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Wu EB, Kalyanasundaram A, Brilakis ES, Mashayekhi K, Tsuchikane E. Global Consensus Recommendations on Improving the Safety of Chronic Total Occlusion Interventions. Heart Lung Circ 2024; 33:915-931. [PMID: 38839467 DOI: 10.1016/j.hlc.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 09/18/2023] [Accepted: 11/06/2023] [Indexed: 06/07/2024]
Abstract
Safety is of critical importance to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). This global consensus statement provides guidance on how to optimise the safety of CTO) PCI, addressing the following 12 areas: 1. Set-up for safe CTO PCI; 2. Guide catheter--associated vessel injuries; 3. Hydraulic dissection, extraplaque haematoma expansion, and aortic dissections; 4. Haemodynamic collapse during CTO PCI; 5. Side branch occlusion; 6. Perforations; 7. Equipment entrapment; 8. Vascular access considerations; 9. Contrast-induced acute kidney injury; 10. Radiation injury; 11 When to stop; and, 12. Proctorship. This statement complements the global CTO crossing algorithm; by advising how to prevent and deal with complications, this statement aims to facilitate clinical practice, research, and education relating to CTO PCI.
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Affiliation(s)
- Eugene B Wu
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong.
| | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology, II University Heart Center, Freiburg Bad Krozingen, Germany
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2
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Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Allana SS, Alaswad K, Basir MB, Krestyaninov O, Khelimskii D, Gorgulu S, Davies RE, Benton SM, Khatri JJ, Poommipanit P, Choi JW, Jaber WA, Rinfret S, Nicholson W, Al-Azizi KM, Potluri S, Aygul N, Altunkeser BB, Koutouzis M, Tsiafoutis I, Milkas A, ElGuindy AM, Abi Rafeh N, Goktekin O, Mastrodemos OC, Rangan BV, Sandoval Y, Burke MN, Brilakis ES. Incidence, mechanisms, treatment, and outcomes of donor vessel injury during percutaneous coronary interventions for chronic total occlusion. Catheter Cardiovasc Interv 2023; 102:585-593. [PMID: 37560823 DOI: 10.1002/ccd.30798] [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: 03/25/2023] [Revised: 06/22/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Donor vessel injury is a potentially life-threatening complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). AIMS Our goal was to examine the incidence, mechanisms, treatment, and outcomes of patients with donor vessel injury in a large multicenter CTO PCI registry. METHODS We analyzed the baseline clinical and angiographic characteristics, and procedural outcomes of 12,349 CTO PCIs performed between 2012 and 2022 at 44 centers. RESULTS The incidence of donor vessel injury was 0.35% (n = 43). The baseline clinical characteristics of patients with and without donor vessel injury were similar. Cases complicated by donor vessel injury were more complex with higher Japanese CTO score (2.9 ± 1.1 vs. 2.4 ± 1.3; p = 0.004) and lower procedural success rate (69.8% vs. 85.2%; p = 0.004). The retrograde approach was used more commonly in donor vessel injury cases (68.9% vs. 30.9%; p < 0.001). Most (53.5%) donor vessel injuries were guide catheter-induced, whereas 20.9% were due to donor vessel thrombosis. Of the 43 patients with donor vessel injury, 36 (83.7%) were treated with stenting and seven (16.3%) received a left ventricular assist device. The incidence of major adverse cardiovascular events (MACEs) was significantly higher in cases with donor vessel injury (23.3% vs. 2.0%; p < 0.001). Of the 43 patients with donor vessel injury, five patients (11.6%) experienced acute myocardial infarction and four patients (9.3%) died. CONCLUSIONS Donor vessel injury, occurred in 0.35% of CTO PCIs performed by experienced operators, was mainly due to guide catheter-induced dissection or thrombosis and was associated with lower procedural success and higher MACE.
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Affiliation(s)
- Spyridon Kostantinis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan, USA
| | - Mir B Basir
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan, USA
| | - Oleg Krestyaninov
- Department of Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Dmitrii Khelimskii
- Department of Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | - Rhian E Davies
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | - Stewart M Benton
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | | | - Paul Poommipanit
- Department of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Wissam A Jaber
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Stephane Rinfret
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - William Nicholson
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Karim M Al-Azizi
- Department of Cardiology, The Heart Hospital - Plano, Plano, Texas, USA
| | - Srinivasa Potluri
- Department of Cardiology, The Heart Hospital - Plano, Plano, Texas, USA
| | - Nazif Aygul
- Department of Cardiology, Selcuk University Medical Faculty, Konya, Turkey
| | | | - Michael Koutouzis
- Department of Cardiology, Red Cross Hospital of Athens, Athens, Greece
| | | | - Anastasios Milkas
- Department of Cardiology, Athens Naval and Veterans Hospital, Athens, Greece
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | - Nidal Abi Rafeh
- Department of Cardiology, North Oaks Health System, Hammond, Los Angeles, USA
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Olga C Mastrodemos
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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3
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Allana SS, Brilakis ES. The importance of the "safety coronary guidewire" in the donor vessel during Chronic total occlusion percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S292-S295. [PMID: 36737384 DOI: 10.1016/j.carrev.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Donor vessel injury is a well-known complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Due to significant amount of myocardium at risk, donor vessel injury may lead to rapid hemodynamic collapse. In this setting, prompt restoration of blood flow into the donor artery is of paramount importance. Advancement of a safety coronary workhorse guidewire in the donor vessel prior to attempting CTO PCI is a simple maneuver that provides access to the donor artery for rapid coronary intervention and restoration of blood flow, in the event of donor vessel injury. We describe two cases of CTO PCI that illustrate the value of the safety coronary guidewire.
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Affiliation(s)
- Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
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Klaudel J, Klaudel B, Glaza M, Trenkner W, Derejko P, Szołkiewicz M. Forewarned Is Forearmed: Machine Learning Algorithms for the Prediction of Catheter-Induced Coronary and Aortic Injuries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17002. [PMID: 36554883 PMCID: PMC9779019 DOI: 10.3390/ijerph192417002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Catheter-induced dissections (CID) of coronary arteries and/or the aorta are among the most dangerous complications of percutaneous coronary procedures, yet the data on their risk factors are anecdotal. Logistic regression and five more advanced machine learning techniques were applied to determine the most significant predictors of dissection. Model performance comparison and feature importance ranking were evaluated. We identified 124 cases of CID in electronic databases containing 84,223 records of diagnostic and interventional coronary procedures from the years 2000-2022. Based on the f1-score, Extreme Gradient Boosting (XGBoost) was found to have the optimal balance between positive predictive value (precision) and sensitivity (recall). As by the XGBoost, the strongest predictors were the use of a guiding catheter (angioplasty), small/stenotic ostium, radial access, hypertension, acute myocardial infarction, prior angioplasty, female gender, chronic renal failure, atypical coronary origin, and chronic obstructive pulmonary disease. Risk prediction can be bolstered with machine learning algorithms and provide valuable clinical decision support. Based on the proposed model, a profile of 'a perfect dissection candidate' can be defined. In patients with 'a clustering' of dissection predictors, a less aggressive catheter and/or modification of the access site should be considered.
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Affiliation(s)
- Jacek Klaudel
- Department of Invasive Cardiology and Interventional Radiology, St. Adalbert’s Hospital, Copernicus PL, 80-462 Gdańsk, Poland
- Department of Cardiology, St. Vincent de Paul Hospital, Pomeranian Hospitals, 81-348 Gdynia, Poland
| | - Barbara Klaudel
- Department of Decision Systems and Robotics, Faculty of Electronics, Telecommunications and Informatics, Gdansk University of Technology, 80-233 Gdańsk, Poland
| | - Michał Glaza
- Department of Cardiology, St. Vincent de Paul Hospital, Pomeranian Hospitals, 81-348 Gdynia, Poland
| | - Wojciech Trenkner
- Department of Invasive Cardiology and Interventional Radiology, St. Adalbert’s Hospital, Copernicus PL, 80-462 Gdańsk, Poland
| | - Paweł Derejko
- Department of Cardiology, Medicover Hospital, 02-972 Warszawa, Poland
- Cardiac Arrhythmias Department, National Institute of Cardiology, 04-628 Warszawa, Poland
| | - Marek Szołkiewicz
- Department of Cardiology, St. Vincent de Paul Hospital, Pomeranian Hospitals, 81-348 Gdynia, Poland
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
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Simsek B, Gorgulu S, Kostantinis S, Karacsonyi J, Alaswad K, Jaffer FA, Doshi D, Goktekin O, Kerrigan J, Haddad E, Patel M, Rinfret S, Jaber WA, Nicholson W, Rafeh NA, Allana S, Koutouzis M, Brilakis ES. Radial access for chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS‐CTO registry. Catheter Cardiovasc Interv 2022; 100:730-736. [DOI: 10.1002/ccd.30347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Bahadir Simsek
- Center for Coronary Artery Disease Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota USA
| | - Sevket Gorgulu
- Department of Cardiology Acibadem Kocaeli Hospital Kocaeli Turkey
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota USA
| | - Judit Karacsonyi
- Center for Coronary Artery Disease Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota USA
| | | | - Farouc A. Jaffer
- Division of Cardiology, Massachusetts General Hospital Harvard University Boston Massachusetts USA
| | - Darshan Doshi
- Division of Cardiology, Massachusetts General Hospital Harvard University Boston Massachusetts USA
| | - Omer Goktekin
- Division of Cardiology Bahcelievler Memorial Hospital Istanbul Turkey
| | - Jimmy Kerrigan
- Division of Cardiology Ascension Saint Thomas Heart Nashville Tennessee USA
| | - Elias Haddad
- Division of Cardiology Ascension Saint Thomas Heart Nashville Tennessee USA
| | - Mitul Patel
- Division of Cardiovascular Medicine UCSD Medical Center La Jolla California USA
| | | | | | | | - Nidal Abi Rafeh
- Division of Cardiology North Oaks Medical Center Hammond Louisiana USA
| | - Salman Allana
- Center for Coronary Artery Disease Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota USA
| | | | - Emmanouil S. Brilakis
- Center for Coronary Artery Disease Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota USA
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Lee WC, Wu PJ, Fang CY, Fang HY, Wu CJ, Liu PY. The comparison of efficacy and safety between transradial and transfemoral approach for chronic total occlusions intervention: a meta-analysis. Sci Rep 2022; 12:7591. [PMID: 35534603 PMCID: PMC9085849 DOI: 10.1038/s41598-022-11763-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/18/2022] [Indexed: 11/25/2022] Open
Abstract
This meta-analysis compared the outcomes of transradial access (TRA) and transfemoral access (TFA) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in recent decades. We searched multiple databases for articles published between January 1, 2015, and December 31, 2020. Six observational studies with 11,736 patients were analyzed. Data included baseline demographics, Japan-chronic total occlusion (J-CTO) score, sheath size, PCI vessel, retrograde method, procedural time, fluoroscopy time, and contrast volume. The more prevalent target CTO vessel was the left coronary artery in the TRA group and the right coronary artery in the TFA group. Higher J-CTO score, longer procedural time, and more contrast volume were seen in the TFA group. In comparison, the TRA group had better procedural success rate (odds ratio (OR), 0.846; 95% confidence interval (CI) 0.749-0.956) and less vascular complications (OR, 0.323; 95% CI 0.203-0.515), but similar retrograde success rate (OR, 0.965; 95% CI 0.382-2.435). In-hospital death (OR, 0.527; 95% CI 0.187-1.489) and major adverse cardiovascular events (OR, 0.729; 95% CI 0.504-1.054) did not differ between the groups. Overall, fewer vascular complications and higher procedural success rates were noted in the TRA CTO PCI population. However, similar retrograde success rates and clinical outcomes were noted between the groups.
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Affiliation(s)
- Wei-Chieh Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan, ROC
| | - Po-Jui Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd. North District, Tainan, 70403, Taiwan, ROC.
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Gorgulu S, Kalay N, Norgaz T, Kocas C, Goktekin O, Brilakis ES. Femoral or Radial Approach in Treatment of Coronary Chronic Total Occlusion: A Randomized Clinical Trial. JACC Cardiovasc Interv 2022; 15:823-830. [PMID: 35450683 DOI: 10.1016/j.jcin.2022.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare transradial access (TRA) with transfemoral access (TFA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND TRA reduces the risk for vascular access complications but may make complex PCI, such as CTO PCI, more challenging. METHODS FORT CTO (Femoral or Radial Approach in the Treatment of Coronary Chronic Total Occlusion) (NCT03265769) was a prospective, noninferiority, randomized controlled study of TRA vs TFA for CTO PCI. The primary study endpoint was procedural success, defined as technical success without any in-hospital major adverse cardiovascular events. The secondary study endpoint was major access-site complications. RESULTS Between 2017 and 2021, 610 of 800 patients referred for CTO PCI at 4 centers were randomized to TRA (n = 305) or TFA (n = 305). Mean J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 0.1 vs 2.2 ± 0.1; P = 0.279), PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) (1.3 ± 0.9 vs 1.1 ± 1.0; P = 0.058) and PROGRESS CTO complication (2.4 ± 1.8 vs 2.3 ± 1.8; P = 0.561) scores and use of the retrograde approach (11% vs 14%; P = 0.342) were similar in the TRA and TFA groups. TRA was noninferior to TFA for procedural success (84% vs 86%; P = 0.563) but had fewer access-site complications (2.0% vs 5.6%; P = 0.019). There was no difference between TFA and TRA in procedural duration, contrast volume, or radiation dose. CONCLUSIONS TRA was noninferior to TFA for CTO PCI but had fewer access-site complications.
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Affiliation(s)
- Sevket Gorgulu
- Cardiology Department, Acıbadem University Medical Faculty, Istanbul, Turkey.
| | - Nihat Kalay
- Cardiology Department, Acıbadem University Medical Faculty, Istanbul, Turkey
| | - Tugrul Norgaz
- Cardiology Department, Acıbadem University Medical Faculty, Istanbul, Turkey
| | - Cuneyt Kocas
- Cardiology Department, Biruni University Medical Faculty, Istanbul, Turkey
| | - Omer Goktekin
- Cardiology Department, Memorial Bahçelievler Hospital, Istanbul, Turkey
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Lin CJ, Lee WC, Lee CH, Chung WJ, Hsueh SK, Chen CJ, Yang CH, Fang HY, Cheng CI, Wu CJ. Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access. Front Cardiovasc Med 2021; 8:673858. [PMID: 34041286 PMCID: PMC8141614 DOI: 10.3389/fcvm.2021.673858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: The current study aims to verify the feasibility and safety of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) via the distal transradial access (dTRA). Methods: Between April 2017 and December 2019, 298 patients who underwent CTO PCI via dTRA were enrolled in this study. The baseline demographic and procedural characteristics were listed and compared between groups. The incidences of access-site vascular complications and procedural complications and mortality were recorded. Results: The mean J-CTO (Japanese chronic total occlusion) score was 2.6 ± 0.9 points. The mean access time was 4.6 ± 2.9 min, and the mean procedure time was 115.9 ± 55.6 min. Left radial snuffbox access was performed successfully in 286 patients (96.5%), and right radial snuffbox access was performed successfully in 133 patients (97.7%). Bilateral radial snuffbox access was performed in 107 patients (35.9%). 400 dTRA (95.5%) received glidesheath for CTO intervention. Two patients (0.7%) developed severe access-site vascular complications. None of the patients experienced severe radial artery spasm and only 2 patients (0.5%) developed radial artery occlusion during the follow-up period. The overall procedural success rate was 93.5%. The procedural success rate was 96.5% in patients with antegrade approach and 87.7% in patients with retrograde approach. Conclusions: It is both safe and feasible to use dTRA plus Glidesheath for complex CTO intervention. The incidences of procedure-related complications and severe access-site vascular complications, and distal radial artery occlusion were low.
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Affiliation(s)
- Cheng-Jui Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chieh-Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Jung Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-I Cheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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9
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Soud M, SayedAhmad Z, Kajy M, Alahdab F, Darmoch F, Al-Khadra Y, Pacha HM, Sattar Y, Ullah W, King F, Saad AB, Alhatemi G, Hakim Z, Ali OE, Glazier JJ, Alraies MC. The efficacy and safety of transradial and transfemoral approach in treatment of coronary chronic total occlusion: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2020; 18:809-817. [PMID: 32825807 DOI: 10.1080/14779072.2020.1813025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The clinical efficacy and safety of transradial (TR) percutaneous coronary intervention (PCI) in comparison to transfemoral (TF) for chronic total occlusion (CTO) is not well studied in literature. Objectives: We sought to study the outcome and complications associated with TR compared with TF for CTO interventions. METHODS After a systematic literature search was done in PubMed and EMBASE, we performed a meta-analysis of studies comparing TF and TR for CTO PCI. Results: Twelve studies with 19,309 patients were included. Compared to those who has TF access, individuals who were treated via TR approach had statistically significant lower access complication rates [odds ratio (OR): 0.33; 95% confidence interval (CI): 0.22 to 0.49; p < 0.0001]. The procedural success was in the favor of TR method (OR: 1.4; 95% CI: 1.31-1. 51; p < 0.0001). The incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and contrast-induced nephropathy were similar in both groups. CONCLUSION When compared with TF access interventions in CTO PCI; the TR approach appears to be associated with far less access-site complications, higher procedural success, and comparable MACCE.
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Affiliation(s)
- Mohamad Soud
- Department of Cardiology, Rutgers New Jersey Medical School , Newark, New Jersey, USA
| | - Ziad SayedAhmad
- Department of Internal Medicine, Beaumont Hospital , Royal Oak, MI, USA
| | - Marvin Kajy
- Department of Cardiology, Wayne State University, Detroit Medical Center , Detroit, Michigan, USA
| | - Fares Alahdab
- Department of Cardiology, Mayo Clinic Evidence-based Practice Center, Mayo Clinic , Rochester, MN, USA
| | - Fahed Darmoch
- Department of Cardiology, Beth Israel Harvard University , Boston, MA, USA
| | - Yasser Al-Khadra
- Department of Cardiology, Cleveland Clinic Foundation , Cleveland, Ohio, USA
| | - Homam Moussa Pacha
- Department of Cardiology, University of Texas Health Science Center , Houston, Texas, USA
| | - Yasar Sattar
- Department Internal Medicine, City Queens, Icahn School of Medicine at Mount Sinai Elmhurst Hospital New York , USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health , Abington, PA, USA
| | - Fred King
- Department of Cardiology, Rutgers New Jersey Medical School , Newark, New Jersey, USA
| | - Ali Bani Saad
- Department of Cardiology, Wayne State University, Detroit Medical Center , Detroit, Michigan, USA
| | - Ghaith Alhatemi
- Department of Cardiology, Wayne State University, Detroit Medical Center , Detroit, Michigan, USA
| | - Zaher Hakim
- Department of Cardiology, Wayne State University, Detroit Medical Center , Detroit, Michigan, USA
| | - Omar E Ali
- Department of Cardiology, Wayne State University, Detroit Medical Center , Detroit, Michigan, USA
| | - James J Glazier
- Department of Cardiology, Wayne State University, Detroit Medical Center , Detroit, Michigan, USA
| | - M Chadi Alraies
- Department of Cardiology, Wayne State University, Detroit Medical Center , Detroit, Michigan, USA
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10
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Comparison of the transradial and transfemoral approach in treatment of chronic total occlusions with similar lesion characteristics. Anatol J Cardiol 2019; 19:319-325. [PMID: 29724974 PMCID: PMC6280270 DOI: 10.14744/anatoljcardiol.2018.02779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective: There is limited data on the efficacy and the safety of the transradial approach (TRA) for percutaneous coronary intervention (PCI) of chronic total occlusion (CTO), particularly in comparison with the transfemoral approach (TFA) in lesions with similar complexity. Methods: We included 358 patients, who underwent elective CTO PCI between January 2012 and August 2017 and compared the radial (179 patients) and femoral (179 patients) approaches. The J-CTO score was similar in both groups (TRA, 2.5±1.3 vs. TFA, 2.8±1.4, n.s.). The endpoints analyzed included (i) the composite of all-cause death and nonfatal myocardial infarction (MI) and (ii) the composite safety endpoint of major adverse cardiovascular and cerebrovascular events (MACCEs), including death, MI, coronary perforation, contrast-induced nephropathy (CIN), bleeding at the vascular access site requiring transfusion, cardiac tamponade requiring pericardiocentesis, and periprocedural stroke. Results: Patients’ demographics, lesion location, lesion characteristics, and the proportion of antegrade vs. retrograde approach were similar in both groups. The procedural success rate of 96.4% in the radial group and 92.9% in the femoral group was comparable. The total fluoroscopy time (TRA, 42.4±15.7 min vs. TFA, 40.5±15.3 min, n.s.) and contrast medium use (TRA, 532.2±21.7 mL vs. TFA, 528.2±24.6 mL, n.s.) was similar in both groups. There was no in-hospital death or periprocedural MI in both groups. There were three coronary perforations in the TFA group, among them one with tamponade, and one coronary perforation the TRA group. Vascular access site complications (TRA, 0.01% vs. TFA, 0.02%) and CIN (TRA, 0.006% vs. TFA, 0.006%) were rare. One stroke as a result of the procedure was observed in the TFA group. No death was registered. Conclusion: The radial approach in CTO PCI was as fast and successful as the femoral approach, even in a complex lesion subset.
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Fang HY, Wu CJ, Lee WC. Impact of single-plane versus Bi-plane imaging on procedural time, fluorescence time, and contrast medium volume in retrograde chronic total occlusion percutaneous coronary intervention. J Interv Cardiol 2018; 31:799-806. [PMID: 30069907 DOI: 10.1111/joic.12545] [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] [Received: 05/11/2018] [Revised: 07/08/2018] [Accepted: 07/15/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of the study is to evaluate the impact of single-plane and bi-plane imaging on procedural time, fluorescence time, and contrast medium volume in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS Between January 2008 and December 2015, a total of 359 patients received scheduled retrograde CTO PCI and were enrolled in the study; 119 patients underwent PCI by single-plane imaging, and another 240 patients underwent PCI by bi-plane imaging. RESULTS A 95.0% rate of technical success was noted in the single-plane imaging group, and a 95.8% rate of technical success was noted in the bi-plane imaging group. All patients received the CTO approach via the retrograde method, and the retrograde method success rate was 88.2% in single-plane imaging group, and 81.7% in the bi-plane imaging group. A longer procedural time (153.73 ± 53.15 vs 172.88 ± 61.30 min; P = 0.004), longer fluorescence time (71.40 ± 25.96 vs 80.95 ± 34.70 min; P = 0.008), and more contrast medium volume (342.77 ± 102.25 vs 394.58 ± 156.41 mL; P = 0.001) were noted in the bi-plane imaging group. After propensity score match, a longer procedural time, longer fluorescence time, and more contrast volume was noted in bi-plane group. CONCLUSION Bi-plane imaging could not decrease procedural time, fluorescence time, and contrast medium volume in retrograde CTO PCI.
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Affiliation(s)
- Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
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Campón-Checkroun AM, Luceño-Mardones A, Riquelme I, Oliva-Pascual-Vaca J, Ricard F, Oliva-Pascual-Vaca Á. Effects of the Right Carotid Sinus Compression Technique on Blood Pressure and Heart Rate in Medicated Patients with Hypertension. J Altern Complement Med 2018; 24:1108-1112. [PMID: 29733225 DOI: 10.1089/acm.2017.0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES To identify the immediate and middle-term effects of the right carotid sinus compression technique on blood pressure and heart rate in hypertensive patients. DESIGN Randomized blinded experimental study. SETTINGS Primary health centers of Cáceres (Spain). SUBJECTS Sixty-four medicated patients with hypertension were randomly assigned to an intervention group (n = 33) or to a control group (n = 31). INTERVENTION In the intervention group a compression of the right carotid sinus was applied for 20 sec. In the control group, a placebo technique of placing hands on the radial styloid processes was performed. OUTCOME MEASURES Blood pressure and heart rate were measured in both groups before the intervention (preintervention), immediately after the intervention, 5 min after the intervention, and 60 min after the intervention. RESULTS The intervention group significantly decreased systolic and diastolic blood pressure and heart rate immediately after the intervention, with a large clinical effect; systolic blood pressure remained reduced 5 min after the intervention, and heart rate remained reduced 60 min after the intervention. No significant changes were observed in the control group. CONCLUSIONS Right carotid sinus compression could be clinically useful for regulating acute hypertension.
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Affiliation(s)
- Angélica María Campón-Checkroun
- 1 Escuela de Osteopatía de Madrid , Madrid, Spain .,2 Department of Physical Therapy, Universidad Católica de Ávila , Ávila, Spain
| | | | - Inmaculada Riquelme
- 3 Department of Nursing and Physiotherapy, University of the Balearic Islands , Palma, Spain .,4 University Institute of Health Sciences Research (IUNICS-IdISPa), University of the Balearic Islands , Palma, Spain
| | - Jesús Oliva-Pascual-Vaca
- 1 Escuela de Osteopatía de Madrid , Madrid, Spain .,5 Department of Physical Therapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla , Sevilla, Spain .,6 EU Francisco Maldonado, Department of Physical Therapy, Universidad de Sevilla , Osuna, Spain
| | | | - Ángel Oliva-Pascual-Vaca
- 1 Escuela de Osteopatía de Madrid , Madrid, Spain .,5 Department of Physical Therapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla , Sevilla, Spain
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Fang HY, Wu CJ, Fang CY, Lee WC. Influence about the flow of distal branch after intervention of the right coronary artery chronic total occlusion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:411-417. [PMID: 28366607 DOI: 10.1016/j.carrev.2017.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/16/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Limited data are available for the clinical outcomes after the recanalization of right coronary artery (RCA) chronic total occlusion (CTO). The study aims to assess the clinical outcomes in the antegrade flow of the distal branch after successful RCA CTO percutaneous coronary intervention (PCI). METHODS Between January 2002 and December 2012, 538 patients who underwent RCA CTO PCI were enrolled. The clinical outcomes as myocardial infarction (MI), target vessel revascularization, cardiac death, major adverse cardiac events, and all-cause mortality, were compared to the antegrade flow of distal branch after successful RCA CTO PCI. RESULTS The CTOs were located in proximal segments (57.6%), mid segments (27.5%) and distal segments (14.9%). The average Syntax score was 18.4±9.6 and 47.8% patients had a Syntax score greater than 27.5. A total of 62.8% patients had final thrombolysis of myocardial infarction (TIMI)-3 flow of distal branch, 16.9% patients had final TIMI-3 flow of only one major branch, 11.3% patients had TIMI-1-2 flow, and 8.9% patients had no antegrade flow. The incidence of periprocedural MI was lower in both side branches were preserved (13.9% vs. 23.0% and 18.8%, p=0.01). The clinical outcomes were similar between the groups with and without good antegrade flow of distal side branch. End stage renal disease (ESRD) and left ventricular ejection fraction (LVEF) <40% predicted three-year cardiac death. CONCLUSIONS There is no significant difference of clinical outcomes when distal side branches of RCA are recanalized successfully. ESRD and LVEF <40% were the predictors for three-year cardiac death.
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Affiliation(s)
- Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Vascular Access Site and Outcomes Among 26,807 Chronic Total Coronary Occlusion Angioplasty Cases From the British Cardiovascular Interventions Society National Database. JACC Cardiovasc Interv 2017; 10:635-644. [DOI: 10.1016/j.jcin.2016.11.055] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 11/30/2016] [Indexed: 11/21/2022]
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Fang HY, Lee WC, Fang CY, Wu CJ. Application of a snare technique in retrograde chronic total occlusion percutaneous coronary intervention - a step by step practical approach and an observational study. Medicine (Baltimore) 2016; 95:e5129. [PMID: 27741138 PMCID: PMC5072965 DOI: 10.1097/md.0000000000005129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has recently become popular among interventional cardiologists. CTO originating from the ostium has been one of the most difficult CTO lesions to treat with PCI for a number of reasons. Our aim was to illustrate a specific technique during retrograde CTO PCI referred to as the "snare technique."We retrospectively examined the use of "snare technique" among 371 consecutive retrograde CTO PCIs performed at our institution between 2006 and 2015."Snare technique" was used in 10 patients among the 371 retrograde CTO PCIs. The baseline clinical and angiographic characteristics of patients with or without "snare technique" were similar. The "snare technique" group had significantly fewer side branches at occlusion (30.0% vs 71.2%, P = 0.01) and a higher incidence of externalization (90% vs 25.5%, P < 0.001). The contrast volume was significantly lower in the "snare technique" group (285.0 ± 68.5 vs 379.2 ± 144.0, P = 0.04). The incidence of major complications, retrograde success, or final success did not differ between the groups.The "snare technique" is safe and feasible in retrograde CTO PCI, especially in cases of difficult coronary engagement in cases such as ostial occlusion, challenging coronary anatomy, or retrograde guidewire cannot get in antegrade guiding catheter.
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Affiliation(s)
- Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Correspondence: Hsiu-Yu Fang, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung 123, Ta Pei Road, Niao Sung District, Kaohsiung City 80144, Taiwan, R.O.C. (e-mail: )
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Dash D. Complications encountered in coronary chronic total occlusion intervention: Prevention and bailout. Indian Heart J 2016; 68:737-746. [PMID: 27773418 PMCID: PMC5079195 DOI: 10.1016/j.ihj.2016.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/16/2016] [Accepted: 03/07/2016] [Indexed: 11/30/2022] Open
Abstract
Despite the continuing developments of improved medical devices and increasing operator expertize, coronary chronic total occlusion (CTO) remains as one of the most challenging lesion subsets in interventional cardiology. Percutaneous coronary intervention (PCI) of CTO is a complex procedure carrying the risk of complications that are responsible for significant morbidity and mortality. The complications can be classified as coronary (such as coronary occlusion, perforation, device embolization, or entrapment); cardiac non-coronary (such as periprocedural myocardial infarction); extra cardiac (such as vascular access complications, systemic embolization, contrast-induced nephropathy, and radiation-induced injury). Further, certain complications (such as donor vessel dissection or thrombosis) are unique to CTO-PCI. There are also complications related to specialized techniques, such as dissection/reentry and retrograde crossing techniques. A thorough understanding of the potential complications is critical to mitigate risk during these complex procedures.
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Affiliation(s)
- Debabrata Dash
- Interventional Cardiologist, S. L Raheja (A Fortis Associate) Hospital, Nanavati Superspeciality Hospital, Mumbai, India; Guest Professor of Cardiology, Beijing Tiantan Hospital, Beijing, China.
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Fu Q, Hu H, Wang D, Chen W, Tan Z, Li Q, Chen B. Randomized comparative study of left versus right radial approach in the setting of primary percutaneous coronary intervention for ST-elevation myocardial infarction. Clin Interv Aging 2015; 10:1003-8. [PMID: 26150704 PMCID: PMC4484656 DOI: 10.2147/cia.s81568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Growing evidence suggests that the left radial approach (LRA) is related to decreased coronary procedure duration and fewer cerebrovascular complications as compared to the right radial approach (RRA) in elective percutaneous coronary intervention (PCI). However, the feasibility of LRA in primary PCI has yet to be studied further. Therefore, the aim of this study was to investigate the efficacy of LRA compared with RRA for primary PCI in ST-elevation myocardial infarction (STEMI) patients. MATERIALS AND METHODS A total of 200 consecutive patients with STEMI who received primary PCI were randomized to LRA (number [n]=100) or RRA (n=100). The study endpoint was needle-to-balloon time, defined as the time from local anesthesia infiltration to the first balloon inflation. Radiation dose by measuring cumulative air kerma (CAK) and CAK dose area product, as well as fluoroscopy time and contrast volume were also investigated. RESULTS There were no significant differences in the baseline characteristics between the two groups. The coronary procedural success rate was similar between both radial approaches (98% for left versus 94% for right; P=0.28). Compared with RRA, LRA had significantly shorter needle-to-balloon time (16.0±4.8 minutes versus 18.0±6.5 minutes, respectively; P=0.02). Additionally, fluoroscopy time (7.4±3.4 minutes versus 8.8±3.5 minutes, respectively; P=0.01) and CAK dose area product (51.9±30.4 Gy cm(2) versus 65.3±49.1 Gy cm(2), respectively; P=0.04) were significantly lower with LRA than with RRA. CONCLUSION Primary PCI can be performed via LRA with earlier blood flow restoration in the infarct-related artery and lower radiation exposure when compared with RRA; therefore, the LRA may become a feasible and attractive alternative to perform primary PCI for STEMI patients.
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Affiliation(s)
- Qiang Fu
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hongyu Hu
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dezhao Wang
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei Chen
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhixu Tan
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qun Li
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Buxing Chen
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
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Khand A, Patel B, Palmer N, Jones J, Andron M, Perry R, Mehrotra S, Mitsudo K. Retrograde Wiring of Collateral Channels of the Heart in Chronic Total Occlusions. Angiology 2015; 66:925-32. [DOI: 10.1177/0003319715573902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To conduct a systematic review and meta-analysis on retrograde wiring in chronic total occlusions (CTOs) with focus on its safety and feasibility. Methods and Results: We searched publications from 1990 to December 2013 in PubMed, Ovid, EMBASE, and the Cochrane database inserting a number of terms relating to the collateral circulation of the heart in CTOs. A total of 18 case series (n range17-462) with a total of 2280 CTO revascularization attempts fulfilled criteria for a study of retrograde wiring of collateral channels in CTOs. There were no randomized studies comparing a primary antegrade with a primary retrograde approach. Procedural CTO revascularization rates ranged from 67% to 90.6% with a large proportion having previously failed an “antegrade” approach. The septal perforator collaterals and epicardial channels were used in 73.2% (n = 1670) and 21.7% (n = 495) of cases. Although collateral/coronary perforation was not infrequent (n = 90, 5%), serious acute complications were uncommon; in the combined population 18 cases of cardiac tamponade (0.8%) and 3 deaths (0.1%). Septal perforating wiring (79.3%) was significantly more likely to be successful compared to epicardial coronary artery wiring (72.5%) when chosen by the operator as a route of retrograde access to the CTO body (relative risk 1.11 [95% confidence interval: 1.02-1.20; P = .013]). Conclusion: Successful retrograde wiring of collateral channels in selected patients undertaken by “CTO dedicated” operators can significantly enhance the chances of revascularization of complex CTOs with a low risk of acute serious complications. Septal perforator channels are significantly more likely to be successfully retrogradely wired compared to epicardial vessels when either is selected, by reference to their anatomical suitability by the operator, as a route of access.
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Affiliation(s)
- Aleem Khand
- Department of Cardiology, University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- School of Ageing and Chronic Diseases, University of Liverpool, Liverpool, United Kingdom
| | - Bilal Patel
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Nicholas Palmer
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Julia Jones
- Department of Cardiology, University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom
| | - Mohammed Andron
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Raph Perry
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Sanjay Mehrotra
- Department of Cardiology, Narayana Hrudayalaya, Bangalore, India
| | - Kazuaki Mitsudo
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
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Alaswad K, Menon RV, Christopoulos G, Lombardi WL, Karmpaliotis D, Grantham JA, Marso SP, Wyman MR, Pokala NR, Patel SM, Kotsia AP, Rangan BV, Lembo N, Kandzari D, Lee J, Kalynych A, Carlson H, Garcia SA, Thompson CA, Banerjee S, Brilakis ES. Transradial approach for coronary chronic total occlusion interventions: Insights from a contemporary multicenter registry. Catheter Cardiovasc Interv 2015; 85:1123-9. [DOI: 10.1002/ccd.25827] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 01/03/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - Rohan V. Menon
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Georgios Christopoulos
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | | | | | - J. Aaron Grantham
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City; Kansas City Missouri
| | - Steven P. Marso
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City; Kansas City Missouri
| | | | - Nagendra R. Pokala
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Siddharth M. Patel
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Anna P. Kotsia
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Bavana V. Rangan
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | | | | | | | | | | | - Santiago A. Garcia
- Minneapolis VA Healthcare System and University of Minnesota; Minneapolis Minnesota
| | | | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Emmanouil S. Brilakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
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Chen HC, Lee WC, Hsueh SK, Cheng CI, Chen CJ, Yang CH, Fang CY, Hang CL, Yip HK, Wu CJ, Fang HY. Transradial percutaneous coronary intervention for chronic total occlusion of coronary artery disease using sheathless standard guiding catheters. IJC HEART & VASCULATURE 2014; 6:35-41. [PMID: 28785624 PMCID: PMC5497147 DOI: 10.1016/j.ijcha.2014.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/02/2014] [Accepted: 12/20/2014] [Indexed: 11/30/2022]
Abstract
Objectives Our aim was to evaluate the feasibility and safety of routine transradial approach (TRA) percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions using the sheathless technique with standard guiding catheters. Background Transradial approach PCI was applied for CTO lesions. A major limitation of TRA CTO PCI is the inability to use large guiding catheters because of the relatively small size of the radial artery. Therefore, the sheathless technique for TRA PCI has been recently developed. However, reports on TRA CTO PCI using the sheathless technique are still lacking. Methods Sixty-eight patients with CTO lesions were enrolled for TRA PCI using the sheathless technique with standard guiding catheters. The baseline characteristics, coronary angiographic characteristics and major procedure or access site related complications were compared between procedure success and procedure failure group to determine the predictors of success in sheathless CTO PCI. In-hospital and 30-day clinical outcomes were also evaluated in this study. Routine assessments of radial artery occlusion via Doppler ultrasound and pulse oximeter were recorded during one-year clinical follow-up. Results The mean duration of CTO by history was 31.8 ± 42.3 months. The 7 Fr standard guiding catheter was used with the sheathless technique in 91.2%, and bilateral sheathless approach in 42.6% of the study patients. The procedure-related complications included coronary perforation needing covered stent deployment (2.9%), cardiac tamponade (2.9%), collateral perforation needing coil deployment (4.4%), and contrast induced nephropathy (2.9%). Only 2 patients (2.9%) experienced forearm ecchymosis at the radial artery access sites. In-hospital mortality and 30-day all-cause mortality were 2.9%, and 30-day MACEs were 1.5%. The rate of radial artery occlusion during one-year clinical follow-up was only 3.0%. Conclusions It is feasible and safe to routinely use the sheathless technique with standard guiding catheters for TRA CTO PCI, with a low incidence of procedure-related complications and long-term radial artery occlusion.
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Affiliation(s)
- Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Cheng-I Cheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
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Shorrock D, Michael TT, Patel V, Kotsia A, Rangan BV, Abdullah SA, Grodin JM, Banerjee A, Brilakis ES. Frequency and outcomes of aortocoronary dissection during percutaneous coronary intervention of chronic total occlusions: a case series and systematic review of the literature. Catheter Cardiovasc Interv 2014; 84:670-5. [PMID: 24327476 DOI: 10.1002/ccd.25338] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 11/08/2013] [Accepted: 11/27/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Aortocoronary dissection can complicate percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs). METHODS We retrospectively examined the frequency and outcomes of aortocoronary dissection among 336 consecutive CTO PCIs performed at our institution between 2005 and 2012 and performed a systematic review of the published literature. RESULTS Aortocoronary dissection occurred in six patients (1.8%, 95% confidence intervals 0.7%, 3.8%). All aortocoronary dissections occurred in the right coronary artery (CTO target vessel in five patients and donor vessel in one patient). The baseline clinical characteristics of patients with and without aortocoronary dissection were similar. Compared to patients without, those with aortocoronary dissection were more likely to undergo crossing attempts using the retrograde approach (25% vs. 67%, P = 0.036) and experience a major complication (2.4% vs. 33.3%, P = 0.008). Technical and procedural success rates were similar in both groups. Of the six patients with aortocoronary dissection one underwent emergency coronary bypass graft surgery (CABG), four were treated with ostial stenting, and one was treated conservatively without subsequent adverse clinical outcomes. Systematic literature review provided 107 published cases of aortocoronary dissection during PCI, that occurred mainly in the right coronary artery (74.8%) and were treated with stenting (49.5%), emergency CABG (29%), or conservatively (21.5%). CONCLUSIONS Aortocoronary dissection is an infrequent complication of CTO PCI and although it can be treated with stents in most patients, it may infrequently require emergency CABG.
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Affiliation(s)
- Deborah Shorrock
- VA North Texas Healthcare System, Dallas, Texas; University of Texas Southwestern Medical Center, Dallas, Texas
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22
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El Sabbagh A, Patel VG, Jeroudi OM, Michael TT, Alomar ME, Mogabgab O, Fuh E, Roesle M, Rangan BV, Abdullah S, Hastings JL, Grodin J, Kumbhani DJ, Alexopoulos D, Fasseas P, Banerjee S, Brilakis ES. Angiographic success and procedural complications in patients undergoing retrograde percutaneous coronary chronic total occlusion interventions: A weighted meta-analysis of 3482 patients from 26 studies. Int J Cardiol 2014; 174:243-8. [DOI: 10.1016/j.ijcard.2014.04.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 03/09/2014] [Accepted: 04/01/2014] [Indexed: 11/30/2022]
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23
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Fang HY, Lu SY, Lee WC, Lin YS, Cheng CI, Chen CJ, Yang CH, Yip HK, Hang CL, Fang CY, Wu CJ. The predictors of successful percutaneous coronary intervention in ostial left anterior descending artery chronic total occlusion. Catheter Cardiovasc Interv 2014; 84:E30-7. [DOI: 10.1002/ccd.25514] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/06/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Hsiu-Yu Fang
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Shang-Yeh Lu
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Wei-Chieh Lee
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology; Chang Gung Memorial Hospital; Chiayi; Chang Gung Institute of Technology; Chiayi Taiwan
| | - Cheng-I Cheng
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Chien-Jen Chen
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Cheng-Hsu Yang
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Hon-Kan Yip
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Chi-Ling Hang
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Chih-Yuan Fang
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
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24
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Burzotta F, De Vita M, Lefevre T, Tommasino A, Louvard Y, Trani C. Radial approach for percutaneous coronary interventions on chronic total occlusions: Technical issues and data review. Catheter Cardiovasc Interv 2013; 83:47-57. [DOI: 10.1002/ccd.25118] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/23/2013] [Accepted: 06/27/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology; , Catholic University of Sacred Heart; Rome Italy
| | - Maria De Vita
- Interventional Cardiology; Morgagni-Pierantoni Hospital; Forlì Italy
| | - Thierry Lefevre
- Interventional Cardiology; Istitut Cardiovasculaire Paris Sud; Massy France
| | | | - Yves Louvard
- Interventional Cardiology; Istitut Cardiovasculaire Paris Sud; Massy France
| | - Carlo Trani
- Institute of Cardiology; , Catholic University of Sacred Heart; Rome Italy
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25
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Michael TT, Papayannis AC, Banerjee S, Brilakis ES. Subintimal dissection/reentry strategies in coronary chronic total occlusion interventions. Circ Cardiovasc Interv 2013; 5:729-38. [PMID: 23074346 DOI: 10.1161/circinterventions.112.969808] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subintimal dissection/reentry techniques are increasingly being used for crossing coronary chronic total occlusions both antegradely (using a knucle wire or the Bridgepoint system) or retrogradely (using the controlled antegrade and retrograde tracking and dissection, and reverse controlled antegrade and retrograde tracking and dissection technique). Subintimal dissection/reentry techniques can increase procedural success rates, but their subsequent clinical outcomes are poorly studied, and they appear to be associated with high rates of in-stent restenosis and repeat target lesion revascularization. In the present review, we describe in detail the chronic total occlusions subintimal dissection/reentry techniques, clarify the related terminology and summarize the published studies in this area and the current gaps of knowledge.
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Affiliation(s)
- Tesfaldet T Michael
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX 75216, USA
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26
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Transradial percutaneous coronary intervention for chronic total occlusion using sheathless technique and retrograde approach. Catheter Cardiovasc Interv 2013; 82:E206-10. [DOI: 10.1002/ccd.24758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 10/26/2012] [Accepted: 11/07/2012] [Indexed: 11/07/2022]
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27
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Bagur R, Rinfret S. Transradial Approach for Chronic Total Occlusion Percutaneous Coronary Intervention. Interv Cardiol Clin 2012; 1:355-363. [PMID: 28582021 DOI: 10.1016/j.iccl.2012.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Over the last two decades, the transradial approach has gained an important role in interventional cardiology. A large body of evidence exists supporting the safety and feasibility of the transradial approach in a broad spectrum of patients and settings. In addition, the transradial approach has been applied with good results for chronic total occlusion (CTO) recanalization. This article provides an overview of basic principles and techniques required to perform successful transradial CTO percutaneous coronary intervention.
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Affiliation(s)
- Rodrigo Bagur
- Interventional Cardiology Laboratories, Quebec Heart & Lung Institute-Laval University, 2725 Chemin Sainte-Foy, G1V 4G5, Québec (Québec), Canada
| | - Stéphane Rinfret
- Interventional Cardiology Laboratories, Quebec Heart & Lung Institute-Laval University, 2725 Chemin Sainte-Foy, G1V 4G5, Québec (Québec), Canada.
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28
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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]
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