1
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Filho EM, Araujo GN, Machado GP, Padilla L, de Paula JET, Botelho AC, Campos CM, Quesada FLH, Alcantara M, Santiago R, de Los Santos FD, Oliveira MD, Ribeiro MH, Perez L, Pinto ME, Côrtes LA, Piccaro P, Brilakis ES, Quadros AS. Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions. Catheter Cardiovasc Interv 2024; 103:539-547. [PMID: 38431912 DOI: 10.1002/ccd.30987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 11/25/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications. AIM Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use. RESULTS From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in the GCE group were older and had more comorbidities. The median J-CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78-2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41-2.41, p = 0.986), in-hospital death (OR: 1.39, 95% CI: 0.54-3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52-2.19, p = 0.850) were similar in both groups. CONCLUSION In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.
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Affiliation(s)
| | - Gustavo N Araujo
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Instituto de Cardiologia de Santa Catarina, São José, Brazil
| | | | - Lucio Padilla
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Félix D de Los Santos
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Centro Medico ABC, Mexico City, Mexico
| | - Marcos D Oliveira
- Hospital São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Marcelo H Ribeiro
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Hospital SOS Cardio, Florianópolis, Brazil
| | - Luiz Perez
- Hospital Clinico Regional Dr Guillermo Grant Benavente, Concepcion, Chile
| | | | | | - Pedro Piccaro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Garbo R, Iannaccone M, Werner GS, Mashayekhi K, Boudou N, Bufe A, Agostoni P, Avran A, Gagnor A, Gasparini G, Gorgulu S, Galassi AR, Sianos G, di Mario C. Utility of Guiding Catheter Extensions for Recanalization of Chronic Total Occlusions: A EuroCTO Club Expert Panel Report. JACC Cardiovasc Interv 2023; 16:1833-1844. [PMID: 37587590 DOI: 10.1016/j.jcin.2023.05.019] [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: 10/02/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 08/18/2023]
Abstract
Guiding catheter extensions (GCEs) have become indispensable tools in the modern approach to percutaneous coronary intervention (PCI). The support offered during complex PCI of uncrossable, or tortuous lesions is particularly valuable in the setting of chronic total occlusions (CTO), both for conventional anterograde wire escalation and for anterograde or retrograde dissection and re-entry techniques. This EuroCTO consensus document describes the use of GCE during CTO recanalization and provides a practical guide to anatomies and techniques in which these devices are applicable. We describe the peculiar features of the most-used device and the practical technique for GCE delivery in standard PCI; further specific indications for antegrade and retrograde CTO PCI are discussed in a specific section. In the antegrade approach, the GCEs may be useful to increase support or facilitate antegrade dissection and re-entry techniques, while in the retrograde approach for reverse controlled antegrade and retrograde tracking, to increase retrograde support for gear delivery, for treatment of CTO in bifurcation and ipsilateral externalization with a single guide catheter. The last section of the paper describes GCE-related complications, challenges, limitations, and future perspectives.
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Affiliation(s)
- Roberto Garbo
- Maria Pia Hospital, GVM Care & Research, Turin, Italy
| | | | | | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Heartcenter Lahr, Lahr, Germany
| | | | - Alexander Bufe
- HELIOS Klinikum Krefeld, University Witten/Herdecke, Witten, Germany
| | | | | | - Andrea Gagnor
- Maria Vittoria Hospital, ASL Città di Torino, Turin, Italy
| | | | | | | | | | - Carlo di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
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3
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Ayoub M, Corpataux N, Behnes M, Schupp T, Forner J, Akin I, Neumann FJ, Westermann D, Rudolph V, Mashayekhi K. Safety and Efficiency of Rotational Atherectomy in Chronic Total Coronary Occlusion-One-Year Clinical Outcomes of an Observational Registry. J Clin Med 2023; 12:jcm12103510. [PMID: 37240617 DOI: 10.3390/jcm12103510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
The study sought to assess the procedural success of rotational atherectomy (RA) in coronary chronic total occlusion (CTO) and to investigate the in-hospital and one-year outcomes following RA. From 2015 to 2019, patients undergoing percutaneous coronary intervention for CTO (CTO PCI) were retrospectively included into the hospital database. The primary endpoint was procedural success. Secondary endpoints were in-hospital and one-year major adverse cardiovascular and cerebral event (MACCE) rates. During the study period of 5 years, 2.789 patients underwent CTO PCI. Patients treated with RA (n = 193, 6.92%) had a significantly higher procedural success (93.26% vs. 85.10%, p = 0.0002) compared to those treated without RA (n = 2.596, 93.08%). Despite a significantly higher rate of pericardiocentesis (3.11% vs. 0.50%, p = 0.0013) in the RA group, the in-hospital and one-year MACCE rate was similar in both groups (4.15% vs. 2.77%, p = 0.2612; 18.65% vs. 16.72%, p = 0.485). In conclusion, RA is associated with higher procedural success for CTO PCI, but has higher risks for pericardial tamponade than CTO PCI without the need for RA. Nevertheless, in-hospital and one-year MACCE rates did not differ in-between both groups.
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Affiliation(s)
- Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Noé Corpataux
- Department of Cardiology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
| | - Volker Rudolph
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
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Karacsonyi J, Kostantinis S, Simsek B, Rempakos A, Allana SS, Alaswad K, Krestyaninov O, Khatri J, Poommipanit P, Jaffer FA, Choi J, Patel M, Gorgulu S, Koutouzis M, Tsiafoutis I, Sheikh AM, ElGuindy A, Elbarouni B, Patel T, Jefferson B, Wollmuth JR, Yeh R, Karmpaliotis D, Kirtane AJ, McEntegart MB, Masoumi A, Davies R, Rangan BV, Mastrodemos OC, Doshi D, Sandoval Y, Basir MB, Megaly MS, Ungi I, Abi Rafeh N, Goktekin O, Brilakis ES. Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention. J Pers Med 2023; 13:515. [PMID: 36983697 PMCID: PMC10051461 DOI: 10.3390/jpm13030515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions.
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Affiliation(s)
- Judit Karacsonyi
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Athanasios Rempakos
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Salman S. Allana
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Oleg Krestyaninov
- Meshalkin Novosibirsk Research Institute, Novosibirsk 630055, Russia
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Paul Poommipanit
- Cardiology, Case Western Reserve University, University Hospitals, Cleveland, OH 44610, USA
| | - Farouc A. Jaffer
- Department of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - James Choi
- Department of Cardiology, Baylor Heart and Vascular Hospital, Dallas, TX 75226, USA
| | - Mitul Patel
- Cardiovascular Institute, University of California San Diego, VA San Diego Healthcare System, La Jolla, CA 92037, USA
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University School of Medicine, Istanbul 34295, Turkey
| | - Michalis Koutouzis
- First Cardiology Department Athens, Red Cross Hospital of Athens, Athens 11526, Greece
| | - Ioannis Tsiafoutis
- First Cardiology Department Athens, Red Cross Hospital of Athens, Athens 11526, Greece
| | - Abdul M. Sheikh
- Interventional Cardiology Department, Wellstar Health System, Marietta, GA 30141, USA
| | - Ahmed ElGuindy
- Aswan Heart Centre, Department of Cardiology, Magdi Yacoub Foundation, Aswan 4271185, Egypt
| | - Basem Elbarouni
- Department of Internal Medicine, St. Boniface General Hospital, Winnipeg, MB R2H 2A6, Canada
| | - Taral Patel
- Interventional Cardiology, Tristar Centennial Medical Center, Nashville, TN 37203, USA
| | - Brian Jefferson
- Interventional Cardiology, Tristar Centennial Medical Center, Nashville, TN 37203, USA
| | - Jason R. Wollmuth
- Interventional Cardiology, Providence Heart institute, Portland, OR 97213, USA
| | - Robert Yeh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Dimitrios Karmpaliotis
- Interventional Cardiology, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ 07960, USA
| | - Ajay J. Kirtane
- Division of Cardiology, Columbia University, New York, NY 10032, USA
| | | | - Amirali Masoumi
- Interventional Cardiology, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ 07960, USA
| | - Rhian Davies
- Interventional Cardiology, WellSpan York Hospital, York, PA 17403, USA
| | - Bavana V. Rangan
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Olga C. Mastrodemos
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Darshan Doshi
- Department of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Yader Sandoval
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Mir B. Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Michael S. Megaly
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Imre Ungi
- Division of Invasive Cardiology, Department of Internal Medicine and Cardiology Center, University of Szeged, 6725 Szeged, Hungary
| | - Nidal Abi Rafeh
- Cardiology, North Oaks Health System, Hammond, LA 70403, USA
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul 34676, Turkey
| | - Emmanouil S. Brilakis
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
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5
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Werner GS, Brilakis ES. Chronic Total Coronary Occlusion. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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6
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Voll F, Kuna C, Kufner S, Cassese S. [Technical armamentarium for chronic total occlusion of coronary vessels]. Herz 2021; 46:406-418. [PMID: 34398249 DOI: 10.1007/s00059-021-05053-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
Percutaneous revascularization of chronic total occlusion (CTO) of coronary vessels represents a major challenge for contemporary interventional cardiologists. In the last decade there has been an unprecedented effort towards the standardization of revascularization procedures for CTO of coronary vessels. This endeavour has been possible by virtue of the growing interest of various cardiological societies for this patient group. Along with supportive endovascular technologies and percutaneous devices specifically dedicated to this interventional target, the increasing experience of interventionalists enabled continuously growing success for revascularization of CTO of coronary vessels. This review article highlights the currently available tools as well as technologies, techniques and strategies for the percutaneous recanalization of CTO of coronary vessels.
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Affiliation(s)
- F Voll
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, München, Deutschland
| | - C Kuna
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, München, Deutschland
| | - S Kufner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, München, Deutschland
| | - S Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, München, Deutschland.
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7
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Ye Y, Zhao X, Du J, Zeng Y. Efficacy and safety of balloon-assisted microdissection with Sapphire® II 1.0-mm balloon in balloon-uncrossable chronic total occlusion lesions. J Int Med Res 2021; 48:300060520965822. [PMID: 33103520 PMCID: PMC7645396 DOI: 10.1177/0300060520965822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Earlier studies have shown that the balloon-assisted microdissection (BAM) technique is feasible using a 1.2- to 1.5-mm small balloon in balloon-uncrossable chronic total occlusion (CTO) lesions. This study was performed to assess the efficacy and safety of the BAM technique with a Sapphire® II 1.0-mm balloon. Methods In this retrospective study, patients undergoing percutaneous coronary intervention for CTO were consecutively screened for balloon-uncrossable CTO lesions using BAM with the Sapphire® II 1.0-mm balloon. The patients’ clinical and angiographic characteristics and procedural outcomes were collected for analyses. Results Twenty-four balloon-uncrossable CTO lesions were identified. Most of the CTO lesions were located in the right coronary artery, followed by the left anterior descending artery and left circumflex artery. The mean Japanese Multicenter CTO Registry (J-CTO) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) scores were 1.96 and 1.38, respectively. The total technical success rates were 91.6% (22/24) and 75.00% (18/24) for the lesions that were successfully treated with BAM. No patients developed major complications with the exception of one patient who developed a femoral hematoma. Conclusion BAM with the Sapphire® II 1.0-mm balloon may be an effective and safe technique for balloon-uncrossable CTO lesions.
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Affiliation(s)
- Yicong Ye
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Xiliang Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Jianjun Du
- Department of Cardiology, Tongliao Hospital, Neimengu, China
| | - Yong Zeng
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
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8
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Elrayes MM, Xenogiannis I, Nikolakopoulos I, Vemmou E, Wollmuth J, Abi Rafeh N, Karmpaliotis D, Gasparini GL, Burke MN, Brilakis ES. An algorithmic approach to balloon‐uncrossable coronary lesions. Catheter Cardiovasc Interv 2020; 97:E817-E825. [DOI: 10.1002/ccd.29215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Mahmoud M. Elrayes
- Department of Cardiology Specialized Medical Hospital, Mansoura University Mansoura Egypt
| | - Iosif Xenogiannis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota
| | - Evangelia Vemmou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota
| | | | - Nidal Abi Rafeh
- St. George Hospital University Medical Center Beirut Lebanon
| | | | | | - Martin Nicholas Burke
- 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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9
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Xenogiannis I, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Mahmud E, Choi JW, Burke MN, Doing AH, Dattilo P, Toma C, Smith AJC, Uretsky B, Krestyaninov O, Khelimskii D, Holper E, Potluri S, Wyman RM, Kandzari DE, Garcia S, Koutouzis M, Tsiafoutis I, Khatri JJ, Jaber W, Samady H, Jefferson BK, Patel T, Moses JW, Lembo NJ, Parikh M, Kirtane AJ, Ali ZA, Doshi D, Tajti P, Rangan BV, Abdullah S, Banerjee S, Brilakis ES. Usefulness of Atherectomy in Chronic Total Occlusion Interventions (from the PROGRESS-CTO Registry). Am J Cardiol 2019; 123:1422-1428. [PMID: 30798947 DOI: 10.1016/j.amjcard.2019.01.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 11/28/2022]
Abstract
There is limited data on the use of atherectomy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared the clinical and procedural characteristics and outcomes of CTO PCIs performed with or without atherectomy in a contemporary multicenter CTO PCI registry. Between 2012 and 2018, 3,607 CTO PCIs were performed at 21 participating centers. Atherectomy was used in 117 (3.2%) cases: rotational atherectomy in 105 cases, orbital atherectomy in 8, and both in 4 cases. Patients in whom atherectomy was used, were older (68 ± 8 vs 64 ± 10 years, p <0.0001) and had higher Japan-chronic total occlusion score (3.0 ± 1.2 vs 2.4 ± 1.3, p <0.0001). CTO PCI cases in which atherectomy was used had similar technical (91% vs 87%, p = 0.240) and procedural (90% vs 85%, p = 0.159) success and in-hospital major adverse cardiac event (4% vs 3%, p = 0.382) rates. However, atherectomy cases were associated with higher rates of donor vessel injury (4% vs 1%, p = 0.031), tamponade requiring pericardiocentesis (2.6% vs 0.4%, p = 0.012) and more often required use of a left ventricular assist device (9% vs 5%, p = 0.031). Atherectomy cases were associated with longer procedural duration (196 [141, 247] vs 119 [76, 180] minutes, p <0.0001), and higher patient air kerma radiation dose (3.6 [2.5, 5.6] vs 2.8 [1.6, 4.7] Gray, p = 0.001). In conclusion, atherectomy is currently performed in approximately 3% of CTO PCI cases and is associated with similar technical and procedural success and overall major adverse cardiac event rates, but higher risk for donor vessel injury and tamponade.
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Affiliation(s)
- Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego, La Jolla, California
| | - Ehtisham Mahmud
- VA San Diego Healthcare System and University of California San Diego, La Jolla, California
| | - James W Choi
- Baylor Heart and Vascular Hospital, Dallas, Texas
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Phil Dattilo
- Medical Center of the Rockies, Loveland, Colorado
| | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - A J Conrad Smith
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barry Uretsky
- VA Central Arkansas Healthcare System, Little Rock, Arkansas
| | | | | | | | | | | | | | - Santiago Garcia
- VA Minneapolis Healthcare System and University of Minnesota, Minneapolis, Minnesota
| | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia
| | - Habib Samady
- Emory University Hospital Midtown, Atlanta, Georgia
| | | | - Taral Patel
- Tristar Centennial Medical Center, Nashville, Tennesse
| | | | | | | | | | | | | | - Peter Tajti
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Bavana V Rangan
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Shuaib Abdullah
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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10
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Abstract
PURPOSE OF REVIEW To summarize novel techniques and developments in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). RECENT FINDINGS Using an algorithmic, step-by-step approach can help overcome several complex CTO lesions subsets, such as proximal cap ambiguity, ostial location, in-stent occlusion, bifurcations, balloon uncrossable and undilatable lesions. Similarly, an algorithmic approach can help prevent and optimally treat CTO PCI-related complication, such as perforation, radiation, and contrast-induced nephropathy. Continual update and reassessment of each operator's algorithm for performing CTO PCI can lead to improved outcomes.
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11
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Tsukui T, Sakakura K, Taniguchi Y, Yamamoto K, Wada H, Momomura SI, Fujita H. Comparison of the device performance between the conventional guide extension catheter and the soft guide extension catheter. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:113-119. [PMID: 29936110 DOI: 10.1016/j.carrev.2018.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/27/2018] [Accepted: 05/29/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The guide extension catheter is frequently used in current percutaneous coronary intervention, and the GuideLiner (Vascular Solutions Inc., Minneapolis, MN) has been the standard guide extension catheter. Recently, the Guideplus (Nipro, Osaka, Japan) has emerged as a new guide extension catheter. The aim of the present study was to compare device performance between the Guideplus and GuideLiner. METHODS We compared the purpose of guide extension catheter and the device unsuccessful rate between the Guideplus and GuideLiner. We classified the purpose of guide extension catheter into 4 categories: (1) to advance devices into the target lesion, (2) to engage guide catheter into the ostium, (3) to support the small profile balloon crossing the CTO or 99% stenosis that the microcatheter could not cross, and (4) others. RESULTS Ninety-two lesions were classified as the Guideplus group, whereas 103 lesions were classified as the GuideLiner group. The purpose of guide extension catheter was significantly different between the 2 groups (P < 0.001). The Guideplus was frequently used to support the small profile balloon crossing the CTO or 99% stenosis (20.7%), whereas the GuideLiner was not used (0%). The device unsuccessful rate was significantly less in the Guideplus (8.7%) than in the GuideLiner (20.4%) (P = 0.022). CONCLUSIONS The purpose of guide extension catheter was significantly different between the Guideplus and GuideLiner. The Guideplus was more frequently used to support the small profile balloon crossing the CTO or 99% stenosis. The device unsuccessful rate was less in the Guideplus, which may suggest the better performance as the guide extension catheter.
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Affiliation(s)
- Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Ali M, Yagoub H, Ibrahim A, Ahmed M, Ibrahim M, Saunders J, Brennan A, Cahill D, Hennessy T, Hynes BG, Arnous S, Kiernan TJ. Anchor-balloon technique to facilitate stent delivery via the GuideLiner catheter in percutaneous coronary intervention. Future Cardiol 2018; 14:291-299. [PMID: 29927308 DOI: 10.2217/fca-2017-0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM The GuideLiner (GL) is a widely used catheter primarily in complex percutaneous coronary intervention (PCI). Deep seating of the GL and distal stent placement may be facilitated by the anchor-balloon technique (ABT). METHODS We aimed to prospectively analyze procedural details, technical success, complications and in-hospital outcome in patients who underwent PCI using the GL catheter and the ABT. RESULTS A total of 118 patients underwent PCI with the aid of the GL and ABT. Procedure success rate was 95% (112/118) and only seven patients (5.9%) encountered complications. ABT was indicated and successfully used in 29 patients (25%). CONCLUSION GL and ABT successfully aided stent delivery in unfavorable and heavily calcified lesions which otherwise may have been considered unsuitable for PCI.
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Affiliation(s)
- Mohamed Ali
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Hatim Yagoub
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Abdalla Ibrahim
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Mohamed Ahmed
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Munir Ibrahim
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Jean Saunders
- Department of Mathematics & Statistics, University of Limerick, Limerick, Ireland
| | - Alice Brennan
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Donal Cahill
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Terence Hennessy
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Brian G Hynes
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Samer Arnous
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Thomas J Kiernan
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
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Koutouzis M, Avdikos G, Nikitas G, Zografos T, Tsiafoutis I, Agelaki M, Lazaris E. “Ping-pong” technique for treating a balloon uncrossable chronic total occlusion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:117-119. [DOI: 10.1016/j.carrev.2017.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/02/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
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Tanabe M, Kodama K, Asada K, Kunitomo T. Lesion characteristics and procedural outcomes of re-attempted percutaneous coronary interventions for chronic total occlusion. Heart Vessels 2017; 33:573-582. [PMID: 29224054 DOI: 10.1007/s00380-017-1091-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 12/01/2017] [Indexed: 12/31/2022]
Abstract
This study was performed to investigate lesion characteristics and procedural outcomes of re-attempted percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Prior failure of percutaneous revascularization of CTO has been identified as an independent predictor of failure at subsequent attempts. However, procedural outcomes of re-attempted PCI for CTO have not been elucidated. We evaluated lesion characteristics and procedural outcomes in 310 consecutive patients undergoing CTO-PCI, and compared the results between re-attempted (n = 59) and initial procedures (n = 251). Overall, 266 CTO lesions (85.8%) were treated successfully. In addition, the technical success rate in the re-attempted CTO lesions was 69.5% (41 of 59), although this was lower than for initially attempted lesions (89.6%, 225 of 251; P = 0.0021). In the details of reasons of previous failures, treatment devices failed to cross even after guidewire cross and procedure discontinuation due to management of complications achieved higher rates of technical success compared to those with the inability of guidewire crossing in re-attempted CTO-PCI (87.5 and 85.7 vs. 65.9%, respectively). CTO lesions in which PCI was re-attempted had more complex features, including calcification, tortuous morphology, and long lesion length, whereas patient demographics were similar. Re-attempted CTO lesions required complex procedures, including the retrograde approach (55.9 vs. 13.9%, P < 0.001), longer fluoroscopic time, and larger radiation dose. Meanwhile, rates of complications and in-hospital MACCE were similarly low in both groups. The technical success rates of re-attempted CTO-PCI lesions were acceptable. Furthermore, CTO-PCIs in re-attempted lesions were as safe as initially attempted CTO-PCI. However, re-attempted CTO-PCI lesions showed features of high anatomical complexity that required more complex and longer procedures, including the retrograde approach, for successful interventional revascularization. Re-attempted CTO-PCI due to treatment devices failed to cross even after guidewire cross and procedure discontinuation due to management of complications in previous attempt had higher success rates that those with the inability of guidewire crossing.
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Affiliation(s)
- Masaki Tanabe
- Department of Cardiology, Kyoto Okamoto Memorial Hospital, 58 Sayama Nishinokuchi, Kumiyama, Kyoto, 611-0034, Japan.
| | - Kenji Kodama
- Department of Cardiology, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan
| | - Kohei Asada
- Division of Cardiology, Okamura Memorial Hospital, Shizuoka, Japan
| | - Takeo Kunitomo
- Department of Cardiology, Nagahama City Hospital, Nagahama, Shiga, Japan
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15
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Guelker JE, Blockhaus C, Kroeger K, Wehner R, Klues H, Bufe A. The GuideLiner catheter: A supportive tool in percutaneous coronary intervention of chronic total occlusion. J Saudi Heart Assoc 2017; 30:69-74. [PMID: 29910576 PMCID: PMC6000889 DOI: 10.1016/j.jsha.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/29/2017] [Accepted: 09/04/2017] [Indexed: 11/30/2022] Open
Abstract
Background Failure of delivering a stent or a balloon across the target lesion during percutaneous coronary intervention (PCI) of chronic total occlusion (CTO), especially in arteries with calcified tortuous anatomy, is often due to insufficient backup support from the guiding catheter. The purpose of this study was to assess the feasibility of the GuideLiner (GL) catheter use. Methods We examined 18 patients and used the GL catheter to overcome poor support and excessive friction in standardized antegrade and retrograde CTO procedures. The GL is a coaxial, monorail guiding catheter extension delivered through a standard guiding catheter and is available in different sizes. Results Almost all lesions were classified as severely calcified (94.4 ± 0.24%). The Japanese CTO score reflecting lesion complexity was 3.56 ± 0.78. All procedures were performed femorally; the retrograde approach was used in 27.8 ± 0.46% of cases. The overall success rate was 88.9 ± 0.32%; there were no relevant complications. Conclusions The GL catheter is an adjunctive interventional device which enhances and amplifies CTO-PCI. Its use is indicated in cases in which back-up force needs to be strengthened to pass a CTO despite advanced calcification. It can be recommended as an important additional tool in advanced interventional cardiology such as antegrade and retrograde CTO-PCI if other techniques like anchor balloon or anchor wire are not possible.
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Affiliation(s)
- Jan-Erik Guelker
- Hertcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyaGermany.,Institute of Heart and Circulation Research, University of Cologne, Cologne, GermanybGermany
| | - Christian Blockhaus
- Hertcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyaGermany.,Institute of Heart and Circulation Research, University of Cologne, Cologne, GermanybGermany
| | - Knut Kroeger
- Department of Vascular medicine, Helios Clinic Krefeld, Krefeld, GermanycGermany
| | - Rosemarie Wehner
- RWI - Leibniz-Institute for Economic Research, Essen, GermanyeGermany
| | - Heinrich Klues
- Hertcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyaGermany.,Institute of Heart and Circulation Research, University of Cologne, Cologne, GermanybGermany
| | - Alexander Bufe
- Hertcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyaGermany.,Institute of Heart and Circulation Research, University of Cologne, Cologne, GermanybGermany.,University of Witten-Herdecke, Witten, GermanydGermany
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16
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Bharadwaj AS, Bhatheja S, Sharma SK, Kini AS. Utility of the guideliner catheter for percutaneous coronary interventions in patients with prior transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2017; 91:271-276. [DOI: 10.1002/ccd.27211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/24/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Aditya S. Bharadwaj
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York
| | - Samit Bhatheja
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York
| | - Samin K. Sharma
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York
| | - Annapoorna S. Kini
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York
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17
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Huang Z, Zhang B, Chai W, Ma D, Liao H, Zhong Z, Wang F, Lin J. Usefulness and Safety of a Novel Modification of the Retrograde Approach for the Long Tortuous Chronic Total Occlusion of Coronary Arteries. Int Heart J 2017; 58:351-356. [PMID: 28539570 DOI: 10.1536/ihj.16-337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate the feasibility and efficacy of the Guidezilla guide extension catheter in a reverse controlled antegrade and retrograde subintimal tracking (CART) technique for chronic total occlusion (CTO) recanalization.We retrospectively collected 80 CTO cases using reverse CART technology from January 2015 to October 2015 and 20 CTO cases using Guidezilla reverse-CART technology from October 2015 to March 2016. Guidezilla was applied in cases when it was difficult to advance a retro-guidewire through an occlusion segment into the antegrade guide catheter.The Guidezilla group had more cases with an occlusion longer > 20 mm (100.0% versus 72.5%, P = 0.005) and "bending > 45°" (90.0% versus 63.7%, P = 0.029) than the non-Guidezilla group, while the non-Guidezilla group had more retry lesions (25.0% versus 63.8%, P = 0.002). The septal collateral channel was the preferred choice for retro-recanalization in both groups (90.0% in Guidezilla group and 68.8% in non-Guidezilla group). All cases in the Guidezilla group achieved technical success with a TIMI 3 flow in the distal true lumen (100.0% versus 75.0% in non-Guidezilla group, P = 0.010). Cardiac tamponade and perforation in the epicardial artery was observed in 1 case each in the Guidezilla group. In the non-Guidezilla group, 19 complications occurred during the PCI procedure. No target vessel revascularization or in-hospital death occurred in either group.CTO lesions using the Guidezilla guide extension catheter to facilitate entry to an antegrade catheter in reverse CART technology is convenient and safe with a high success rate.
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Affiliation(s)
- Zehan Huang
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Bin Zhang
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Weilu Chai
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Dunliang Ma
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Hongtao Liao
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Zhian Zhong
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Feng Wang
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Jingye Lin
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
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18
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Christopoulos G, Kotsia AP, Rangan BV, Vo M, Alaswad K, Karmpaliotis D, Banerjee S, Brilakis ES. “Subintimal external crush” technique for a “balloon uncrossable” chronic total occlusion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:63-65. [DOI: 10.1016/j.carrev.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 11/25/2022]
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19
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Werner GS, Brilakis ES. Chronic Total Coronary Occlusion. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Emmanouil S. Brilakis
- Cardiac Catheterization Laboratories; VA North Texas Health Care System; Dallas TX USA
- Minneapolis Heart Institute; Minneapolis MN USA
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20
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Sharma D, Shah A, Osten M, Ing D, Barolet A, Overgaard CB, Džavík V, Seidelin PH. Efficacy and Safety of the GuideLiner Mother-in-Child Guide Catheter Extension in Percutaneous Coronary Intervention. J Interv Cardiol 2016; 30:46-55. [PMID: 27862338 DOI: 10.1111/joic.12354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) procedures are increasingly performed on complex tortuous and heavily calcified coronary lesions. The GuideLiner® catheter (Vascular Solutions, Inc. Minneapolis, MN) is a rapid exchange guide catheter extension system. There is paucity of data about the efficacy of this device in complex PCI. Therefore, we aim to report the indications, success, and efficacy of GuideLiner use in treating complex lesion subset in the present study. METHODS We collected data from all patients in whom the GuideLiner was used to facilitate PCI between April 1, 2011 and December 31, 2014 at a tertiary referral center in Toronto, Canada. Demographic and procedural data were obtained from an institutional prospective data registry. Indications for use of the GuideLiner, and angiographic and procedural data specific to the device were also collected. RESULTS The GuideLiner was utilized in 307 (317 lesions) of 6105 PCI procedures performed at our institution during the study period. The mean age was 68.4 ± 11.2 years and 82% were male. The majority of lesions were types B2 or C (98%), calcified (86.3%), with proximal tortuosity (88.6%). The overall technical success rate of the GuideLiner was 88%. The procedural success rate was 98.7%. The complication rate was low (1.6%). CONCLUSIONS Use of the GuideLiner catheter facilitated successful completion of PCI procedures in a majority of patients with complex lesions. Operators should be aware of the potential complications associated with GuideLiner use.
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Affiliation(s)
- Divyesh Sharma
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Ashish Shah
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Mark Osten
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Douglas Ing
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Alan Barolet
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Peter H Seidelin
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
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Kaneko U, Kashima Y, Kanno D, Sugie T, Kobayashi K, Fujita T. Successful rotational atherectomy over RG3 guidewire after failure of various techniques to deliver RotaWire. Cardiovasc Interv Ther 2016; 32:386-391. [PMID: 27682657 DOI: 10.1007/s12928-016-0432-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/21/2016] [Indexed: 11/26/2022]
Abstract
Although performing rotational atherectomy (RA) requires guidewire exchange for the dedicated guidewire, RotaWire guidewire (Boston Scientific) exhibits much lower performance than conventional guidewire. Consequently, there are times when RotaWire cannot be advanced past the lesion independently or using a microcatheter exchange technique, rendering RA impossible. We present a case of a heavily calcified, device-uncrossable, and non-expansible chronic total occlusion lesion successfully revascularized with RA over RG3 guidewire (Asahi Intecc), which has a length of 330 cm, hydrophilic coating, and a 0.010-inch-long shaft. RG3 provided excellent cross-ability and RA could also be performed over RG3 without guidewire exchange for the RotaWire.
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Affiliation(s)
- Umihiko Kaneko
- Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, North 49, East 16, 8-1, Higashi-Ward, Sapporo, 007-0849, Japan.
| | - Yoshifumi Kashima
- Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, North 49, East 16, 8-1, Higashi-Ward, Sapporo, 007-0849, Japan
| | - Daitaro Kanno
- Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, North 49, East 16, 8-1, Higashi-Ward, Sapporo, 007-0849, Japan
| | - Takuro Sugie
- Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, North 49, East 16, 8-1, Higashi-Ward, Sapporo, 007-0849, Japan
| | - Ken Kobayashi
- Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, North 49, East 16, 8-1, Higashi-Ward, Sapporo, 007-0849, Japan
| | - Tsutomu Fujita
- Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, North 49, East 16, 8-1, Higashi-Ward, Sapporo, 007-0849, Japan
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Karacsonyi J, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Bahadorani J, Doing A, Ali ZA, Karatasakis A, Danek BA, Rangan BV, Alame AJ, Banerjee S, Brilakis ES. Prevalence, indications and management of balloon uncrossable chronic total occlusions: Insights from a contemporary multicenter US registry. Catheter Cardiovasc Interv 2016; 90:12-20. [DOI: 10.1002/ccd.26780] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/21/2016] [Accepted: 08/15/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Judit Karacsonyi
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged; Szeged Hungary
| | | | | | - Farouc A. Jaffer
- Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Robert W. Yeh
- Beth Israel Deaconess Medical Center, Boston; Massachusetts
| | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego; San Diego California
| | - John Bahadorani
- VA San Diego Healthcare System and University of California San Diego; San Diego California
| | | | | | - Aris Karatasakis
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Barbara A. Danek
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Bavana V. Rangan
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Aya J. Alame
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Subhash Banerjee
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Emmanouil S. Brilakis
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
- Minnepolis Heart Institute; Minneapolis Minnesota
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23
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Guide extension catheter stepwise advancement facilitated by repeated distal balloon anchoring. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 18:66-69. [PMID: 27638104 DOI: 10.1016/j.carrev.2016.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/21/2016] [Accepted: 07/28/2016] [Indexed: 11/23/2022]
Abstract
Coronary stent delivery can be extremely challenging in tortuous and calcified lesions especially when radial approach is chosen. Guide extension catheter is a useful tool for overcoming the inherent difficulties arising by the use of radial access in complex percutaneous interventions. We describe a technique for guide extension catheter system advancement by presenting two cases. This was performed stepwise by repeated distal balloon anchoring in the coronary artery of interest.
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24
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Chronic total coronary occlusion recanalization: Current techniques and new devices. J Saudi Heart Assoc 2016; 29:110-115. [PMID: 28373785 PMCID: PMC5366668 DOI: 10.1016/j.jsha.2016.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/05/2016] [Accepted: 08/12/2016] [Indexed: 11/23/2022] Open
Abstract
Percutaneous coronary intervention (PCI) of total chronic coronary occlusion (CTO) still remains a major challenge. The prevalence of a CTO has been reported to be up to 30% among patients with a clinical indication for coronary angiography. Progress has been made with further advanced interventional techniques and continuously sophisticated interventional tools. Nevertheless the number of interventions carried out to recanalize a CTO is less than 10% of all procedures. Benefits of a successful CTO recanalization include relief of angina pectoris and ischemia-related dyspnea, substantial improvement in left ventricular function and, avoidance of surgery treatment. A vast variety of new CTO PCI techniques and materials has been introduced into clinical practise and pushed success rates of reopening a CTO up to around 90% in experienced hands. Particulary the introduction of the retrograde technique was a milestone. New developed microcatheters and special polymer coated wires allow to recanalize via small collaterals and vessels. Other tools such as intravascular ultrasound (IVUS) and multislice computertomography (MSCT) help to identify the anatomy and the characteristic of the lesions. Any invasive cardiac center should adopt CTO PCI procedures as standard therapy. Objective This review wants to assess and describe the latest development in CTO recanalization strategies.
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25
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Fabris E, Kennedy MW, Di Mario C, Sinagra G, Roolvink V, Ottervanger JP, Van't Hof AWJ, Kedhi E. Guide extension, unmissable tool in the armamentarium of modern interventional cardiology. A comprehensive review. Int J Cardiol 2016; 222:141-147. [PMID: 27494727 DOI: 10.1016/j.ijcard.2016.07.168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/27/2016] [Indexed: 11/19/2022]
Abstract
Due to the aging population undergoing percutaneous coronary intervention (PCI), interventional cardiologists are confronted daily with treatment of lesions with complex anatomy. Despite improvements in stent devices and PCI techniques, these lesions remain a challenge in terms of procedural success. Guide-extensions (GE) are coaxial "mother and child" catheters employed to facilitate device delivery but they can be used in many different complex scenarios. A comprehensive review of the possible applications of GE and of the GuideLiner™ (GL), the most widely used GE device, is missing. We therefore aim to provide a comprehensive review of all the potential applications of the GL and other GE devices, describe its limitations as well as tips and tricks for successful usage of this GE catheter.
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Affiliation(s)
- Enrico Fabris
- ISALA Hartcentrum, Zwolle, The Netherlands; Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | | | - Carlo Di Mario
- Royal Brompton Hospital & NHLI Imperial College, London, United Kingdom
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
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26
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Citius, Altius, Fortius: The impact of guide catheter extensions in contemporary percutaneous coronary intervention. Anatol J Cardiol 2016; 16:340-1. [PMID: 27240607 DOI: 10.14744/anatoljcardiol.2016.00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Waterbury TM, Sorajja P, Bell MR, Lennon RJ, Mathew V, Singh M, Sandhu GS, Gulati R. Experience and complications associated with use of guide extension catheters in percutaneous coronary intervention. Catheter Cardiovasc Interv 2015; 88:1057-1065. [DOI: 10.1002/ccd.26329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 10/24/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Thomas M. Waterbury
- Division of Cardiovascular Diseases; Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern; Minneapolis Minnesota
| | - Malcolm R. Bell
- Division of Cardiovascular Diseases; Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Ryan J. Lennon
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | - Verghese Mathew
- Division of Cardiovascular Diseases; Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Mandeep Singh
- Division of Cardiovascular Diseases; Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Gurpreet S. Sandhu
- Division of Cardiovascular Diseases; Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Rajiv Gulati
- Division of Cardiovascular Diseases; Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
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Successful interventional revascularization utilizing hybrid procedural steps of rotational atherectomy and retrograde approach via an ipsilateral collateral. Cardiovasc Interv Ther 2015; 31:309-15. [DOI: 10.1007/s12928-015-0359-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 09/22/2015] [Indexed: 01/06/2023]
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Benezet J, Gutiérrez-Barrios A, Agarrado A, Oneto J. Transradial anterograde recanalization of a totally occluded right coronary artery using a Guideliner catheter. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:166-7. [PMID: 25700575 DOI: 10.1016/j.acmx.2014.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 11/19/2022] Open
Affiliation(s)
- Javier Benezet
- Department of Cardiology, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain.
| | | | - Antonio Agarrado
- Department of Cardiology, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain
| | - Jesús Oneto
- Department of Cardiology, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain
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Novel Use of the GuideLiner Catheter to Deliver Rotational Atherectomy Burrs in Tortuous Vessels. Case Rep Cardiol 2014; 2014:594396. [PMID: 25140260 PMCID: PMC4129961 DOI: 10.1155/2014/594396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 07/10/2014] [Indexed: 11/18/2022] Open
Abstract
Rotational atherectomy (RA) for heavily calcified lesions is essential for improved stent delivery and stent expansion. In tortuous vessels it is often difficult to advance the burr without rotation and possible injury to the endothelium of healthy vessel. The GuideLiner catheter, a child in mother catheter, has recently been used to allow for increased support for delivery of stents through tortuous vessels. We report a novel use of the GuideLiner for the delivery of an RA burr in tortuous vessels requiring increased guide support.
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Kotsia AP, Christopoulos G, Brilakis E. Use of the retrograde approach for treating a ‘balloon-uncrossable’ coronary chronic total occlusion. Interv Cardiol 2014. [DOI: 10.2217/ica.14.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Affiliation(s)
- Lorenzo Azzalini
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal
| | - Hung Q. Ly
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal
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