases and by MOs in 15%. Mean patient age was 64.4 ± 10 years and 81% were men. SO cases were more complex with higher Japan-CTO (2.38 ± 1.29 vs. 2.28 ± 1.20, p = 0.005) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention scores (1.13 ± 1.01 vs. 0.97 ± 0.93, p < 0.001) compared with MO cases. Procedural time (131 [87, 181] vs. 112 [72, 167] min, p < 0.001), fluoroscopy time (49 [31, 76] vs. 42 [25, 68] min, p < 0.001), air kerma radiation dose (2.32 vs. 2.10, p < 0.001), and contrast volume (230 vs. 210, p < 0.001) were higher in MO cases. Cases performed by MOs and SO had similar technical (86% vs. 86%, p = 0.9) and procedural success rates (84% vs. 85%, p = 0.7), as well as major adverse complication event rates (MACE 2.17% vs. 2.42%, p = 0.6). On multivariable analyses, MOs were not associated with higher technical success or lower MACE rates. CONCLUSION In a contemporary, multicenter registry, 15% of CTO PCI cases were performed by multiple operators. Despite being more complex, SO cases had lower procedural and fluoroscopy times, and similar technical and procedural success and risk of complications compared with MO cases.
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Affiliation(s)
- Judit Karacsonyi
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | | | - Dimitri Karmpaliotis
- Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, New Jersey, USA
| | | | - Ziad Ali
- St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | | | - Amirali Masoumi
- Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, New Jersey, USA
| | - Paul Poomipanit
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Farouc A Jaffer
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - James Choi
- Baylor Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas, USA
| | - Mitul Patel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Michalis Koutouzis
- 2nd Department of Cardiology, Red Cross Hospital of Athens, Athens, Greece
| | | | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | | | - Basem Elbarouni
- Department of Internal Medicine, Section of Cardiology, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Wissam Jaber
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ahmed ElGuindy
- Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Robert Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana Rangan
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Evangelia Vemmou
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Imre Ungi
- Division of Invasive Cardiology, Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | | | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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25
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Kostantinis S, Simsek B, Karacsonyi J, Alaswad K, Basir MB, Megaly M, Gorgulu S, Krestyaninov O, Khelimskii D, Davies RE, Benton SM, Khatri JJ, ElGuindy AM, Goktekin O, Abi Rafeh N, Allana S, Brilakis ES, Prasad M. Gender differences in chronic total occlusion percutaneous coronary interventions: Insights from the PROGRESS‐CTO registry. Catheter Cardiovasc Interv 2022; 100:1010-1018. [DOI: 10.1002/ccd.30425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/15/2022] [Accepted: 10/02/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Spyridon Kostantinis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota USA
| | - Bahadir Simsek
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota USA
| | - Judit Karacsonyi
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota USA
| | | | - Mir B. Basir
- Division of Cardiology Henry Ford Hospital Detroit Michigan USA
| | - Michael Megaly
- Division of Cardiology Henry Ford Hospital Detroit Michigan USA
| | - Sevket Gorgulu
- Department of Cardiology Biruni University Medical School Istanbul Turkey
| | - Oleg Krestyaninov
- Department of Cardiology Meshalkin Novosibirsk Research Institute Novosibirsk Russia
| | - Dmitrii Khelimskii
- Department of Cardiology Meshalkin Novosibirsk Research Institute Novosibirsk Russia
| | - Rhian E. Davies
- Department of Cardiology Wellspan York Hospital York Pennsylvania USA
| | - Stewart M. Benton
- Department of Cardiology Wellspan York Hospital York Pennsylvania USA
| | | | - Ahmed M. ElGuindy
- Department of Cardiology, Aswan Heart Center Magdi Yacoub Foundation Cairo Egypt
| | - Omer Goktekin
- Department of Cardiology Memorial Bahcelievler Hospital Istanbul Turkey
| | - Nidal Abi Rafeh
- Department of Cardiology North Oaks Health System Hammond Los Angeles USA
| | - Salman Allana
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota USA
| | - Emmanouil S. Brilakis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota USA
| | - Megha Prasad
- Division of Cardiology Columbia University Irving Medical Center/New York‐Presbyterian Hospital New York New York USA
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Di Mario C, Mashayekhi KA, Garbo R, Pyxaras SA, Ciardetti N, Werner GS. Recanalisation of coronary chronic total occlusions. EUROINTERVENTION 2022; 18:535-561. [PMID: 36134683 DOI: 10.4244/eij-d-21-01117] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators in this demanding, rapidly evolving field of interventional cardiology.
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Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Kambis A Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Roberto Garbo
- GVM Care & Research, Maria Pia Hospital, Turin, Italy
| | | | - Niccolò Ciardetti
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Gerald S Werner
- Department of Cardiology, Klinikum Darmstadt GmbH, Darmstadt, Germany
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Miura K, Tanaka H, Kishi K, Muramatsu T, Okada H, Oikawa Y, Kawasaki T, Yoshikawa R, Okamura A, Tsuchikane E. Impact of Timing and Treatment Strategy on Coronary Perforation During Percutaneous Coronary Intervention for Chronic Total Occlusion. Am J Cardiol 2022; 172:26-34. [PMID: 35430083 DOI: 10.1016/j.amjcard.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022]
Abstract
Coronary perforations during chronic total occlusion percutaneous coronary intervention (CTO-PCI) are potential complications and reportedly associated with adverse events. This study aimed to describe the clinical characteristics and timing of perforations during CTO-PCI. Data from the Japanese CTO-PCI expert registry included 8,760 patients who underwent CTO-PCI between January 2014 and January 2019. The major adverse cardiac and cerebrovascular events were defined as death, tamponade, myocardial infarction, stent thrombosis, stroke, and revascularization. The guidewire manipulation time was defined as the time required to cross the CTO without perforation. Among these patients, 333 (3.8%) developed perforation during the CTO crossing attempt. Of the 333 patients, 29 developed cardiac tamponades (8.7%). Perforations more frequently occurred in a retrograde wiring than in an anterograde wiring (6.6% vs 1.7%, p <0.0001). A longer guidewire manipulation time was associated with the occurrence of perforation (median 101 minutes [interquartile range 59 to 150 minutes] in the perforation group vs 54.9 minutes [interquartile range 21.1 to 112.7 minutes] in the nonperforation group, p <0.0001). Risk factors for perforation were age, history of coronary bypass graft, right coronary artery lesion, de novo lesion, use of a stiff guidewire, and guidewire manipulation time of >60 minutes during anterograde wiring and age, non-left anterior descending artery lesion, use of a polymer-jacketed guidewire, and use of epicardial channel during retrograde wiring. In conclusion, risk factors for perforation were different between anterograde and retrograde wirings. A prolonged guidewire manipulation time was associated with the occurrence of perforation, especially during anterograde wiring.
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Kobayashi N, Ito Y, Kishi K, Muramatsu T, Okada H, Oikawa Y, Kawasaki T, Yoshikawa R, Tanaka H, Katoh O. Procedural results and in-hospital outcomes of percutaneous coronary intervention for chronic total occlusion in patients with reduced left ventricular ejection fraction: Sub-analysis of the Japanese CTO-PCI Expert Registry. Catheter Cardiovasc Interv 2022; 100:30-39. [PMID: 35652164 DOI: 10.1002/ccd.30231] [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: 11/22/2021] [Revised: 04/06/2022] [Accepted: 05/03/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the procedural results and in-hospital outcomes of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in patients with reduced left ventricular ejection fraction (LVEF). BACKGROUND While the technical success of general CTO-PCI has improved, CTO-PCI patients with reduced LVEF remain at high-risk for adverse events. METHODS The data of 820 patients with LVEF ≤ 35% (Group 1), 1816 patients with LVEF = 35%-50% (Group 2), and 5503 patients with LVEF ≥ 50% (Group 3), registered in the Japanese CTO-PCI Expert Registry from January 2014 to December 2019, were retrospectively analyzed. The primary endpoint was in-hospital major adverse cardiac or cerebrovascular events (MACCEs), including death, myocardial infarction, stent thrombosis, stroke, and emergent revascularization. Secondary endpoints included procedural details, guidewire success, and technical success. RESULTS There were no differences in guidewire and technical success rates between the groups. In-hospital MACCEs was significantly higher in Group 1 (Group 1 vs. Group 2 vs. Group 3: 3.4% vs. 1.7% vs. 1.5%, p = 0.001) and was especially driven by death (1.3% vs. 0.3% vs. 0.1%, p < 0.001) and stroke (0.7% vs. 0.2% vs. 0.2%, p = 0.007). Multivariate analysis showed that LVEF ≤ 35% (odds ratio [OR]; 1.58, 95% confidence interval [CI]; 1.04-2.41, p = 0.03) and New York Heart Association (NYHA) class ≥ 3 (OR; 2.01, 95% CI; 1.03-3.93, p = 0.04) were predictors of in-hospital MACCEs. CONCLUSIONS In-hospital MACCEs were significantly higher in patients with LVEF ≤ 35%. LVEF ≤;35% and NYHA class ≥ 3 were predictors of in-hospital MACCEs after CTO-PCI.
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Affiliation(s)
- Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan
| | - Toshiya Muramatsu
- Department of Cardiology, Tokyo Heart Center, Shinagawa-ku, Japan, Tokyo
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, the Cardiovascular Institute, Tokyo, Japan
| | | | | | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Osamu Katoh
- Japanese CTO-PCI Expert Foundation, Kurashiki, Japan
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Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, Karmpaliotis D, Masoumi A, Jaffer FA, Doshi D, Khatri J, Poommipanit P, Gorgulu S, Abi Rafeh N, Goktekin O, Krestyaninov O, Davies R, ElGuindy A, Haddad EV, Kerrigan J, Patel M, Chandwaney RH, Mastrodemos OC, Allana S, Rangan BV, Brilakis ES. Predictors of success in primary retrograde strategy in chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-chronic total occlusion registry. Catheter Cardiovasc Interv 2022; 100:19-27. [PMID: 35615875 DOI: 10.1002/ccd.30228] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/03/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND An upfront (primary) retrograde strategy is often used in complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We examined the clinical, angiographic characteristics, and procedural outcomes of CTO PCIs that were approached with a primary retrograde strategy in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436). RESULTS Of 10,286 CTO PCIs performed between 2012 and 2022, a primary retrograde strategy was used in 1329 (13%) with an initial technical success of 66%, and a final success of 83%. Patients who underwent successful versus unsuccessful primary retrograde cases had similar characteristics: age (65 ± 10 vs. 65 ± 9, years, p = 0.203), men (83% vs. 87%, p = 0.066), prior PCI (71% vs. 71%, p = 0.809), and prior coronary artery bypass graft surgery (52% vs. 53%, p = 0.682). The PROGRESS-CTO score (1.3 ± 0.9 vs. 1.6 ± 0.9, p < 0.001), air kerma radiation (3.9 ± 2.8 vs. 3.4 ± 2.6, gray, p = 0.013), and contrast use (294 ± 148 ml vs. 248 ± 128, ml, p < 0.001) were higher in the unsuccessful group, whereas the presence of interventional collaterals (95% vs. 72%, p < 0.001) and Werner collateral connection grade 2 (43% vs. 31%, p < 0.001) were higher in the successful group. On multivariable logistic regression analysis, the only variable associated with a successful primary retrograde strategy was the presence of interventional collaterals: odds ratio: 6.52 (95% confidence intervals; 3.5-12.1, p < 0.001). CONCLUSION Presence of interventional collaterals is independently associated with higher success rates with a primary retrograde strategy in CTO PCI.
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Affiliation(s)
- Bahadir Simsek
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Dimitri Karmpaliotis
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Amirali Masoumi
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Farouc A Jaffer
- Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Darshan Doshi
- Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Jaikirshan Khatri
- Division of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Paul Poommipanit
- Division of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sevket Gorgulu
- Department of Cardiology, Acibadem Kocaeli Hospital, Kocaeli, Turkey
| | - Nidal Abi Rafeh
- Depatment of Cardiology, North Oaks Healthcare System, Hammond, Louisiana, USA
| | - Omer Goktekin
- Department of Cardiology, Bahcelievler Memorial Hospital, Istanbul, Turkey
| | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Rhian Davies
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | - Ahmed ElGuindy
- Department of Cardiology, Aswan Heart Centre, Aswan, Egypt
| | - Elias V Haddad
- Department of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee, USA
| | - Jimmy Kerrigan
- Department of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee, USA
| | - Mitul Patel
- Division of Cardiovascular Medicine, UCSD Medical Center, La Jolla, California, USA
| | - Raj H Chandwaney
- Department of Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma, USA
| | - Olga C Mastrodemos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Salman Allana
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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30
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Niizeki T, Tsuchikane E, Konta T, Kishi K, Muramatsu T, Okada H, Oikawa Y, Kawasaki T, Tanaka H, Katoh O. Prevalence and Predictors of Successful Percutaneous Coronary Intervention in Ostial Chronic Total Occlusion. JACC Cardiovasc Interv 2022; 15:1094-1096. [PMID: 35490129 DOI: 10.1016/j.jcin.2022.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
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Operator experience and clinical outcomes of percutaneous coronary intervention for chronic total occlusion: insights from a pooled analysis of the Japanese CTO PCI Expert Registry and the Retrograde Summit General Registry. Cardiovasc Interv Ther 2022; 37:670-680. [PMID: 35106714 DOI: 10.1007/s12928-022-00840-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/17/2022] [Indexed: 11/02/2022]
Abstract
There have not been enough studies to examine the association between difference in operator experience and technical success rate in contemporary percutaneous coronary intervention for chronic total occlusion (CTO-PCI). The present study sought to provide insights into the impact of operator experience on clinical outcomes of CTO-PCI through a comparison of two largest Japanese CTO-PCI registries consisting of operators with different CTO-PCI experience. After combining clinical data from the Japanese CTO-PCI Expert Registry (ER) 2014-2016 (N = 4316) including CTO-PCI performed by highly experienced operators and the Retrograde Summit General Registry (RSGR) 2014-2016 (N = 2230) including CTO-PCI performed by less experienced operators, a pooled analysis was performed to compare clinical outcomes of CTO-PCI in 2 registries. The overall technical success rate and the incidence of in-hospital major adverse events were comparable between ER and RSGR (90.1% vs 88.9%, p = 0.133, 1.7% vs 1.5%, p = 0.606, respectively). Technical success rate in ER was significantly higher among the patients treated with primary antegrade approach (91.8% vs 89.5%, p = 0.009), whereas there was no significant difference among the patients treated with the primary retrograde approach (85.7% vs 85.3%, p = 0.857). Multivariate analysis suggested ER operator could not be an independent predictor for technical success. CTO-PCI performed by less experienced but appropriately trained operators could achieve similarly high technical success rate with comparable safety compared with those performed by highly experienced specialists in contemporary Japanese context.
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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Niizeki T, Iwayama T, Kumagai Y, Tsuchikane E. A Case Report: Directional coronary atherectomy supported with optical coherence tomography is useful for the slit lesion. J Cardiol Cases 2022; 25:91-94. [PMID: 35079306 PMCID: PMC8766346 DOI: 10.1016/j.jccase.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/22/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Directional coronary atherectomy (DCA) was revived in Japan in 2014. DCA is a special procedure to remove the atherosclerotic plaque of coronary artery during percutaneous coronary intervention. We present the case of a 91-year-old woman with symptoms of angina. Coronary angiography revealed significant stenosis with a slit lesion of the proximal left anterior descending artery. Because she had a high risk of bleeding, we did not want to implant a stent to prevent bleeding events. Then, we performed optical coherence tomography (OCT) and intravascular ultrasound to evaluate the morphology of the slit lesion in more detail. OCT showed clearly that the direction of the flap was counterclockwise and the edge of the flap was located in the epicardium. Since we could understand the localization of plaque distribution fully by OCT examination, we successfully removed the flap by DCA based on information from OCT. After that, we performed balloon dilatation with a 3.0-mm drug-coated balloon and finished without implanting the stent successfully. Her symptoms completely disappeared and postoperative course was good. DCA supported with OCT might be one of the options in high bleeding risk patients, suggesting a potential stent-less therapeutic option. <Learning objective: There may be hesitation about implantation of stents in patients with high risk of bleeding, such as the elderly. Stent-less percutaneous coronary intervention using directional coronary atherectomy followed by drug-coated balloon under optical coherence tomography (OCT) guidance may be the one of the option for patients with a high risk of bleeding, because OCT can more clearly show the feature of the lesion and the effect of treatment compared to intravascular ultrasound.>
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Affiliation(s)
- Takeshi Niizeki
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
- Corresponding author: Takeshi Niizeki, MD, FJCC, Department of Cardiology, Okitama Public General Hospital. Ooaza Nishi Ohtuka 2000, Kawanishi Town, Yamagata Prefecture, Japan, 992-0601, Tel: +81-238-46-5000, Fax: +81-238-46-5711
| | - Tadateru Iwayama
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Yu Kumagai
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
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34
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Eertmans W, Kayaert P, Bennett J, Ungureanu C, Bataille Y, Saad G, Haine S, Coussement P, Pereira B, Agostoni P, Janssens L, Vandeloo B, Maréchal P, Cornelis K, de Hemptinne Q, Aminian A, Stammen F, Carlier S, Timmermans P, Vercauteren S, Sonck J, De Vroey F, Drieghe B, McCutcheon K, Scott B, Davin L, Gafari C, Dens J. The evolution of the CTO-PCI landscape in Belgium and Luxembourg: a four-year appraisal. Acta Cardiol 2021; 76:1043-1051. [PMID: 32755286 DOI: 10.1080/00015385.2020.1801197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND To chart the evolution of the CTO-PCI landscape in Belgium and Luxembourg, the Belgian Working Group on Chronic Total Occlusions (BWGCTO) was established in 2016. METHODS Between May 2016 and December 2019, patients undergoing a CTO-PCI treatment were prospectively and consecutively enrolled. Twenty-one centres in Belgium and one in Luxembourg participated. Individual operators had mixed levels of expertise in treating CTO lesions. Demographic, angiographic, procedural parameters and incidence of major adverse cardiac and cerebrovascular events (MACCE) were systematically registered. RESULTS Over a four-year enrolment period, 1832 procedures were performed in 1733 patients achieving technical success in 1474 cases (80%), with an in-hospital MACCE rate of 2.3%. Fifty-nine (3%) cases were re-attempt procedures of which 41 (69%) were successful. High-volume centres treated more complex lesions (mean J-CTO score: 2.15 ± 1.21) as compared to intermediate (mean J-CTO score: 1.72 ± 1.23; p < 0.001) and low-volume centres (mean J-CTO score: 0.99 ± 1.21; p = 0.002). Despite this, success rates did not differ between centres (p = 0.461). Overall success rates did not differ over time (p = 0.810). High-volume centres progressively tackled more complex CTOs while keeping success rates stable. In all centres, the most applied strategy was antegrade wire escalation (83%). High-volume centres more often successfully applied antegrade dissection and re-entry and retrograde techniques in lesions with higher complexity. CONCLUSION With variable experience levels, operators treated CTOs with high success and relatively few complications. Although AWE remains the most used technique, it is paramount for operators to be skilled in all contemporary techniques in order to be successful in more complex CTOs.
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Affiliation(s)
- Ward Eertmans
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Johan Bennett
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
| | | | - Yoann Bataille
- Department of Cardiology, CHR de la Citadelle, Liège, Belgium
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Georges Saad
- Department of Cardiology, CHR de la Citadelle, Liège, Belgium
| | - Steven Haine
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Department of Cardiovascular Diseases, University of Antwerp, Wilrijk, Belgium
| | | | - Bruno Pereira
- Department of Cardiology, INCCI Haerz Center, Luxembourg, Luxembourg
| | | | - Luc Janssens
- Department of Cardiology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Bert Vandeloo
- Department of Cardiology, Centrum voor Hart- en Vaatziekten, UZ Brussel, Jette, Belgium
| | | | | | - Quentin de Hemptinne
- Department of Cardiology, CHU Saint-Pierre Université Libre de Bruxelles, Brussel, Belgium
| | - Adel Aminian
- Department of Cardiology, CHU Charleroi, Charleroi, Belgium
| | | | | | | | | | - Jeroen Sonck
- Department of Cardiology, Centrum voor Hart- en Vaatziekten, UZ Brussel, Jette, Belgium
- Department of Cardiology, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
| | - Frédéric De Vroey
- Department of Cardiology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Benny Drieghe
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA), Middelheim Hospital, Antwerp, Belgium
| | | | - Chadi Gafari
- Department of Cardiology, CHU Ambroise Paré, Mons, Belgium
| | - Jo Dens
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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Xenogiannis I, Alaswad K, Krestyaninov O, Khelimskii D, Khatri JJ, Choi JW, Jaffer FA, Patel M, Mahmud E, Doing AH, Dattilo P, Koutouzis M, Tsiafoutis I, Uretsky B, Jefferson BK, Patel T, Jaber W, Samady H, Sheikh AM, Yeh RW, Tamez H, Elbarouni B, Love MP, Abi Rafeh N, Maalouf A, Fadi AJ, Toma C, Shah AR, Chandwaney RH, Omer M, Megaly MS, Vemmou E, Nikolakopoulos I, Rangan BV, Garcia S, Abdullah S, Banerjee S, Burke MN, Karmpaliotis D, Brilakis ES. Impacto de la adherencia a un algoritmo híbrido para la selección de la estrategia inicial de cruce en la intervención coronaria percutánea de oclusiones crónicas. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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36
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Januszek RA, Bryniarski L, Siudak Z, Malinowski KP, Surowiec S, Bryniarski K, Jędrychowska M, Wańha W, Bartuś K, Wojakowski W, Wójcik J, Legutko J, Surdacki A, Bartuś S. Predictors and trends of contrast use and radiation exposure in a large cohort of patients treated with percutaneous coronary interventions: Chronic total occlusion analysis based on a national registry. Cardiol J 2021; 30:VM/OJS/J/74257. [PMID: 34642921 PMCID: PMC10713226 DOI: 10.5603/cj.a2021.0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/19/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim herein, was to assess predictors and current trends of radiation exposure and total contrast amount use in patients treated with percutaneous coronary intervention within chronic total occlusion (CTO PCI) and non-CTO PCI. METHODS Based on a nationwide registry (ORPKI), 535,857 patients treated with PCI between 2014 and 2018 were analysed. The study included 12,572 (2.34%) patients treated with CTO PCI. The CTO PCI and non-CTO PCI groups were compared before and after propensity score matching (PSM). Multifactorial mixed regression models were used to assess predictors of contrast amount use and radiation exposure. RESULTS The mean total contrast dose and radiation exposure decrease reached statistical significance in following years for the CTO PCI (p = 0.002 and p < 0.001) and non-CTO PCI groups (p < 0.001 and p < 0.001). Multifactorial analysis revealed that non-CTO PCI was a strong independent predictor of lower total contrast dose (estimate: -17.41; 95% confidence interval [CI]: -18.45 to -16.49, p < 0.001) and radiation exposure (estimate: -264.28; 95% CI: -273.75 to -254.81, p < 0.001). After PSM, it was confirmed that CTO PCI was an independent predictor of greater radiation exposure (estimate: 328.6; 95% CI: 289.1-368.1; p < 0.001) and total contrast dose (estimate: 30.5; 95% CI: 27.28-33.74; p < 0.001). CONCLUSIONS Contrast dose and radiation exposure have decreased in previous years with regard to the CTO PCI and non-CTO PCI groups. CTO PCI was found to be an independent predictor of greater total contrast dose and radiation exposure in the overall group of patients treated with PCI.
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Affiliation(s)
- Rafał A Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.
- Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland.
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | | | - Sławomir Surowiec
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Krzysztof Bryniarski
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Magdalena Jędrychowska
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Jarosław Wójcik
- Department of Cardiology, Hospital of Invasive Cardiology IKARDIA, Nałęczów, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Seki T, Tokumasu H, Tanaka H, Katoh H, Kawakami K. Appropriateness of Percutaneous Coronary Intervention Performed by Japanese Expert Operators in Patients With Chronic Total Occlusion. Circ J 2021; 86:799-807. [PMID: 34615814 DOI: 10.1253/circj.cj-21-0483] [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: 11/09/2022]
Abstract
BACKGROUND The appropriateness of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions has rarely been investigated.Methods and Results:The Japanese CTO-PCI Expert Registry enrolled consecutive patients undergoing CTO-PCI carried out by highly experienced Japanese CTO specialists who performed more than 50 CTO-PCIs per year and 300 CTO-PCIs in total. This study included patients undergoing CTO-PCI between January 2014 and December 2019. The appropriateness, trends, and differences among the procedures performed by the operators using the 2017 appropriate use criteria were analyzed. Furthermore, we performed a logistic regression analysis to assess whether the appropriateness was associated with in-hospital major adverse cardiovascular and cerebrovascular events (MACCE). Of the 5,062 patients who underwent CTO-PCI, 4,309 (85.1%) patients who did not undergo the non-invasive stress test were classified as having no myocardial ischemia. Of the total cases, 3,150 (62.2%) were rated as "may be appropriate," and 642 (12.7%) as "rarely appropriate" CTO-PCI cases. The sensitivity analyses showed that the number (%) of "may be appropriate" ranged from 4,125 (57.8%) to 4,744 (66.4%) and the number of "rarely appropriate" ranged from 843 (11.8%) to 970 (13.6%) among best and worst scenarios. CONCLUSIONS In a large Japanese CTO-PCI registry, approximately 13% of CTO-PCI procedures were classified as "rarely appropriate". Substantial efforts would be required to decrease the number of "rarely appropriate" CTO-PCI procedures.
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Affiliation(s)
- Tomotsugu Seki
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University.,Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | | | | | | | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
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Aljabbary T, Katyukha A, Elbaz-Greener G, Gressmann K, Bagai A, Graham JJ, Vijayaraghavan R, Kalra S, Vo M, Wijeysundera HC. Overview of Contemporary Chronic Total Occlusion Percutaneous Coronary Intervention Techniques: A Narrative Systematic Review. CJC Open 2021; 3:1273-1281. [PMID: 34888507 PMCID: PMC8636234 DOI: 10.1016/j.cjco.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/31/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite the abundance of coronary chronic total occlusions (CTO) percutaneous coronary intervention (PCI) studies, the literature is not easy to digest for both general PCI operators and CTO PCI specialists because of the many varied terms used for approaches and inconsistency in terminology. This inconsistency makes it challenging to understand the advantages and disadvantages of these different approaches and, most importantly, their downstream clinical outcomes. Accordingly, we conducted a systematic review of all published studies on CTO PCI to describe techniques and algorithms used in the last decade to provide an overview on the efficacy and safety of contemporary CTO PCI techniques. METHODS We performed a comprehensive search of the PubMed, EMBASE, and the Cochrane library databases for manuscripts about PCI of CTOs. We included studies published between the years 2005 and 2019. We categorized studies into those using a single approach (antegrade, retrograde) and those with a prespecified algorithm (ie, hybrid approach). RESULTS Fifty-five observational studies including 28,907 patients who underwent CTO were included in this review. CTO PCI generally carries low risk of major procedural complications, with angiographic success rates being higher in studies that used an algorithmic vs single technical approach. CONCLUSIONS This systematic review highlights the wide variation in definitions and practices in CTO PCI and calls for standardization in terminology and practice.
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Affiliation(s)
- Talal Aljabbary
- Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Andriy Katyukha
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Akshay Bagai
- Terrence Donnelly Heart Center, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - John J. Graham
- Terrence Donnelly Heart Center, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | | | - Sanjog Kalra
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Minh Vo
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Harindra C. Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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39
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Sekiguchi M, Muramatsu T, Kishi K, Sumitsuji S, Okada H, Oikawa Y, Yoshikawa R, Kawasaki T, Tanaka H, Tsuchikane E. Occlusion patterns, strategies and procedural outcomes of percutaneous coronary intervention for in-stent chronic total occlusion. EUROINTERVENTION 2021; 17:e631-e638. [PMID: 33720017 PMCID: PMC9724848 DOI: 10.4244/eij-d-20-01151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In-stent chronic total occlusion (CTO) presents various occlusion patterns, which complicate percutaneous coronary intervention (PCI). AIMS The aim of the study was to investigate the initial outcome and strategy of PCI for in-stent CTO according to the angiographic occlusion patterns. METHODS This study assessed 791 in-stent CTOs from the Japanese CTO-PCI Expert Registry from 2015 to 2018. They were divided into four patterns: pattern A (n=419), CTO within the stent segment; pattern B (n=196), CTO beyond the distal edge; pattern C (n=85), CTO beyond the proximal edge; and pattern D (n=69) CTO beyond both the proximal and distal edges. RESULTS There were significant differences in the technical success rates (96.2%, 86.2%, 92.9%, and 75.4% for patterns A-D, respectively; p<0.001), guidewire crossing times (22 [interquartile range: 10-46], 52 [24-102], 40 [20-78], and 86 [45-127] min, respectively; p<0.001), and the rates of antegrade approach alone (90.9%, 61.2%, 67.1%, and 31.9%, respectively; p<0.001). CONCLUSIONS PCI for CTO within the stent segment was associated with excellent initial outcomes with the antegrade approach. However, PCI for CTO beyond both the proximal and distal edges was associated with the poorest outcomes, even with the bidirectional approach.
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Affiliation(s)
- Makoto Sekiguchi
- Department of Cardiology, Fukaya Red Cross Hospital, 5-8-1 Kamishiba-machi, Fukaya, Saitama, 366-0052, Japan
| | | | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Satoru Sumitsuji
- Department of Cardiology for International Education and Research, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Yuji Oikawa
- Department of Cardiology, The Cardiovascular Institute, Tokyo, Japan
| | | | | | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
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Fan Y, Maehara A, Yamamoto M, Hakemi E, Fall K, Matsumura M, Ali ZA, Kirtane A, Moses J, Huang H, Mintz GS, Ochiai M, Karmpaliotis D, Russo JJ, Prasad M, Ahmad Y, Gargoulas F, Leon MB, Stone GW. Outcomes of retrograde approach for chronic total occlusions by guidewire location. EUROINTERVENTION 2021; 17:e647-e655. [PMID: 33589409 PMCID: PMC9754022 DOI: 10.4244/eij-d-20-01169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Connecting the antegrade wire (AW) and the retrograde wire (RW) is a goal of chronic total occlusion (CTO) treatment, but angiographic guidewire location is sometimes misleading. AIMS The aim of this study was to evaluate the association between intravascular ultrasound (IVUS)-defined AW and RW position and procedural outcomes when treating CTO lesions using the retrograde approach. METHODS Overall, 191 CTO lesions treated using an IVUS-guided retrograde approach at three centres in Japan, China, and the USA were included. RESULTS When the AW and RW angiographically overlapped, four wire positions were seen on IVUS: (i) AW within the plaque (AW-intraplaque) and RW-intraplaque in 34%; (ii) AW-intraplaque and RW in the subintimal space (RW-subintima) in 28%; (iii) AW-subintima and RW-subintima in 22%; or (iv) AW-subintima and RW-intraplaque in 16%. The procedure succeeded without repositioning the wire in 89% of AW-intraplaque/RW-intraplaque, 61% of AW-intraplaque/RW-subintima and 57% of AW-subintima/RW-subintima, but only one (3%) AW-subintima/RW-intraplaque. Lesion and procedure complexity and failure/complications were greatest in AW-subintima/RW-intraplaque. CONCLUSIONS IVUS-identified vascular compartment concordance versus IVUS-identified vascular compartment mismatch leads to higher success rates irrespective of intraplaque or subintimal passage. AW-subintima/RW-intraplaque was associated with the most complex CTO morphology and procedure, and repositioning the wire was almost always necessary. Visual summary. When the antegrade wire is in the subintimal space and the retrograde wire is in the intraplaque, re-wiring is almost always necessary.
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Affiliation(s)
- Yongzhen Fan
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA,ZhongNan Hospital of Wuhan University, Wuhan, China
| | - Akiko Maehara
- Columbia University Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | | | - Emad Hakemi
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Khady Fall
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad A. Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA,St. Francis Hospital, Roslyn, NY, USA
| | - Ajay Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Jeffrey Moses
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA,St. Francis Hospital, Roslyn, NY, USA
| | - He Huang
- Xiangtan Central Hospital, Xiangtan, China
| | - Gary S. Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | | | - Dimitrios Karmpaliotis
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
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Singh J, Mahanta D, Mahapatra RP, Barik R. Tunnelling a calcified total occlusion. Asian Cardiovasc Thorac Ann 2021; 30:711-714. [PMID: 34495774 DOI: 10.1177/02184923211041078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Among the complex and high-risk coronary intervention cases, a calcified total occlusion of coronary artery poses a great challenge. We came across a 48 years old male who had calcified total occlusion of the right coronary artery. The chronic total occlusion was crossed using Nic-Nano balloon and the calcific plaque was modified using intravascular lithotripsy as an alternative technique to rotational atherectomy which we felt as an evolving alternative approach to treat the calcified total occlusion.
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Affiliation(s)
- Jogendra Singh
- Department of Cardiology, 410775All India Institute of Medical Sciences, India
| | - Dibyasundar Mahanta
- Department of Cardiology, 410775All India Institute of Medical Sciences, India
| | - Rudra P Mahapatra
- Department of Cardiothoracic Surgery, 410775All India Institute of Medical Sciences, India
| | - Ramachandra Barik
- Department of Cardiology, 410775All India Institute of Medical Sciences, India
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Moroni F, Santiago R, DI Pietro R, Calcagno S, Azzalini L. Complications during chronic total occlusion percutaneous coronary intervention: a sign- and symptom-based approach to early diagnosis and treatment. Minerva Cardiol Angiol 2021; 69:773-786. [PMID: 34338491 DOI: 10.23736/s2724-5683.21.05831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Coronary chronic total occlusions (CTO) are frequently found in patients undergoing coronary angiography. Despite their high prevalence and indication for revascularization in a relevant proportion of cases, CTO recanalization is attempted only in a minority of cases. This is due to higher risk of procedural complications compared to non-CTO interventions and because the CTO-PCIs are the most complex procedures in interventional cardiology. In particular, the perceived higher risk of complications during CTO intervention might discourage new operators from engaging in this challenging field. The aim of this work is to review the potential complications of CTO percutaneous coronary intervention, and to provide an algorithmic, sign- and symptom-based approach to facilitate early recognition and effective management.
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Affiliation(s)
- Francesco Moroni
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.,Università Vita-Salute San Raffaele, Milan, Italy
| | - Ricardo Santiago
- PCI Cardiology Group and Bayamon Heart & Lung Institute, Bayamon, Puerto Rico
| | | | - Simone Calcagno
- Interventional Cardiology Unit, SM Goretti Hospital, Latina, Italy
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA -
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43
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Ochiumi Y, Yamamoto M, Tsuchikane E, Muramatsu T, Kishi K, Okada H, Oikawa Y, Muto M, Kawasaki T, Yoshikawa R, Otsuka T. Predictors of prolonged guidewire manipulation time for native coronary chronic total occlusion percutaneous coronary intervention via primary antegrade approach. Catheter Cardiovasc Interv 2021; 98:E571-E580. [PMID: 34173710 DOI: 10.1002/ccd.29844] [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: 02/02/2021] [Revised: 05/19/2021] [Accepted: 06/14/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study aimed to identify the predictive factors for the guidewire manipulation time (GWMT) of ≥20 and 30 min for chronic total occlusion-percutaneous coronary intervention (CTO-PCI) via the primary antegrade approach (PAA). BACKGROUND Selection of primary retrograde approach (PRA) and the optimal timing to switch from antegrade to retrograde approach for coronary CTO-PCI is still debatable. METHODS Using the Japanese CTO-PCI expert registry data, we selected and analyzed 4461 patients who underwent CTO-PCI via PAA alone. The considerable lesion/anatomical factors for GWMT ≥20 and 30 min were analyzed. The risks of prolonged GWMT ≥20 and 30 min were stratified as easy, intermediate, difficult, and very difficult according to the multivariate analysis. RESULTS Nine lesion/anatomical characteristics (blunt stump, side branch at proximal cap, bifurcation at the exit point, calcification, tortuosity, occlusion length ≥ 20 mm, reattempt, nonleft anterior descending artery (nonleft anterior descending artery [LAD]), and tandem CTO) were independent predictors of GWMT ≥20 min (all p < 0.05). Excluding the nonLAD and tandem CTO, the same factors of GWMT ≥20 min correlated with GWMT ≥30 min (all p < 0.05). The distributions were increased in easy, intermediate, difficult, and very difficult subsets of GWMT ≥20 min (58.3%, 77.2%, 89.1%, and 100%) and GWMT ≥30 min (47.5%, 69.2%, 83.9%, and 100%). CONCLUSIONS These predictive factors of prolonged GWMT should be assessed before CTO-PCI via PAA and when considering an adequate timing to switch the retrograde or PRA if clinically available.
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Affiliation(s)
- Yusuke Ochiumi
- Department of Cardiology, Nagoya Heart Center, Aichi, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Nagoya Heart Center, Aichi, Japan.,Department of Cardiology, Toyohashi Heart Center, Aichi, Japan
| | | | | | - Koichi Kishi
- Department of Cardiology, Red Cross Hospital, Tokushima, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | | | - Makoto Muto
- Division of Cardiology, Prefecture Cardiovascular and Respiratory Center, Saitama, Japan
| | | | | | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, and Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
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Hong SJ, Kim BK, Cho I, Kim HY, Rha SW, Lee SH, Park SM, Kim YH, Chang HJ, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Effect of Coronary CTA on Chronic Total Occlusion Percutaneous Coronary Intervention: A Randomized Trial. JACC Cardiovasc Imaging 2021; 14:1993-2004. [PMID: 34147439 DOI: 10.1016/j.jcmg.2021.04.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study was to test whether the success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) increased with pre-procedural coronary computed tomography angiography (CTA). BACKGROUND Coronary CTA provides valuable information before and during CTO-PCI. However, there are no randomized data that explore whether coronary CTA increases its success rate. METHODS In this multicenter, randomized trial, a total of 400 patients with CTO were randomized to receive PCI with pre-procedural coronary CTA (coronary CTA-guided group; n = 200) or without coronary CTA (angiography-guided group; n = 200) between January 2014 and September 2019. The primary endpoint was the successful recanalization rate, a final TIMI (Thrombolysis In Myocardial Infarction) grade ≥2, and ≤30% residual stenosis on the final angiogram. RESULTS A total of 10 operators performed PCI. Successful recanalization was achieved in 187 patients (93.5%) in the coronary CTA-guided group and in 168 patients (84.0%) in the angiography-guided group (absolute difference, 9.5% [95% confidence interval: 3.4% to 15.6%]; p = 0.003). When comparing the success rates according to the Multicenter CTO Registry of Japan score (J-CTO), the coronary CTA guidance was favored over the angiography-guidance in the subset of J-CTO ≥2 versus in the subset of J-CTO <2 (p interaction = 0.035). Coronary perforations occurred in 2 (1%) and 8 patients (4%) in the coronary CTA- and angiography-guided groups, respectively (p = 0.055). Periprocedural myocardial infarction was not observed in the coronary CTA-guided group, whereas it occurred in 4 patients (2%) in the angiography-guided group (p = 0.123). Total procedure and fluoroscopic times were not different. There were no differences between the groups in the occurrences of cardiac death, target vessel-related myocardial infarction, or target-vessel revascularization at 1 year. CONCLUSIONS Pre-procedural coronary CTA-guidance for CTO resulted in higher success rates with numerically fewer immediate periprocedural complications such as coronary perforations or periprocedural myocardial infarction than angiography guidance. Higher success rates were more prominently observed in patients with CTO who had a high J-CTO score than those who did not. (Role of CT Scan for the Successful Recanalization of Chronic Total Occlusion; a Randomized Comparison Between 3D CT-guided PCI vs. Conventional Treatment [CT-CTO Trial]; NCT02037698).
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Affiliation(s)
- Sung-Jin Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Iksung Cho
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee-Yeol Kim
- Catholic University St. Mary's Hospital, Bucheon, South Korea
| | | | - Seung-Hwan Lee
- Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Sang Min Park
- Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, South Korea
| | - Yong Hoon Kim
- Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Hyuk-Jae Chang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul-Min Ahn
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Werner GS, Lorenz S, Yaginuma K, Koch M, Tischer K, Werner J, Keuser T, Moehlis H, Riegel W. A prospective study on the incidence of contrast-associated acute kidney injury after recanalization of chronic total coronary occlusions with contemporary interventional techniques. Int J Cardiol 2021; 337:38-43. [PMID: 34015410 DOI: 10.1016/j.ijcard.2021.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Contrast-associated acute kidney injury (CA-AKI) is a potential risk associated with the percutaneous coronary interventions (PCI) for chronic total coronary occlusions (CTO). This study should evaluate the incidence of CA-AKI in an era of advanced strategies of recanalization techniques and identify modifiable determinants. METHODS We analysed 1924 consecutive CTO procedures in 1815 patients between 2012 and 2019. All patients were carefully monitored at least up to 48 h after a CTO procedure for changes in renal function. RESULTS The incidence of CA-AKI was 5.6%, but there was no relation to the technical approach such as frequency of the retrograde technique, intravascular ultrasound or radial access. Procedures with CA-AKI had longer fluoroscopy times (37.6 vs 46.1 min; p = 0.005). The major determinants of CA-AKI were age, presence of diabetes and reduced ejection fraction, as well as chronic kidney disease stage ≥2, serum haemoglobin, and fluoroscopy time. Contrast volume or contrast volume/GFR ratio were not independent determinants of CA-AKI. Periprocedural perforations were more frequent in CA-AKI patients (11.3 vs 2.3%; p < 0.001), and in-hospital mortality was higher (2.8 vs 0.4%; p < 0.001). CONCLUSIONS CA-AKI was associated with the risk of in-hospital adverse events. Established patient-related risk factors for CA-AKI (age, diabetes, preexisting chronic kidney disease, low ejection fraction) were confirmed in this study. In addition, the length of the procedure, coronary perforations and low preprocedural serum haemoglobin were risk factors that might be preventable in patients at high risk for CA-AKI.
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Affiliation(s)
- Gerald S Werner
- Medizinische Klinik 1, Klinikum Darmstadt GmbH, Darmstadt, Germany.
| | - Simon Lorenz
- Medizinische Klinik 3, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Kenji Yaginuma
- Department of Cardiology, Juntendo University Urayasu Hospital, Tokyo, Japan
| | - Mathias Koch
- Medizinische Klinik 1, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | | | - Juliane Werner
- Medizinische Klinik 1, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Thomas Keuser
- Medizinische Klinik 1, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Hiller Moehlis
- Medizinische Klinik 1, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Werner Riegel
- Medizinische Klinik 3, Klinikum Darmstadt GmbH, Darmstadt, Germany
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Kalra S, Doshi D, Sapontis J, Kosmidou I, Kirtane AJ, Moses JW, Riley RF, Jones P, Nicholson WJ, Salisbury AC, Lombardi WL, McCabe JM, Pershad A, Hirai T, Hakemi E, Russo JJ, Prasad M, Ahmad Y, Hatem R, Gkargkoulas F, Spertus JA, Wyman RM, Jaffer F, Spaedy A, Cook S, Marso SP, Nugent K, Federici R, Yeh RW, Leon MB, Stone GW, Ali ZA, Parikh MA, Maehara A, Cohen DJ, Batres C, Grantham JA, Karmpaliotis D. Outcomes of retrograde chronic total occlusion percutaneous coronary intervention: A report from the OPEN-CTO registry. Catheter Cardiovasc Interv 2021; 97:1162-1173. [PMID: 32876381 DOI: 10.1002/ccd.29230] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/02/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We sought to assess in-hospital and long-term outcomes of retrograde compared with antegrade-only percutaneous coronary intervention for chronic total occlusion (CTO PCI). BACKGROUND Procedural and clinical outcomes following retrograde compared with antegrade-only CTO PCI remain unknown. METHODS Using the core-lab adjudicated OPEN-CTO registry, we compared the outcomes of retrograde to antegrade-only CTO PCI. Primary endpoints included were in-hospital major adverse cardiac and cerebrovascular events (MACCE) (all-cause death, stroke, myocardial infarction [MI], emergency cardiac surgery, or clinically significant perforation) and MACCE at 1-year (all-cause death, MI, stroke, target lesion revascularization, or target vessel reocclusion). RESULTS Among 885 single CTO procedures from the OPEN-CTO registry, 454 were retrograde and 431 were antegrade-only. Lesion complexity was higher (J-CTO score: 2.7 vs. 1.9; p < .001) and technical success lower (82.4 vs. 94.2%; p < .001) in retrograde compared with antegrade-only procedures. All-cause death was higher in the retrograde group in-hospital (2 vs. 0%; p = .003), but not at 1-year (4.9 vs. 3.3%; p = .29). Compared with antegrade-only procedures, in-hospital MACCE rates (composite of all-cause death, stroke, MI, emergency cardiac surgery, and clinically significant perforation) were higher in the retrograde group (10.8 vs. 3.3%; p < .001) and at 1-year (19.5 vs. 13.9%; p = .03). In sensitivity analyses landmarked at discharge, there was no difference in MACCE rates at 1 year following retrograde versus antegrade-only CTO PCI. Improvements in Seattle Angina Questionnaire Quality of Life scores at 1-year were similar between the retrograde and antegrade-only groups (29.9 vs 30.4; p = .58). CONCLUSIONS In the OPEN-CTO registry, retrograde CTO procedures were associated with higher rates of in-hospital MACCE compared with antegrade-only; however, post-discharge outcomes, including quality of life improvements, were similar between technical modalities.
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Affiliation(s)
- Sanjog Kalra
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Darshan Doshi
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Ioanna Kosmidou
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Ajay J Kirtane
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Jeffrey W Moses
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
- St. Francis Heart Center, St. Francis Hospital, Roslyn, New York
| | - Robert F Riley
- Heart and Vascular Institute, The Christ Hospital, Cincinnati, Ohio
| | - Philip Jones
- St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | | | - Adam C Salisbury
- St. Luke's Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri, Kansas City, Missouri
| | - William L Lombardi
- Department of Medicine, University of Washington Medical Center, Seattle, Washington
| | - James M McCabe
- Department of Medicine, University of Washington Medical Center, Seattle, Washington
| | - Ashish Pershad
- Department of Medicine, Banner University Medical Center, Phoenix, Arizona
| | - Taishi Hirai
- Department of Medicine, University of Missouri, Kansas City, Missouri
| | - Emad Hakemi
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
| | | | - Megha Prasad
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
| | - Yousif Ahmad
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
| | - Raja Hatem
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Fotis Gkargkoulas
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
| | - John A Spertus
- Department of Medicine, University of Missouri, Kansas City, Missouri
| | | | - Farouc Jaffer
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Stephen Cook
- Peacehealth Sacred Heart Medical Center, Springfield, Oregon
| | | | - Karen Nugent
- St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Martin B Leon
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ziad A Ali
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Manish A Parikh
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
- NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Akiko Maehara
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - David J Cohen
- Department of Medicine, University of Missouri, Kansas City, Missouri
| | - Candido Batres
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
| | - J Aaron Grantham
- St. Luke's Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri, Kansas City, Missouri
| | - Dimitri Karmpaliotis
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
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Karacsonyi J, Vemmou E, Nikolakopoulos I, Ungi I, Abi Rafeh N, ElGuindy A, Azzalini L, Burke MN, Brilakis ES. Current challenges and prevention strategies for chronic total occlusion (CTO) complications. Expert Rev Cardiovasc Ther 2021; 19:337-347. [PMID: 33730518 DOI: 10.1080/14779072.2021.1905521] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) can be challenging, but high success rates (85-90%) are currently achieved at experienced centers with approximately 3% risk for a major periprocedural complication.Areas covered: CTO PCI complications can be categorized according to location such as cardiac and non-cardiac (vascular access complications, thromboembolic complications, contrast-related and radiation injury) complications. Cardiac complications are further subdivided into coronary (acute closure, perforation, and equipment loss or entrapment) and non-coronary (hypotension, myocardial infarction, tamponade, arrhythmias).Expert opinion: In this article, we review strategies to prevent and treat CTO PCI complications. Careful monitoring throughout the case enables prevention and early detection of a complication. If a complication occurs, rapid implementation of treatment using an algorithmic approach can minimize its adverse impact.
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Affiliation(s)
- Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Evangelia Vemmou
- Minneapolis Heart Institute and Minneapolis Heart Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute and Minneapolis Heart Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Imre Ungi
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | | | - Ahmed ElGuindy
- Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
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Fu M, Chang S, Ge L, Huang D, Yao K, Zhang F, Qin Q, Ma J, Qian J, Ge J. Reattempt Percutaneous Coronary Intervention of Chronic Total Occlusions after Prior Failures: A Single-Center Analysis of Strategies and Outcomes. J Interv Cardiol 2021; 2021:8835104. [PMID: 33935602 PMCID: PMC8079192 DOI: 10.1155/2021/8835104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 03/24/2021] [Accepted: 04/09/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The initial recanalization rate of coronary chronic total occlusions (CTOs) is >85% when performed by experienced operators, but only 10% of prior failed CTO patients receive reattempted recanalization. This retrospective study analyzed the success rate and strategies used in reattempt percutaneous coronary intervention (PCI) of CTOs after prior failures. METHODS Overall, 206 patients with 212 CTOs were enrolled. All patients with prior recanalization failures received reattempt PCIs from January 2015 to March 2019 at Zhongshan Hospital, Fudan University. Data on clinical factors (age, sex, comorbidities, left ventricular ejection fraction, history of cigarette usage, and revascularization), angiographic characteristics of CTOs (target lesion, Japanese Chronic Total Occlusion (J-CTO) score, the morphology of CTO lesions, and collateral channel scale), strategies (procedural approach and use of devices), and major adverse events were obtained and analyzed. RESULTS The mean age of enrolled patients was 60.96 ± 12.36 years, with a male predominance of 90.3%. Of the patients, 47.1% had a prior myocardial infarction and 70.4% underwent stent implantation previously, while the in-stent occlusion rate was 6.6%. CTOs were primarily localized in the left anterior descending artery (43.9%) and the right coronary artery (43.9%). 80.7% of lesions were classified as very difficult (J-CTO score ≥3), and the overall success rate was 81.1%. In multivariable regression analysis, J-CTO score, collateral channel scale, application of coronary multispiral computed tomography angiography, dual injection, intravascular ultrasound, active greeting technique, parallel wiring, and CTO morphology were predictors of recanalization success. There were no significant differences in rates of procedural complications between the final recanalization success and failure groups. CONCLUSIONS Recanalization of complex CTOs is associated with high success rate and low complication rates when performed by high-volume CTO operators and after multiple reattempts.
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Affiliation(s)
- Mingqiang Fu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Shufu Chang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Lei Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Dong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Kang Yao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Qing Qin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
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Vemuri KS, Sihag BK, Sharma Y, Nevali KP, Vijayvergiya R, Kumar RM, Bahl A, Singh P, Mehrotra S, Khanal S, Dahiya N, Gupta A, Gupta H, Naganur S, Basant K, Panda P, Gupta A, Barwad P. Real world perspective of coronary chronic total occlusion in third world countries: A tertiary care centre study from northern India. Indian Heart J 2021; 73:156-160. [PMID: 33865511 PMCID: PMC8065346 DOI: 10.1016/j.ihj.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The aim of this study is to determine the prevalence, clinical characteristics, angiographic profile and predictors of outcome for percutaneous coronary interventions (PCI) of coronary chronic total occlusions (CTO) in a tertiary referral centre of north India. BACKGROUND There is no data on the prevalence and very few reports on clinical characteristics, angiographic profile and outcome of PCI in CTO from India. METHODS Retrospective analysis was done for the data of 12,020 patients undergoing coronary angiography (CAG) between January 2018 to January 2019 at our centre. Detailed baseline clinical, angiographic and revascularization data was collected. Outcome of CTO PCI was also noted. All baseline parameters were analysed for predicting the outcome of CTO PCI. RESULTS CTO was identified in 16.3% (1968) patients undergoing CAG and in 24.4% of patients with hemodynamically significant CAD. CTO was predominantly found in LAD (48%) followed by RCA (42.9%) and LCx (25.3%) arterial distribution. Mean JCTO score was 1.93 ± 0.7. PCI as a management strategy was adopted in 456 of 1968 patients (23.1%) and was successful in 340 of 456 (74.6%) of patients. Almost all CTO PCI were attempted by an antegrade approach only. Increasing age, male sex, CTO in LCx arterial distribution and higher J CTO score were associated with poorer outcome in CTO PCI. CONCLUSIONS CTO's are commonly encountered during CAG procedures. In patients undergoing CTO PCI, a fair success rate can be achieved in a high volume experienced centre.
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Affiliation(s)
- Krishna Santosh Vemuri
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Bhupinder Kumar Sihag
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Yashpaul Sharma
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Krishna Prasad Nevali
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Rajesh Vijayvergiya
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Rohit Manoj Kumar
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Ajay Bahl
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Parminder Singh
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Saurabh Mehrotra
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Suraj Khanal
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Neelam Dahiya
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Ankur Gupta
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Himanshu Gupta
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Sanjeev Naganur
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Kumar Basant
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Prashant Panda
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Ankush Gupta
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Parag Barwad
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India.
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Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Jinnouchi H, Wada H, Fujita H. Clinical Factors Associated with Long Fluoroscopy Time in Percutaneous Coronary Interventions to the Culprit Lesion of Non-ST-Segment Elevation Myocardial Infarction. Int Heart J 2021; 62:282-289. [PMID: 33731534 DOI: 10.1536/ihj.20-634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) were comparable or even worse than those with ST-segment elevation myocardial infarction (STEMI). Although successful percutaneous coronary intervention (PCI) to the culprit lesions of NSTEMI would improve the clinical outcomes, some PCI require long fluoroscopy time, reflecting the difficulty of PCI. This study aims to find clinical factors associated with long fluoroscopy time in PCI to the culprit lesion of NSTEMI. We included 374 patients and divided those into the conventional fluoroscopy time (n = 302) and long fluoroscopy time (n = 72) groups according to the quintiles of fluoroscopy time. Clinical and angiographic parameters were compared between the two groups. Calcification and tortuosity were significantly more severe in the long fluoroscopy time group than in the conventional fluoroscopy time group. The prevalence of previous coronary artery bypass grafting (CABG) and bifurcation lesions was significantly greater in the long fluoroscopy time group than in the conventional fluoroscopy time group. In the multivariate stepwise logistic regression analysis, previous CABG (odds ratio [OR], 3.368; 95% confidence interval [CI], 1.407-8.064; P = 0.006), bifurcation lesion (OR, 2.407; 95% CI, 1.285-4.506; P = 0.006), excessive tortuosity (versus mild to moderate tortuosity; OR, 4.095; 95% CI, 1.159-14.476; P = 0.029), and moderate to severe calcification (versus none to mild; OR, 5.792; 95% CI, 3.254-10.310; P < 0.001) were significantly associated with long fluoroscopy time. In conclusion, previous CABG, bifurcation, excessive tortuosity, and moderate to severe calcification were associated with long fluoroscopy time. Our study provided a reference for PCI operators to identify the difficulties in PCI to the culprit lesion of NSTEMI.
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Affiliation(s)
- Shun Ishibashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Satoshi Asada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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