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Panuccio G, Werner GS, De Rosa S, Torella D, Leistner DM, Siegrist PT, Haghikia A, Skurk C, Mashayekhi K, Landmesser U, Abdelwahed YS. Full-Moon Coronary Calcification as Detected With Computed Tomography Angiography in Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol 2024; 222:149-156. [PMID: 38761964 DOI: 10.1016/j.amjcard.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/04/2024] [Accepted: 05/11/2024] [Indexed: 05/20/2024]
Abstract
"Full moon" is a central calcification that occludes the entire vessel on coronary computed tomography angiography (CCTA). We examined the association of full moon calcification as identified by CCTA, on clinical and procedural outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We studied patients who underwent elective CTO-PCI in 2 European centers and had preprocedural CCTA. The primary end point was the inability to cross the lesion and/or the need for extensive debulking techniques. Secondary end points were procedural success, in-hospital cardiac mortality, the need for extensive debulking techniques, myocardial infarction, major adverse cardiac events (defined as in-hospital death, myocardial infarction, and clinically driven target vessel revascularization), and stent thrombosis. Secondary procedural end points included procedural time, fluoroscopy time, number of guidewires and balloons, stent length, number and diameter, and contrast volume. Multivariable logistic regression analysis was performed, identifying potential covariates related to the primary outcome according to knowledge and previous studies. Subsequently, a stepwise selection approach was performed to select factors with the greatest predictive value. Of 140 patients included, 28 (20%) had a full moon calcified CTO plaque. Patients in the full moon group were older and had more cardiovascular risk factors. There was not significant difference in the need for retrograde approach and anterograde dissection and reentry techniques between the full moon group and the other groups (32.1% vs 37.5%, p = 0.59 and 0% vs 1.7%, p = 0.47, respectively). Patients in the full moon group had greater incidence of the primary outcome than did those who did not have full moon morphology (53.5% vs 12.5%, p <0.001). On multivariable analysis that included chronic kidney failure and previous coronary artery bypass surgery, full moon calcification was associated with greater incidence of the primary end point (odds ratio 6.5, 95% confidence interval 2.1 to 20.5, p = 0.001). Moreover, less procedural success (71.4% vs 87.5%, p = 0.03), greater incidence of coronary perforations (14.2% vs 3.5%, p <0.02), and greater procedural (172.5 [118.0 to 237.5] vs 144.0 [108.50 to 174.75], p = 0.02) and fluoroscopic time (62.6 [38.1 to 83.0] vs 42.8 [29.5 to 65.7], p = 0.03) were observed in the full moon group. Overall major adverse cardiac events did not differ between the 2 groups (1 patient in the full moon group vs 1 patient in the non-full moon group; 3.5% vs 0.8%, p = 0.29). In conclusion, full moon calcification on CCTA was independently associated with procedural complexity and adverse outcomes in CTO-PCI.
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Affiliation(s)
- Giuseppe Panuccio
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany; Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | | | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Daniele Torella
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - David M Leistner
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany
| | | | - Arash Haghikia
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | | | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Youssef S Abdelwahed
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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Hirai K, Kawasaki T, Kishi K, Muramatsu T, Okada H, Oikawa Y, Yoshikawa R, Katoh H, Tsuchikane E, Tanaka H, Katoh O. Determinants of One-Year Outcome After Successful Percutaneous Coronary Intervention for Chronic Total Occlusion; Insight from Japanese CTO-PCI Expert Registry. Am J Cardiol 2024; 225:108-117. [PMID: 38885920 DOI: 10.1016/j.amjcard.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 05/30/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
Although outcomes have improved with new-generation drug-eluting stents, few reports have analyzed the risk factors associated with chronic outcomes of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI). This study aimed to investigate the independent risk factors for target lesion revascularization (TLR) and major adverse cardiac and cerebrovascular events (MACCEs) after CTO-PCI using Japanese multicenter data. A total of 3,666 patients, who underwent CTO-PCI and completed a 1-year follow-up, registered at the Japanese CTO-PCI Expert Registry from 2014 to 2019, were examined. The primary outcome was defined as TLR, and the secondary outcome was MACCEs at the 1-year follow-up. TLRs and MACCEs occurred in 175 (4.8%) and 524 (14.3%) patients, respectively. Multivariate logistic regression analysis demonstrated that in-stent occlusion (ISO) (odds ratio [OR] 2.604, 95% confidence interval [CI] 1.695 to 4.001), hemodialysis (OR 1.784, 95% CI 1.062 to 2.997), diabetes mellitus with insulin use (OR 1.741, 95% CI 1.060 to 2.861), moderate-to-severe calcification (OR 1.726, 95% CI 1.197 to 2.487), and the right coronary artery as the target vessel (OR 1.468, 95% CI 1.018 to 2.117) were significantly associated with TLR. Hemodialysis (OR 2.214, 95% CI 1.574 to 3.113), ISO (OR 1.499, 95% CI 1.127 to 1.993), arteriosclerosis obliterans (OR 1.414, 95% CI 1.074 to 1.863), and multivessel disease (OR 1.356, 95% CI 1.117 to 1.647) were significantly associated with MACCEs. One-year outcomes of new-generation drug-eluting stents for CTO-PCI were favorable, and ISO as a lesion factor and hemodialysis as a patient factor were strongly associated with TLR and MACCEs, respectively.
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Affiliation(s)
- Keisuke Hirai
- Department of Cardiology, Shin-Koga Hospital, Fukuoka, Japan.
| | | | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | | | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, the Cardiovascular Institute, Tokyo, Japan
| | | | - Harumi Katoh
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Okayama, Japan
| | | | - Hiroyuki Tanaka
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Osamu Katoh
- Department of Cardiology, Kusatsu Heart Center, Shiga, Japan
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Allana SS, Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Alexandrou M, Choi JW, Alaswad K, Krestyaninov O, Khelimskii D, Gorgulu S, Davies R, Benton S, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Azzalini L, Kearney K, Chandwaney R, Nicholson W, Jaber W, Rinfret S, Frizzell J, Patel T, Jefferson B, Aygul N, Rangan BV, Brilakis ES. The Retrograde Approach to Chronic Total Occlusion Percutaneous Coronary Interventions: Technical Analysis and Procedural Outcomes. JACC Cardiovasc Interv 2023; 16:2748-2762. [PMID: 38030360 DOI: 10.1016/j.jcin.2023.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with lower success and higher complication rates when compared with the antegrade approach. OBJECTIVES This study sought to assess contemporary techniques and outcomes of retrograde CTO PCI. METHODS We examined the baseline characteristics, procedural techniques and outcomes of 4,058 retrograde CTO PCIs performed at 44 centers between 2012 and 2023. Major adverse cardiac events (MACE) included any of the following in-hospital events: death, myocardial infarction, repeat target vessel revascularization, pericardiocentesis, cardiac surgery, and stroke. RESULTS The average J-CTO (Multicenter CTO Registry in Japan) score was 3.1 ± 1.1. Retrograde crossing was successful in 60.5% and lesion crossing in 81.6% of cases. The collaterals pathways successfully used were septals in 62.0%, saphenous vein grafts in 17.4%, and epicardials in 19.1%. The technical and procedural success rates were 78.7% and 76.6%, respectively. When retrograde crossing failed, technical success was achieved in 50.3% of cases using the antegrade approach. In-hospital MACE was 3.5%. The clinical coronary perforation rate was 5.8%. The incidence of in-hospital MACE with retrograde true lumen crossing, just marker antegrade crossing, conventional reverse controlled antegrade and retrograde tracking (CART), contemporary reverse CART, extended reverse CART, guide-extension reverse CART, and CART was 2.1%, 0.8%, 5.5%, 3.0%, 2.1%, 3.2%, and 4.1%, respectively; P = 0.01). CONCLUSIONS Retrograde CTO PCI is utilized in highly complex cases and yields moderate success rates with 5.8% perforation and 3.5% periprocedural MACE rates. Among retrograde crossing strategies, retrograde true lumen puncture was the safest. There is need for improvement of the efficacy and safety of retrograde CTO PCI.
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Affiliation(s)
- Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | | | | | - Dmitrii Khelimskii
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | | | | | | | | | | | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kathleen Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | | | | | - Taral Patel
- Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | - Brian Jefferson
- Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | | | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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Mashayekhi KA, Pyxaras SA, Werner GS, Galassi AR, Garbo R, Boudou N, Leibundgut G, Avran A, Bryniarski L, Bufe A, Sianos G, Di Mario C. Contemporary issues of percutaneous coronary intervention in heavily calcified chronic total occlusions: an expert review from the European CTO Club. EUROINTERVENTION 2023; 19:e113-e122. [PMID: 36971414 PMCID: PMC10240733 DOI: 10.4244/eij-d-22-01096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/22/2023] [Indexed: 06/07/2023]
Abstract
Severe calcification is frequent in coronary chronic total occlusions (CTO), and its presence has been associated with increased procedural complexity and poor long-term outcomes following percutaneous coronary intervention (PCI) in an already challenging anatomical setting. The diagnostic characterisation of heavily calcified CTOs using non-invasive and invasive imaging tools can lead to the application of different therapeutic options during CTO PCI, in order to achieve adequate lesion preparation and optimal stent implantation. In this expert review, the European Chronic Total Occlusion Club provides a contemporary, methodological approach, specifically addressing heavily calcified CTOs, suggesting an integration of evidence-based diagnostic methods to tailored, up-to-date percutaneous therapeutic options.
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Affiliation(s)
- Kambis A Mashayekhi
- MediClin Heart Center Lahr, Lahr, Germany
- Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | | | - Gerald S Werner
- Medizinische Klinik I (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Alfredo R Galassi
- U.O.C. Cardiologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza (ProMISE) "G. D'Alessandro", A.O.U. Policlinico Paolo Giaccone, Università degli Studi, Palermo, Italy
| | - Roberto Garbo
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Nicolas Boudou
- Interventional Cardiology, Clinique Saint Augustin, Bordeaux, France
| | - Gregor Leibundgut
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Alexandre Avran
- Department of Interventional Cardiology, Clinique Louis Pasteur, Essey-lès-Nancy, France
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Alexander Bufe
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
| | - Georgios Sianos
- 1st Cardiology Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
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5
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Terashita K, Shimada Y, Yamanaka Y, Motohashi Y, Tonomura D, Yoshitani K, Yoshida M, Tsuchida T, Fukumoto H. Intraplaque wiring enables drug-coated balloons to be utilized for percutaneous recanalization of chronically occluded coronary arteries. Catheter Cardiovasc Interv 2023; 101:764-772. [PMID: 36786488 DOI: 10.1002/ccd.30596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/05/2023] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES This study aimed to determine whether drug-coated balloon (DCB) angioplasty following intraplaque wiring and the use of modified balloons is safe and effective in the percutaneous treatment of coronary chronic total occlusions (CTOs). BACKGROUND DCB is an alternative therapeutic option without the limitations of permanent vascular implants. However, its efficacy in CTOs has yet to be confirmed. The combination of modified balloons and DCB can be effectively applied when the intraplaque passage of the guidewire is achieved in CTOs. METHODS Data from 124 consecutive CTO lesions (105 patients) treated at our hospital between February 2016 and December 2020 were screened for inclusion and retrospectively analyzed. Among the 118 lesions successfully recanalized, intraplaque wiring was achieved in 108, and 85 were treated by the DCB-only approach following cutting/scoring balloon dilatation. RESULTS Follow-up data were available for 82 lesions (71 patients). The median occlusion length was 18.5 mm, and the J-CTO score was 1.7 ± 0.9. No in-hospital major adverse cardiac events occurred, including abrupt vessel closure. During the median 29-month follow-up period, target lesion revascularization was performed for 10 lesions. Follow-up coronary angiography (8.7 ± 3.9 months after the index procedure) was performed for 64 lesions, demonstrating late lumen loss of -0.15 mm (interquartile range -0.4 to 0.23 mm), binary restenosis (diameter stenosis ≥50%) in 12 lesions (18.8%), and late lumen enlargement in 37 (57.8%). CONCLUSION The DCB-only approach following the use of modified balloons is a promising strategy for coronary CTOs when intraplaque wiring is achieved.
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Affiliation(s)
- Kazunori Terashita
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Yoshihisa Shimada
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Yuki Yamanaka
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Yoshikazu Motohashi
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Daisuke Tonomura
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Kazuyasu Yoshitani
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Masataka Yoshida
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Takao Tsuchida
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Hitoshi Fukumoto
- Division of Cardiology, Cardiovascular Center, Shiroyama Hospital, Habikino, Osaka, Japan
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Megaly M, Buda K, Karacsonyi J, Kostantinis S, Simsek B, Basir MB, Mashayekhi K, Rinfret S, McEntegart M, Yamane M, Azzalini L, Alaswad K, Brilakis ES. Extraplaque versus intraplaque tracking in chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv 2022; 100:1021-1029. [PMID: 36168859 DOI: 10.1002/ccd.30403] [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: 08/02/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the clinical outcomes after extraplaque (EP) versus intraplaque (IP) tracking in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND The impact of modern dissection and reentry (DR) techniques on the long-term outcomes of CTO PCI remains controversial. METHODS We performed a systematic review and meta-analysis of studies that compared EP versus IP tracking in CTO PCI. Odds ratios (ORs) with 95% confidence intervals (CIs) are calculated using the Der-Simonian and Laird random-effects method. RESULTS Our meta-analysis included seven observational studies with 2982 patients. Patients who underwent EP tracking had significantly more complex CTOs with higher J-CTO score, longer lesion length, and more severe calcification and had significantly longer stented segments. During a median follow-up of 12 months (range 9-12 months), EP tracking was associated with a higher risk of major adverse cardiovascular events (MACE) (OR 1.50, 95% CI (1.10-2.06), p = 0.01) and target vessel revascularization (TVR) (OR 1.69, 95% CI (1.15-2.48), p = 0.01) compared with IP tracking. There was no difference in the incidence of all-cause death (OR 1.37, 95% CI (0.67-2.78), p = 0.39), myocardial infarction (MI) (OR 1.48, 95% CI (0.82-2.69), p = 0.20), stent thrombosis (OR 2.09, 95% CI (0.69-6.33), p = 0.19), or cardiac death (OR 1.10, 95% CI (0.39-3.15), p = 0.85) between IP and EP tracking. CONCLUSION EP tracking is utilized in more complex CTOs and requires more stents. EP tracking is associated with a higher risk of MACE, driven by a higher risk of TVR at 1 year, but without an increased risk of death or MI compared with IP tracking. EP tracking is critically important for contemporary CTO PCI.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Willis Knighton Heart Institute, Shreveport, Louisiana, USA
| | - Kevin Buda
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | | | | | - Bahadir Simsek
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Mir B Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Kambis Mashayekhi
- University Heartcenter Freiburg-Bad Krozingen - Bad Krozingen, Germany
| | - Stephane Rinfret
- Department of Cardiology, Emory University, Atlanta, Georgia, USA
| | | | | | | | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
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7
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Werner GS, Brilakis ES. Chronic Total Coronary Occlusion. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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8
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Xu R, Shi Y, Chang S, Qin Q, Li C, Fu M, Ge L, Qian J, Ma J, Ge J. Outcomes of contemporary versus conventional reverse controlled and antegrade and retrograde subintimal tracking in chronic total occlusion revascularization. Catheter Cardiovasc Interv 2021; 99:226-233. [PMID: 34787375 DOI: 10.1002/ccd.30018] [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: 09/06/2021] [Accepted: 10/17/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) lesions remain technically challenging for percutaneous coronary intervention (PCI). The introduction of a retrograde approach has allowed marked improvement in the success rate of CTO recanalization. Reverse controlled anterograde and retrograde sub-intimal tracking (reverse CART) is the predominant retrograde wire crossing technique and can be broadly classified into three categories: (1) conventional (2) contemporary and (3) extended. The present study aimed to compare the safety and efficacy of conventional and contemporary reverse CART techniques. METHODS From March 2015 to May 2020, 303 patients achieving successful retrograde guidewire crossing with conventional or contemporary reverse CART during CTO PCI were included in the study. The patient characteristics, procedural outcomes and in-hospital and 1-year clinical events were compared between the conventional and contemporary groups. RESULTS The distributions of the baseline and angiographic characteristics were similar in both study arms, except the CTO lesions of the conventional group were more complex, as reflected by borderline significantly higher mean J-CTO scores (3.4 ± 0.7 vs. 3.3 ± 0.8; p = 0.059). Recanalization using contemporary reverse CART was associated with a short procedure time (189.8 ± 44.4 vs. 181.7 ± 37.3 min; p = 0.044) and decreased procedural complications, particularly target vessel perforation (3.6% vs. 0.6%; p = 0.063) and major side-branch occlusion (36.7% vs. 28.0%; p = 0.051). Technical and procedural success and the in-hospital and 1-year outcomes were not significantly different between the groups. CONCLUSIONS Contemporary reverse CART is associated with favorably high efficiency and low-complication rates and carries a comparable success rate and 1-year clinical outcomes as conventional reverse CART.
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Affiliation(s)
- Rende Xu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuekai Shi
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shufu Chang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qing Qin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mingqiang Fu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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9
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Xhepa E, Cassese S, Ndrepepa G, Joner M, Kufner S, Aytekin A, Lahmann A, Voll F, Fusaro M, Pinieck S, Schunkert H, Kastrati A, Fusaro M. Clinical and angiographic outcomes of crossing techniques for coronary chronic total occlusions: the ISAR-CTO registry. EUROINTERVENTION 2021; 17:e656-e663. [PMID: 33646124 PMCID: PMC9724870 DOI: 10.4244/eij-d-20-01248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinical and angiographic outcomes following recanalisation of coronary chronic total occlusions (CTO) through contemporary dissection and re-entry techniques (DART) as opposed to intraplaque techniques remain controversial. AIMS The aim of this study was to compare clinical and angiographic outcomes following subintimal and intraplaque CTO recanalisation. METHODS A total of 454 consecutive patients undergoing successful CTO recanalisation (473 vessels) were included. Intraplaque techniques were used in 403 (85.2%) and DART in 70 (14.8%) vessels. Surveillance angiography was scheduled at 6-9 months and clinical follow-up was performed up to 12 months. RESULTS There were no significant differences in terms of the cumulative incidence of MACE (p=0.908) or binary restenosis (p=0.320) between the two groups. There was no independent correlation between recanalisation technique and MACE occurrence or in-segment binary restenosis. Target lesion revascularisation (TLR) was performed in 60 (17.5%) and 12 (18.1%) (p=0.719) lesions, respectively. The occurrence of occlusive restenosis was low (7 [2.3%] vs 1 [1.6%]; p=0.824) and comparable between groups. CONCLUSIONS Contemporary DART are associated with similar midterm clinical and angiographic outcomes compared to intraplaque recanalisation. The rate of occlusive restenosis was low and comparable in both groups. Regardless of recanalisation technique, the overall incidences of binary restenosis and TLR following CTO recanalisation remain higher than those reported for non-CTO PCI.
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Affiliation(s)
- Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Gjin Ndrepepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sebastian Kufner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Alp Aytekin
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Anna Lahmann
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Felix Voll
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michele Fusaro
- Department of Diagnostic and Interventional Radiology, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
| | - Susanne Pinieck
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstrasse 36, 80636 Munich, Germany
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10
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Zografos T, Tsiafoutis I, Tsoumeleas A, Floropoulou C, Gkini C, Koutouzis M. Chronic Total Occlusion PCI Techniques in 2020. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00914-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Mahadevan K, Cosgrove C, Strange JW. Factors Influencing Stent Failure in Chronic Total Occlusion Coronary Intervention. Interv Cardiol 2021; 16:e27. [PMID: 34721666 PMCID: PMC8532005 DOI: 10.15420/icr.2021.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022] Open
Abstract
Stent failure remains one of the greatest challenges for interventional cardiologists. Despite the evolution to superior second- and third-generation drug-eluting stent designs, increasing use of intracoronary imaging and the adoption of more potent antiplatelet regimens, registries continue to demonstrate a prevalence of stent failure or target lesion revascularisation of 15-20%. Predisposition to stent failure is consistent across both chronic total occlusion (CTO) and non-CTO populations and includes patient-, lesion- and procedure-related factors. However, histological and pathophysiological properties specific to CTOs, alongside complex strategies to treat these lesions, may potentially render percutaneous coronary interventions in this cohort more vulnerable to failure. Prevention requires recognition and mitigation of the precipitants of stent failure, optimisation of interventional techniques, including image-guided precision percutaneous coronary intervention, and aggressive modification of a patient's cardiovascular risk factors. Management of stent failure in the CTO population is technically challenging and itself begets recurrence. We aim to provide a comprehensive review of factors influencing stent failure in the CTO population and strategies to attenuate these.
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Affiliation(s)
- Kalaivani Mahadevan
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation TrustBristol, UK
| | - Claudia Cosgrove
- Department of Cardiology, St George’s University NHS TrustLondon, UK
| | - Julian W Strange
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation TrustBristol, UK
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12
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Tian T, Guan C, Gao L, Yuan J, Cui J, Hu F, Tang Y, Dou K, Wu Y, Yang Y, Qiao S, Xu B, Yang W. Predictors for adverse outcomes of patients with recanalized chronic total occlusion lesion. Eur J Clin Invest 2021; 51:e13368. [PMID: 32748956 DOI: 10.1111/eci.13368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/27/2020] [Accepted: 07/26/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND It is ill-defined which factors affect the prognosis of patients with recanalized chronic total occlusion (CTO). This study sought to investigate predictors for adverse outcome in such a cohort with long-time follow-up. METHODS From 2010 to 2013, patients with successfully recanalized CTO were included. The primary endpoint was a composite of all-cause death, myocardial infarction or target vessel revascularization (TVR). The secondary endpoints were TVR and target lesion revascularization (TLR). RESULTS A total of 1987 patients were enrolled and 1806 (90.6%) subjects completed 5-year follow-up. Multivariate Cox analysis revealed that age ≥ 75 years (HR,1.70; 95% CI, 1.09-2.64; P = .02), left ventricular ejection fraction <40% (HR, 1.94; 95% CI, 1.02-3.69; P = .04) and residual SYNTAX score (HR, 1.02; 95% CI, 1.01-1.04; P = .01) were predictors for the primary endpoint. Non-LAD CTO (HR, 1.82; 95% CI, 1.23-2.70; P < .01), J-CTO score (HR, 1.31; 95% CI, 1.11-1.54; P < .01) and residual SYNTAX score (HR, 1.02; 95% CI, 1.00-1.04; P = .04) were independently related to TVR. Non-LAD CTO, high J-CTO score and residual SYNTAX score was also correlated with TLR. CONCLUSIONS Advanced age, left ventricular dysfunction and residual SYNTAX score were predictors for composite cardiovascular events in patients with CTO after revascularization. Those with non-LAD CTO, high J-CTO and residual SYNTAX score had higher risk for revascularization.
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Affiliation(s)
- Tao Tian
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Changdong Guan
- Catheterization Laboratories, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Lijian Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianson Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingang Cui
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Fenghuan Hu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yida Tang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Kefei Dou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yuejin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Shubin Qiao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Bo Xu
- Catheterization Laboratories, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Weixian Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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13
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Intravascular Healing Is Not Affected by Approaches in Contemporary CTO PCI: The CONSISTENT CTO Study. JACC Cardiovasc Interv 2020; 13:1448-1457. [PMID: 32553333 DOI: 10.1016/j.jcin.2020.03.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to assess angiographic, imaging, and clinical outcomes following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with dissection and re-entry techniques (DART) and subintimal (SI) stenting compared with intimal techniques. BACKGROUND Reliable procedural success and safety in CTO PCI require the use of DART to treat the most complex patients. Potential concerns regarding the durability of DART with SI stenting still need to be addressed. METHODS This was a prospective, multicenter, single-arm trial of patients with appropriate indications for CTO PCI. RESULTS Successful CTO PCI was performed in 210 of 231 patients (91% success). At 1 year, the primary endpoint of target vessel failure (cardiac death, myocardial infarction related to the target vessel, or any ischemia-driven revascularization) occurred in 5.7% of patients, meeting the pre-set performance goal. Major adverse cardiovascular events (all-cause mortality, myocardial infarction, or target vessel revascularization) occurred in 10% at 1 year and 17% by 2 years and was not influenced by DART. Quality-of-life measures significantly improved from baseline to 12 months. There was no difference in intravascular healing assessed using optical coherence tomography at 12 months for patients treated with DART and SI stenting compared with intimal strategies. CONCLUSIONS Contemporary CTO PCI is associated with medium-term clinical outcomes comparable with those achieved in other complex PCI cohorts and significant improvements in quality of life. The use of DART with SI stenting does not adversely affect intravascular healing at 12 months or medium-term major adverse cardiovascular events. (Consistent CTO Trial; NCT02227771).
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14
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Dash D. Iteration of Reverse Controlled Antegrade and Retrograde Tracking for Coronary Chronic Total Occlusion Intervention: a Current Appraisal. Korean Circ J 2020; 50:867-879. [PMID: 32725995 PMCID: PMC7515754 DOI: 10.4070/kcj.2020.0156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 11/11/2022] Open
Abstract
Coronary chronic total occlusion (CTO) remains one of the most challenging subsets for percutaneous coronary intervention (PCI). The retrograde recanalization is one of the most significant amendments of the technique that remains critical to improved success of CTO PCI. Currently the reverse controlled antegrade and retrograde tracking (CART) is the most dominant retrograde technique. With emergence of new equipment and important iterations, this approach has become safer, faster and more successful. In this review, the author proposes the iteration and standardization of this technique which would further facilitates its adoption with more efficacy and safety.
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15
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Procedural outcomes of chronic total occlusion percutaneous coronary intervention in patients with dissection and reentry versus wire escalation techniques: a meta-analysis. Coron Artery Dis 2020; 31:703-715. [PMID: 32639248 DOI: 10.1097/mca.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The procedural safety of dissection and reentry (DR) techniques in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains controversial, when compared with conventional wire escalation (WE) techniques. The meta-analysis was performed to evaluate the impact of DR techniques vs. WE techniques on periprocedural outcomes in patients with CTO undergoing PCI. METHODS Studies were searched in electronic database from inception to December 2018. Results were pooled using random effects model and fixed effects model. RESULTS The pooled analyses revealed that DR techniques increased risks of periprocedural complications in patients with CTO PCI, including higher coronary perforation rate [risk ratio (RR) = 2.10, 95% confidence interval (CI) 1.24-3.55], periprocedural myocardial infarction (RR = 1.85, 95% CI 1.23-2.78), branch occlusion (RR = 2.69; 95% CI 1.92-3.77) and coronary hematoma (RR = 3.06; 95% CI 2.45-3.82) detected by intravascular ultrasound, when compared to those with WE techniques. However, DR techniques were more applied in patients with higher complexity CTO lesions, which was evidenced by higher J-CTO score [standard mean differences (SMD) = 0.71, 95% CI 0.51-0.91] and longer fluoroscopy time (SMD = 0.93, 95% CI 0.70-1.16), that may explain the higher complications rates in the DR techniques group as compared with WE techniques. CONCLUSION The present meta-analysis suggests that the DR technique is relatively frequently used during contemporary CTO PCI, especially for challenging more complex CTO lesions. However, it is associated with higher, yet acceptable, rates of periprocedural adverse events as compared with a conventional WE strategy. Further refinement of DR techniques and evidence from large RCTs is needed to define the optimal role of DR in hybrid CTO PCI.
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16
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Zhao Y, Peng H, Li X, Liu J. The impact of dissection and re-entry versus wire escalation techniques on long-term clinical outcomes in patients with chronic total occlusion lesions following percutaneous coronary intervention: An updated meta-analysis. Cardiol J 2020; 28:369-383. [PMID: 32104900 DOI: 10.5603/cj.a2020.0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/25/2020] [Accepted: 02/16/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The meta-analysis was performed to evaluate the effect of dissection and re-entry (DR) vs. wire escalation (WE) techniques on long-term clinical outcomes in patients with chronic total occlusion (CTO) lesions undergoing percutaneous coronary intervention. METHODS Studies were searched in electronic databases from inception to September, 2019. Results were pooled using random effects model and fixed effects model and are presented as risk ratios (RR) with 95% confidence intervals (CI). RESULTS Pooled analyses revealed that patients with DR techniques had overall higher complexity CTO lesions than patients with WE techniques and required a greater number of stents and a greater mean stent length. The "extensive" DR techniques may have a higher incidence of target vessel revascularization (TVR) (RR = 2.30, 95% CI: 1.77-2.98), in-stent restenosis (RR = 1.71, 95% CI: 1.30-2.23), in-stent reocclusion (RR = 1.86, 95% CI: 1.03-3.3) and death/myocardial infarction/TVR (RR = 2.10, 95% CI: 1.71-2.58), when compared with WE techniques, during the long-term follow-up. However, "limited" DR techniques result in more promising outcomes, and are comparable to conventional WE techniques. CONCLUSIONS Dissection and re-entry techniques were associated with increased risk of long-term negative clinical events, especially "extensive" DR techniques. However, "limited" DR techniques resulted in good long-term outcomes, comparable to WE techniques.
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Affiliation(s)
- Yejing Zhao
- Beijing Anzhen Hospital, Capital University.
| | | | - Xiaonan Li
- Beijing Anzhen Hospital, Capital University
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17
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Xhepa E, Cassese S, Rroku A, Joner M, Pinieck S, Ndrepepa G, Kastrati A, Fusaro M. Subintimal Versus Intraplaque Recanalization of Coronary Chronic Total Occlusions: Mid-Term Angiographic and OCT Findings From the ISAR-OCT-CTO Registry. JACC Cardiovasc Interv 2019; 12:1889-1898. [PMID: 31521651 DOI: 10.1016/j.jcin.2019.04.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/19/2019] [Accepted: 04/30/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The aim of this study was to compare angiographic and optical coherence tomography findings following subintimal as opposed to intraplaque recanalization of chronic total occlusions (CTOs). BACKGROUND There is ongoing controversy regarding outcomes of intraplaque versus subintimal CTO recanalization. METHODS Consecutive patients undergoing angiography and intravascular optical coherence tomography following CTO recanalization were included in the ISAR-OCT-CTO (Intracoronary Stenting and Angiographic Results - Optical Coherence Tomography for Chronic Total Occlusions) registry. The study endpoints were percent diameter stenosis and late lumen loss as well as rate of uncovered and malapposed struts. Independent correlates of uncovered and malapposed struts were assessed by multivariate analysis. RESULTS The study included 75 patients. Intraplaque and dissection and re-entry techniques (DART) were used in 46 and 29 patients, respectively. There were no differences in terms of in-segment percent diameter stenosis (median 36.9 [interquartile range (IQR): 26.4 to 43.1] vs. 31.2 [IQR: 23.2 to 49.5]; p = 0.656), in-stent late lumen loss (0.215 mm [IQR: 0.063 to 0.495 mm] vs. 0.230 mm [IQR: 0.060 to 0.645 mm]; p = 0.837), or in-segment late lumen loss (0.030 mm [IQR: -0.278 to 0.510 mm] vs. 0.130 mm [IQR: -0.120 to 0.500 mm]; p = 0.395) at follow-up between the 2 techniques. Optical coherence tomography analysis showed comparable strut coverage (79.9% vs. 71.3%; p = 0.255) but significantly higher strut malapposition (6.6% vs. 13.6%; p < 0.001) following DART. Use of DART independently correlated with presence of strut malapposition (odds ratio: 3.41; 95% confidence interval: 1.24 to 9.36; p = 0.017) but not of strut coverage (odds ratio: 0.65; 95% confidence interval: 0.28 to 1.49; p = 0.314). CONCLUSIONS Intraplaque and subintimal recanalization techniques are associated with comparable mid-term angiographic results. Although the rate of uncovered struts is high following CTO recanalization, the recanalization technique does not independently correlate with presence of uncovered struts. There is a high rate of strut malapposition following CTO recanalization, particularly if achieved by means of DART.
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Affiliation(s)
- Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Andi Rroku
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Susanne Pinieck
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
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18
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Werner GS. The retrograde approach for recanalisation of chronic total occlusions - the impact on interventional success. EUROINTERVENTION 2019; 15:e310-e312. [PMID: 31322120 DOI: 10.4244/eijv15i4a57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Gerald S Werner
- Medizinische Klinik (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany
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19
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Matsuno S, Tsuchikane E, Harding SA, Wu EB, Kao HL, Brilakis ES, Mashayekhi K, Werner GS. Overview and proposed terminology for the reverse controlled antegrade and retrograde tracking (reverse CART) techniques. EUROINTERVENTION 2019; 14:94-101. [PMID: 29360064 DOI: 10.4244/eij-d-17-00867] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
During recent years, equipment and techniques for percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) have improved significantly. The retrograde approach remains critical to the improved success of CTO PCI. Currently, the reverse controlled antegrade and retrograde tracking (CART) technique has become the dominant retrograde wire crossing technique. In this article, we propose a standardised terminology and classification for this technique divided into three subtypes: a) conventional reverse CART, usually involving the use of large balloons on the antegrade wire to achieve re-entry within the CTO segment; b) "directed" reverse CART, which is characterised by small antegrade balloon size and more active, intentional vessel tracking and penetration with a controllable retrograde wire, still within the CTO segment; and c) "extended" reverse CART, in which the intimal/subintimal dissection is extended proximal or distal to the CTO segment, achieving re-entry outside the CTO segment. The proposed standardised terminology will facilitate the communication, teaching and adoption of the reverse CART techniques.
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Affiliation(s)
- Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
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20
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Finn MT, Doshi D, Cleman J, Song L, Maehara A, Hatem R, Redfors B, Kalra S, Fried JA, Liao M, Batres C, Moses JW, Parikh MA, Collins MB, Nazif TM, Fall KN, Green P, Kirtane AJ, Ali ZA, Leon MB, Mintz GS, Karmpaliotis D. Intravascular ultrasound analysis of intraplaque versus subintimal tracking in percutaneous intervention for coronary chronic total occlusions: One year outcomes. Catheter Cardiovasc Interv 2018; 93:1048-1056. [PMID: 30489684 DOI: 10.1002/ccd.27958] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/12/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We sought to determine the 1-year outcomes of patients receiving successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures comparing subintimal versus intraplaque wire tracking patterns. BACKGROUND CTO PCI utilizes both intraluminal and subintimal wire tracking to achieve successful percutaneous revascularization. Intravascular ultrasound (IVUS) can be used to precisely determine the path of wire tracking. METHODS From 2014 to 2016, data from patients undergoing CTO PCI were collected in a single-center database. The primary composite endpoint was target vessel failure (TVF) defined as cardiovascular death, target vessel myocardial infarction (MI), or target vessel revascularization (TVR). RESULTS In total 157 patients with successful CTO PCI and concomitant IVUS imaging completed 1-year follow-up. Subintimal tracking was detected in 53.5% of cases and those patients had a higher incidence of prior PCI, prior coronary artery bypass grafting, and higher J-CTO score. At 1-year, the unadjusted rate of TVF in the subintimal tracking group was higher than the intraplaque group (17.9 vs. 6.9%, HR 2.74, 95% CI 1.00-7.54, P = 0.04), driven by numerically higher rates of TVR and peri-procedural MI. After multivariable adjustment, no significant differences in the rates of the TVF between subintimal vs. intraplaque groups were present at 1-year (TVF: HR 1.51, 95% CI 0.38-6.00, P = 0.55). Landmark analysis excluding in-hospital events showed no significant differences in TVF to 1-year. CONCLUSIONS IVUS-detected subintimal tracking was observed in over half of successful CTO PCI cases and correlated with baseline and angiographic factors that contributed to the overall rate of TVF at 1-year.
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Affiliation(s)
- Matthew T Finn
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Darshan Doshi
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Jacob Cleman
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Lei Song
- Department of Cardiology, National Center for Cardiovascular Disease, China Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Akiko Maehara
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Raja Hatem
- Department of Cardiology, Hôpital du Sacré-Coeur, Montreal, Québec, Canada
| | - Björn Redfors
- Department of Cardiology, Cardiovascular Research Foundation, New York, New York.,Department of Cardiology, University of Gothenburg, Gothenburg, Sweden
| | - Sanjog Kalra
- Department of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Justin A Fried
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Ming Liao
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Candido Batres
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Jeffery W Moses
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Manish A Parikh
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Michael B Collins
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Tamim M Nazif
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Khady N Fall
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Phillip Green
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Ajay J Kirtane
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Ziad A Ali
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Martin B Leon
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Gary S Mintz
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Dimitri Karmpaliotis
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Department of Cardiology, Cardiovascular Research Foundation, New York, New York
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21
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Karamasis GV, Kalogeropoulos AS, Mohdnazri SR, Al-Janabi F, Jones R, Jagathesan R, Aggarwal RK, Clesham GJ, Tang KH, Kelly PA, Davies JR, Werner GS, Keeble TR. Serial Fractional Flow Reserve Measurements Post Coronary Chronic Total Occlusion Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2018; 11:e006941. [DOI: 10.1161/circinterventions.118.006941] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Grigoris V. Karamasis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
- School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom (G.V.K., S.R.M., F.A.-J., G.J.C., J.R.D., T.R.K.)
| | | | - Shah R. Mohdnazri
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
- School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom (G.V.K., S.R.M., F.A.-J., G.J.C., J.R.D., T.R.K.)
| | - Firas Al-Janabi
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
- School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom (G.V.K., S.R.M., F.A.-J., G.J.C., J.R.D., T.R.K.)
| | - Richard Jones
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
| | - Rohan Jagathesan
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
| | - Rajesh K. Aggarwal
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
| | - Gerald J. Clesham
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
- School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom (G.V.K., S.R.M., F.A.-J., G.J.C., J.R.D., T.R.K.)
| | - Kare H. Tang
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
| | - Paul A. Kelly
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
| | - John R. Davies
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
- School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom (G.V.K., S.R.M., F.A.-J., G.J.C., J.R.D., T.R.K.)
| | - Gerald S. Werner
- Medizinische Klinik I (Cardiology & Intensive care), Klinikum Darmstadt GmbH, Darmstadt, Germany (G.S.W.)
| | - Thomas R. Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
- School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom (G.V.K., S.R.M., F.A.-J., G.J.C., J.R.D., T.R.K.)
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22
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Karatasakis A, Danek BA, Karacsonyi J, Azzalini L, Carlino M, Rinfret S, Vo M, Rangan BV, Burke MN, Banerjee S, Brilakis ES. Mid-term outcomes of chronic total occlusion percutaneous coronary intervention with subadventitial vs. intraplaque crossing: A systematic review and meta-analysis. Int J Cardiol 2018; 253:29-34. [PMID: 29306468 DOI: 10.1016/j.ijcard.2017.08.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/01/2017] [Accepted: 08/14/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Some reports have demonstrated increased risk with subadventitial chronic total occlusion (CTO) crossing, whereas others suggest equipoise between subadventitial and intraplaque crossing techniques. We sought to clarify the effect of subadventitial lesion crossing on mid-term outcomes of CTO percutaneous coronary intervention (PCI). METHODS We conducted a systematic review and meta-analysis of studies reporting post-discharge outcomes after CTO PCI performed via subadventitial vs. intraplaque approaches. RESULTS Five studies comprising a total of 2,539 patients were included. Compared with intraplaque crossing (n=1,654, 65.1%), subadventitial cases (n=885, 34.9%) had a higher J-CTO score (2.9±1.2 vs. 1.6±1.2, p<0.001), and required significantly longer stent lengths (difference in means: 19.66 mm [95% confidence interval (CI), 11.23 to 28.08]; p<0.001). At a median follow-up of 12.0months, subadventitial CTO crossing was associated with a higher overall rate of target vessel revascularization (TVR, crude rate, 11.5% vs. 7.6%, odds ratio [OR]: 2.19 [95% CI, 1.62 to 2.95]; p<0.001); the risk was higher in studies of extensive compared with limited dissection and re-entry techniques (OR: 3.46 [95% CI: 2.24 to 5.36] vs. 1.52 [95% CI, 0.94 to 2.46], pinteraction=0.013). The rates of stent thrombosis, myocardial infarction, and cardiovascular mortality did not vary significantly between subadventitial and intraplaque crossing. CONCLUSIONS CTOs treated with subadventitial crossing were significantly more complex as compared with CTOs treated with intraplaque crossing. Extensive subadventitial crossing techniques were associated with higher TVR rates as compared with limited techniques, supporting the important role of limited techniques in the treatment of complex CTOs.
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Affiliation(s)
- Aris Karatasakis
- Department of Cardiology, UT Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX, United States; Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Barbara A Danek
- Department of Cardiology, UT Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX, United States; Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Judit Karacsonyi
- Department of Cardiology, UT Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX, United States
| | - Lorenzo Azzalini
- Division of Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | - Mauro Carlino
- Division of Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | - Stéphane Rinfret
- Division of Interventional Cardiology, Quebec Heart and Lung Institute and McGill University Health Centre, Montreal, Canada
| | - Minh Vo
- Division of Interventional Cardiology, Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - Bavana V Rangan
- Department of Cardiology, UT Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX, United States
| | - M N Burke
- Division of Interventional Cardiology, Minneapolis Heart Institute, Minneapolis, MN, United States
| | - Subhash Banerjee
- Department of Cardiology, UT Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX, United States
| | - Emmanouil S Brilakis
- Department of Cardiology, UT Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX, United States; Division of Interventional Cardiology, Minneapolis Heart Institute, Minneapolis, MN, United States.
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23
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Huang WC, Teng HI, Hsueh CH, Lin SJ, Chan WL, Lu TM. Intravascular ultrasound guided wiring re-entry technique for complex chronic total occlusions. J Interv Cardiol 2018; 31:572-579. [DOI: 10.1111/joic.12518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022] 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, Chiayi&WanQiao Branch; Taichung Veterans General Hospital; Taichung Taiwan, R.O.C
| | - Chien-Hung Hsueh
- Division of Cardiology, Department of Internal Medicine; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
| | - Shing-Jong Lin
- 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
| | - 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
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24
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Zivelonghi C, Teeuwen K, Agostoni P, van der Schaaf RJ, Ribichini F, Adriaenssens T, Kelder JC, Tijssen JGP, Henriques JPS, Suttorp MJ. Impact of ultra-thin struts on restenosis after chronic total occlusion recanalization: Insights from the randomized PRISON IV trial. J Interv Cardiol 2018; 31:580-587. [DOI: 10.1111/joic.12516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/25/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Carlo Zivelonghi
- Department of Cardiology; Sint Antonius Ziekenhuis; Nieuwegein The Netherlands
- Department of Cardiology; University of Verona; Verona Italy
| | - Koen Teeuwen
- Department of Cardiology; Catharina Hospital; Eindhoven The Netherlands
| | | | | | | | | | - Johannes C. Kelder
- Department of Cardiology; Sint Antonius Ziekenhuis; Nieuwegein The Netherlands
| | - Jan G. P. Tijssen
- Department of Cardiology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - José P. S. Henriques
- Department of Cardiology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Maarten J. Suttorp
- Department of Cardiology; Sint Antonius Ziekenhuis; Nieuwegein The Netherlands
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25
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Tajti P, Brilakis ES. Does the hybrid algorithm has real impact on long-term outcomes or should only be used as a valuable approach for CTO crossing? J Thorac Dis 2018; 10:1320-1324. [PMID: 29707284 DOI: 10.21037/jtd.2018.03.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Peter Tajti
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
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26
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Affiliation(s)
- Peter Tajti
- Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN
- Department of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX
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27
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Full Metal Jacket With Drug-Eluting Stents for Coronary Chronic Total Occlusion. JACC Cardiovasc Interv 2017; 10:1405-1412. [DOI: 10.1016/j.jcin.2017.04.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/03/2017] [Accepted: 04/08/2017] [Indexed: 11/18/2022]
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28
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Park SJ, Lee PH, Lee SW. Chronic Total Occlusion Intervention. JACC Cardiovasc Interv 2017; 10:1022-1024. [DOI: 10.1016/j.jcin.2017.04.003] [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: 03/23/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
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29
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Werner GS. Optimal approach to percutaneous intervention for CTO in 2017: the traditional strategy is still the best. EUROINTERVENTION 2017; 12:e1802-e1804. [PMID: 28167459 DOI: 10.4244/eijv12i15a293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Gerald S Werner
- Medizinische Klinik (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany
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30
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Walsh S, Hanratty C, Spratt J. Optimal approach to percutaneous intervention for CTO in 2017: a hybrid strategy is now the preferred choice. EUROINTERVENTION 2017; 12:e1805-e1807. [DOI: 10.4244/eijv12i15a294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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