1
|
Abdelaziz A, Elsayed H, Hamdaalah A, Atta K, Mechi A, Kadhim H, Aboutaleb AM, Elaraby A, Ellabban MH, Rzk FM, Eid M, AboElfarh HE, Ibrahim RA, Zawaneh EA, Ezzat M, Abdelaziz M, Hafez AH, Fadel S, Ghaith HS, Suppah M. Safety and feasibility of rotational atherectomy (RA) versus conventional stenting in patients with chronic total occlusion (CTO) lesions: a systematic review and meta-analysis. BMC Cardiovasc Disord 2024; 24:4. [PMID: 38166554 PMCID: PMC10763069 DOI: 10.1186/s12872-023-03673-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/13/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND AND AIM Interventional cardiologists face challenges in managing chronic total occlusion (CTO) lesions, with conflicting results when comparing rotational atherectomy (RA) to conventional PCI. This meta-analysis aims to provide a critical evaluation of the safety and feasibility of RA in CTO lesions. METHODS PubMed, Scopus, Web of Science, Ovid, and Cochrane central library until April 2023 were searched for relevant studies. MACE was our primary outcomes, other outcomes were all cause of death, cardiac death, MI, and TVR. Also, we reported angiographic outcomes as technical success, procedural success, and procedural complications in a random effect model. The pooled data was analyzed using odds ratio (OR) with its 95% CI using STATA 17 MP. RESULTS Seven studies comprising 5494 patients with a mean follow-up of 43.1 months were included in this meta-analysis. Our pooled analysis showed that RA was comparable to PCI to decrease the incidence of MACE (OR = 0.98, 95% CI [0.74 to 1.3], p = 0.9). Moreover, there was no significant difference between RA and conventional PCI in terms of other clinical or angiographic outcomes. CONCLUSION Our study showed that RA had comparable clinical and angiographic outcomes as conventional PCI in CTO lesions, which offer interventional cardiologists an expanded perspective when addressing calcified lesions. PROSPERO REGISTRATION CRD42023417362.
Collapse
Affiliation(s)
- Ahmed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hanaa Elsayed
- Medical Research group of Egypt (MRGE), Cairo, Egypt.
- Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | | | - Karim Atta
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Ahmed Mechi
- Internal Medicine Department, Medicine College, University of Kufa, Najaf, Iraq
| | - Hallas Kadhim
- College of Medicine, Al Muthanna university, Samawah, Iraq
| | - Aya Moustafa Aboutaleb
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Elaraby
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Hatem Ellabban
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Fayed Mohamed Rzk
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mahmoud Eid
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Hadeer Elsaeed AboElfarh
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Neurology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rahma AbdElfattah Ibrahim
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh, Egypt
| | - Emad Addin Zawaneh
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of medicine, Jordan university of science and technology, Irbid, Jordan
| | - Mahmoud Ezzat
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman H Hafez
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Shaimaa Fadel
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hazem S Ghaith
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mustafa Suppah
- Department of Cardiovascular Medicine, Mayo Clinic, 13400 E Shea Boulevard, Scottsdale, AZ, 85259, USA
| |
Collapse
|
2
|
Impact of chronic total occlusion lesions on clinical outcomes in patients receiving rotational atherectomy: results from the ROCK registry. Heart Vessels 2021; 36:1617-1625. [PMID: 33837813 DOI: 10.1007/s00380-021-01849-4] [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: 01/22/2021] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study was to investigate the impact of chronic total occlusion (CTO) on clinical outcomes in patients with calcified coronary lesions receiving rotational atherectomy (RA). This multi-center registry enrolled consecutive patients with calcified coronary artery disease who underwent RA during percutaneous coronary intervention (PCI) from 9 tertiary centers in Korea between January 2010 and October 2019. The primary outcome was target-vessel failure (TVF) which included the composite of cardiac death, target-vessel myocardial infarction (TVMI), and target-vessel revascularization (TVR). A total of 583 lesions were enrolled in this registry and classified as CTO (n = 42 lesions, 7.2%) and non-CTO (n = 541 lesions, 92.8%). The CTO group consisted of younger patients who were more likely to have a history of previous percutaneous coronary intervention or coronary artery bypass graft surgery. The incidence of the primary outcome was 14.1% and 16.7% for the non-CTO group and CTO group, respectively. The primary outcomes observed in the two groups were not significantly different (log-rank p = 0.736). The 18-month clinical outcomes of the CTO group were comparable to those of the non-CTO group in multivariate analysis. About 7% of patients requiring RA have CTO lesions and these patients experience similar clinical outcomes compared with those having non-CTO lesions. Use of RA for CTO lesions was safe despite higher procedural complexity.
Collapse
|
3
|
Huang WC, Teng HI, Chan WL, Lu TM. Short-term and long-term clinical outcomes of rotational atherectomy in resistant chronic total occlusion. J Interv Cardiol 2018; 31:458-464. [DOI: 10.1111/joic.12489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/02/2017] [Accepted: 12/09/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Wei-Chieh Huang
- Division of Cardiology; Department of Internal Medicine; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
| | - Hsin-I Teng
- Division of Cardiology; Chia-Yi & Wan-Qiao Branch; Taichung Veterans General Hospital; Taichung Taiwan, R.O.C
| | - Wan-Leong Chan
- Department of Health Care Center; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
| | - Tse-Min Lu
- Division of Cardiology; Department of Internal Medicine; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
- Department of Health Care Center; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
- School of Medicine; National Yang-Ming University; Taipei Taiwan, R.O.C
| |
Collapse
|
4
|
Xue J, Li J, Wang H, Sheng L, Gong Y, Sun D, Li S, Li W, Wang D, Li Y. "Seesaw balloon-wire cutting" technique is superior to Tornus catheter in balloon uncrossable chronic total occlusions. Int J Cardiol 2017; 228:523-527. [PMID: 27875729 DOI: 10.1016/j.ijcard.2016.10.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 10/30/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inability to advance a balloon is a well-recognized cause leading to a failure in recanalization of chronic total occlusions (CTOs) despite successfully passing a guidewire. A few techniques and devices have been introduced to facilitate balloon passage, especially the use of Tornus catheter. However, complex manipulation, expensive cost, and availability limit the application of these methods. This study was to evaluate the efficiency and safety of "seesaw balloon-wire cutting" technique in comparison with Tornus catheter for balloon uncrossable CTOs. METHODS Eighty patients with balloon uncrossable CTOs were enrolled in this study. Among them, 40 patients treated with "seesaw balloon-wire cutting" technique were consecutively investigated and 40 patients treated with Tornus catheter before were matched retrospectively. A rotablator or retrograde strategy was taken as a bail-out strategy. Success rates of device and procedure and complication rate were assessed. Complications included coronary dissection, cardiac tamponade, death, Q-wave myocardial infarction (MI), non-Q-wave MI, emergency PCI and bypass surgery. RESULTS Compared with the Tornus catheter, device success rate was significantly higher with the "seesaw balloon-wire cutting" technique (87.5% vs. 45.0%, P<0.001), and the mean procedural time was much shorter (90.5±8.3min vs. 141.5±21.3min, P<0.001). The procedural success rate was also higher with the "seesaw balloon-wire cutting" technique (92.5% vs.72.5%, P=0.037). There were no differences in complication rate. CONCLUSION The "seesaw balloon-wire cutting" technique is superior to the Tornus catheter in treating balloon uncrossable CTOs.
Collapse
Affiliation(s)
- Jingyi Xue
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Jianqiang Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Hongjun Wang
- Department of Cardiology, The First Hospital of Harbin, Harbin, China
| | - Li Sheng
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yongtai Gong
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Danghui Sun
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Shuang Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Weimin Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Dingyu Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yue Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China.
| |
Collapse
|
5
|
Azzalini L, Dautov R, Ojeda S, Serra A, Benincasa S, Bellini B, Giannini F, Chavarría J, Gheorghe LL, Pan M, Carlino M, Colombo A, Rinfret S. Long-term outcomes of rotational atherectomy for the percutaneous treatment of chronic total occlusions. Catheter Cardiovasc Interv 2016; 89:820-828. [PMID: 28029214 DOI: 10.1002/ccd.26829] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/12/2016] [Accepted: 10/08/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To study the long-term outcomes of rotational atherectomy (RA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND There is little evidence on the incidence, procedural results and long-term outcomes of RA for CTO PCI. METHODS This registry included data from consecutive patients undergoing CTO PCI at four specialized centers. Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and ischemia-driven target-vessel revascularization) on follow-up were the primary endpoint. RESULTS A total of 1003 patients were included. Of these, 35 (3.5%) required RA. As compared with Conventional PCI, RA patients were older (68.9 ± 9.5 vs. 64.6 ± 10.7 years, P = 0.02), had higher prevalence of diabetes (58% vs. 37%, P = 0.01) and of a J-CTO score ≥2 (80% vs. 58%, P = 0.009), driven by severe calcification. Antegrade wire escalation was used more frequently in RA (74% vs. 53%, P = 0.08). RA was performed for balloon failure-to-cross in 51% and failure-to-expand in 49%. One burr was utilized in 86%. The 1.25-mm burr was the largest burr used in 43%. Slow flow/no-reflow was observed in 17%. No other serious RA-related complications were observed. Procedural success was 77% vs. 89% (P = 0.04) in RA vs. Conventional PCI. After a mean follow-up of 658 ± 412 days, MACE rates were similar between groups (15% vs. 13%, P = 0.70). CONCLUSIONS The use of RA in CTO PCI was safe, despite a worse patient risk profile and higher procedural complexity, as compared with conventional techniques. Although procedural success was lower in the RA group, there were no differences in long-term clinical outcomes between groups. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Lorenzo Azzalini
- Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Rustem Dautov
- Interventional Cardiology, Department of Medicine, McGill University Medical Center, Montreal, QC, Canada.,Interventional Cardiology, Department of Medicine, Quebec Heart and Lung Institute and Laval University, Quebec City, QC, Canada
| | - Soledad Ojeda
- Interventional Cardiology, Department of Cardiology, Reina Sofía Hospital, University of Córdoba (IMIBIC), Córdoba, Spain
| | - Antonio Serra
- Interventional Cardiology, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Susanna Benincasa
- Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Jorge Chavarría
- Interventional Cardiology, Department of Cardiology, Reina Sofía Hospital, University of Córdoba (IMIBIC), Córdoba, Spain
| | - Livia L Gheorghe
- Interventional Cardiology, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Manuel Pan
- Interventional Cardiology, Department of Cardiology, Reina Sofía Hospital, University of Córdoba (IMIBIC), Córdoba, Spain
| | - Mauro Carlino
- Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Stéphane Rinfret
- Interventional Cardiology, Department of Medicine, McGill University Medical Center, Montreal, QC, Canada.,Interventional Cardiology, Department of Medicine, Quebec Heart and Lung Institute and Laval University, Quebec City, QC, Canada
| |
Collapse
|
6
|
Karacsonyi J, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Bahadorani J, Doing A, Ali ZA, Karatasakis A, Danek BA, Rangan BV, Alame AJ, Banerjee S, Brilakis ES. Prevalence, indications and management of balloon uncrossable chronic total occlusions: Insights from a contemporary multicenter US registry. Catheter Cardiovasc Interv 2016; 90:12-20. [DOI: 10.1002/ccd.26780] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/21/2016] [Accepted: 08/15/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Judit Karacsonyi
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged; Szeged Hungary
| | | | | | - Farouc A. Jaffer
- Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Robert W. Yeh
- Beth Israel Deaconess Medical Center, Boston; Massachusetts
| | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego; San Diego California
| | - John Bahadorani
- VA San Diego Healthcare System and University of California San Diego; San Diego California
| | | | | | - Aris Karatasakis
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Barbara A. Danek
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Bavana V. Rangan
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Aya J. Alame
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Subhash Banerjee
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Emmanouil S. Brilakis
- VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
- Minnepolis Heart Institute; Minneapolis Minnesota
| |
Collapse
|
7
|
Tornus catheter and rotational atherectomy in resistant chronic total occlusions. Int J Cardiol 2013; 167:2653-6. [DOI: 10.1016/j.ijcard.2012.06.124] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 03/17/2012] [Accepted: 06/24/2012] [Indexed: 11/22/2022]
|
8
|
Fernandez JP, Hobson AR, McKenzie D, Shah N, Sinha MK, Wells TA, Levy TM, Swallow RA, Talwar S, O’Kane PD. Beyond the balloon: excimer coronary laser atherectomy used alone or in combination with rotational atherectomy in the treatment of chronic total occlusions, non-crossable and non-expansible coronary lesions. EUROINTERVENTION 2013; 9:243-50. [DOI: 10.4244/eijv9i2a40] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
9
|
Wasiak J, Law J, Watson P, Spinks A. Percutaneous transluminal rotational atherectomy for coronary artery disease. Cochrane Database Syst Rev 2012; 12:CD003334. [PMID: 23235596 PMCID: PMC7170418 DOI: 10.1002/14651858.cd003334.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This is an update of the review on 'Percutaneous transluminal rotational atherectomy for coronary artery disease' first published in The Cochrane Library Issue 4, 2003. Percutaneous transluminal coronary rotational atherectomy (PTCRA) debulks atherosclerotic plaque from coronary arteries using an abrasive burr. On rotation, the burr selectively removes hard tissue. PTCRA has been used both as an alternative to and in conjunction with balloon angioplasty to open up blocked coronary arteries. Its ongoing effectiveness and safety compared with other modes of removing atherosclerotic plaques is reviewed. OBJECTIVES To assess the effects of PTCRA for coronary artery disease in patients with non-complex and complex lesions (e.g. ostial, long or diffuse lesions or those arising from in-stent re-stenosis) of the coronary arteries. SEARCH METHODS For the original review, we searched the Heart Group Specialised Register; The Cochrane Library to Issue 2, 2001; and MEDLINE, CINAHL, EMBASE and Current Contents to December 2002 and reviewed reference lists for relevant articles. For the current review, we searched the same registries from 2002 to 2012 and reviewed reference lists for relevant articles. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials of PTCRA compared with placebo, no treatment or another intervention and excluded cross-over trials. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of the studies identified. Data were extracted independently by two review authors. We asked authors of trials to provide information when missing data were encountered. Statistical summaries used risk ratios (RR) and weighted mean differences. MAIN RESULTS We included 12 trials enrolling 3474 patients. The overall risk of bias was unclear for the majority of articles due to a lack of reported data; however, the authors determined that this would be unlikely to impact negatively as most data outcomes were objective (e.g. death vs. no death). There was no evidence of the effectiveness in improving patient outcomes of PTCRA in non-complex lesions. In complex lesions, there were no statistically significant differences in re-stenosis rates at six months (RR 1.05; 95% confidence interval (CI) 0.83 to 1.33) and at one year (RR 1.21; 95% CI 0.95 to 1.55) in those receiving PTCRA with adjunctive balloon angioplasty (PTCA) (PTCRA/PTCA) compared to those receiving PTCA alone. Morphological characteristics distinguishing complex lesions have not been examined in parallel-arm randomised controlled trials. The evidence for the effectiveness of PTCRA in in-stent re-stenosis is unclearCompared to angioplasty alone, PTCRA/PTCA did not result in a statistically significant increase in the risk of major adverse cardiac events (myocardial infarction (MI), emergency cardiac surgery or death) during the in-hospital period (RR 1.27; 95% CI 0.86 to 1.90). Compared to angioplasty, PTCRA was associated with nine times the risk of an angiographically detectable vascular spasm (RR 9.23; 95% CI 4.61 to 18.47), four times the risk of perforation (RR 4.28; 95% CI 0.92 to 19.83) and about twice the risk of transient vessel occlusions (RR 2.49; 95% CI 1.25 to 4.99) while angiographic dissections (RR 0.48; 95% CI 0.34 to 0.68) and stents used as a bailout procedure (RR 0.29; 95% CI 0.09 to 0.87) were less common. AUTHORS' CONCLUSIONS When conventional PTCA is feasible, PTCRA appears to confer no additional benefits. There is limited published evidence and no long-term data to support the routine use of PTCRA in in-stent re-stenosis. Compared to angioplasty alone, PTCRA/PTCA did not result in a higher incidence of major adverse cardiac events, but patients were more likely to experience vascular spasm, perforation and transient vessel occlusion. In certain circumstances (e.g. patients ineligible for cardiac surgery, those with architecturally complex lesions, or those with lesions that fail PTCA), PTCRA may achieve satisfactory re-vascularisation in subsequent procedures.
Collapse
Affiliation(s)
- Jason Wasiak
- Victorian Adult Burns Service and School of Public Health and Preventative Medicine, Monash University, The Alfred Hospital,Melbourne, Australia.
| | | | | | | |
Collapse
|
10
|
HU XINQUN, TANG LIANG, ZHOU SHENGHUA, FANG ZHENFEI, SHEN XIANGQIAN. A Novel Approach to Facilitating Balloon Crossing Chronic Total Occlusions: The “Wire-Cutting” Technique. J Interv Cardiol 2012; 25:297-303. [DOI: 10.1111/j.1540-8183.2012.00721.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
11
|
Fang HY, Wu CJ. Recanalization of calcified left anterior descending artery chronic total occlusion with rotational atherectomy via bilateral radial approach. Catheter Cardiovasc Interv 2011; 78:873-9. [DOI: 10.1002/ccd.23051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 02/13/2011] [Indexed: 11/08/2022]
|
12
|
Fang HY, Lee CH, Fang CY, Lin CJ, Wu CC, Yang CH, Chen CJ, Hsieh YK, Yip HK, Wu CJ. Application of penetration device (Tornus) for percutaneous coronary intervention in balloon uncrossable chronic total occlusion-procedure outcomes, complications, and predictors of device success. Catheter Cardiovasc Interv 2011; 78:356-62. [PMID: 21413119 DOI: 10.1002/ccd.22862] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 10/05/2010] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate procedure outcomes, complications, and the predictors of device success while using the Tornus in CTO revascularization. BACKGROUND The success of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) may be limited by the presence of severe calcified CTO lesions, especially in the smallest balloon uncrossable arteries. A penetrating device (Tornus) could improve the success rate. METHODS Device and angiographic success rates as well as procedural complications were assessed in 56 patients, who were consecutively and retrospectively enrolled into this study. Device success was defined as successful passage of the Tornus catheter through a CTO lesion. Procedure success was defined by a final TIMI 3 flow and <30% residual stenosis. RESULTS The device success rate was 71.4% in 40 patients and failure rate was 28.6% in 16 patients. The final procedure success was significantly higher in the Tornus success group compared with the Tornus failure group (87.5% vs. 37.5%, P < 0.001). One patient in the Tornus success group (1.8%) had wire perforation resulting in cardiac tamponade and cardiac death. Another patient (1.8%) in the Tornus success group had acute in-stent thrombosis and non-Q MI in 24 hr and was resuscitated by emergent PCI. The only independent predictor of device success was a calcium score < 2 (odds ratio (OR): 3.86 (95% CI: 1.14-13.1, P = 0.03). CONCLUSION The Tornus catheter can be used in severe calcified CTO PCI when the calcium score <2 and not be used in patients with a calcium score ≥2.
Collapse
Affiliation(s)
- Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan, Republic of China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Moliterno DJ. Rotational atherectomy for resistant chronic total occlusions: Another spin for tough old problems. Catheter Cardiovasc Interv 2010; 76:372-3. [DOI: 10.1002/ccd.22752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|