Chronic total coronary occlusion recanalization: Current techniques and new devices

Percutaneous Coronary Intervention Offers Clinical Benefits to Diabetic Patients With Stable Chronic Total Occlusion

Whether percutaneous coronary intervention for chronic total occlusion (CTO-PCI) in diabetic patients offers more benefits compared with initial medical therapy (CTO-MT) is unclear. In this study, diabetic patients with one CTO (clinical manifestations: stable angina or silent ischemia) were enrolled. Consecutively, enrolled patients (n = 1605) were assigned to different groups: CTO-PCI (1044 [65.0%]) and initial CTO-MT (561 [35%]). After a median follow-up of 44 months, CTO-PCI tended to be superior to initial CTO-MT in major adverse cardiovascular events (adjusted hazard-ratio [aHR]: .81, 95% conference-interval: .65-1.02) and significantly superior in cardiac death (aHR: .58 [.39-.87]) and all-cause death (aHR: .678[.473-.970]). Such superiority mainly attributed to a successful CTO-PCI. CTO-PCI tended to be performed in patients with younger age, good collaterals, left anterior descending branch CTO, and right coronary artery CTO. While, those with left circumflex CTO and severe clinical/angiographic situations were more likely to be assigned to initial CTO-MT. However, none of these variables influenced the benefits of CTO-PCI. Thus, we concluded that for diabetic patients with stable CTO, CTO-PCI (mainly successful CTO-PCI) offered patients survival benefits over initial CTO-MT. These benefits were consistent regardless of clinical/angiographic characteristics.

The Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent in Patients with Chronic Total Occlusion Evaluated by Clinical Outcome and Optical Coherence Tomography Imaging Analysis

We sought to determine the effects of the use of a Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent (Combo^® DTS) in patients with chronic total occlusion (CTO) by evaluating clinical outcomes and by performing an optical coherence tomography (OCT) analysis. We retrospectively analyzed data from 39 patients who had successfully undergone OCT-guided revascularization of a CTO being treated with a Combo^® DTS. Clinical assessment, angiography (with quantitative coronary angiography analysis) and OCT examination were performed at baseline and at follow-up. The median follow-up period was 189 days, ranging from 157 to 615 days. At follow-up, revascularization was required due to angiographic restenosis in 40% (14 of 35) of patients. OCT analysis detected neointima proliferation in 23 (76.6%) patients. Neointima formation was often associated with microvessels in 18 patients (60%). Neoatheroslcerosis was observed in 2 (6.6%) patients. Malapposition was found in 4 patients (13.3%), and stent fractures were found in 11 patients (36.6%). Rate of strut coverage was 96.3% at follow-up. In conclusion, the implantation of a Combo^® DTS after successful CTO recanalization was associated with a restenosis rate of 40% despite good stent implantation at baseline, proven by OCT. Neointima formation was found as a main contributor to restenosis. Nevertheless, we observed a low rate of major cardiovascular events in our follow-up.

Does the effectiveness of recanalization of chronic occlusion depend on the location of the obstruction?

Introduction

In past studies, it has been questioned whether success of recanalization of chronic total occlusion (CTO) depends on the location of the occlusion - the circumflex artery (Cx) was considered as the most difficult to open.

Aim

To determine whether the effectiveness of recanalization of CTO depends on the location of the obstruction.

Material and methods

From January 2011 to January 2016, a single operator dedicated to chronic total occlusions performed in our center 357 procedures on 337 patients.

Results

Among 337 patients included in the study, 83.4% were male. Mean age was 62.8 ±9.3 years. Most of the patients had hypertension (86.4%) and hyperlipidemia (99.4%), and 28.8% of them had diabetes. The most frequently opened artery was the right coronary artery (RCA; 52.4%), followed by the left anterior descending artery (LAD; 29.4%), and last the Cx (18.2%). The mean J-CTO score was comparable between the three groups. The success rate of recanalization of CTO was similar for all arteries: 84.5% in the RCA, 81.9% in the LAD and 89.2% in the Cx (overall p = 0.437). Neither procedural complications nor adverse events depended on the location of the CTO.

Conclusions

Our study shows the same efficacy of CTO procedures of all epicardial arteries. We did not observe that effectiveness of recanalization of CTO depends on the location of the obstruction.