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Zhu H, Cai X, Zhan Y, Hong L. The active pulling technique to solve microcatheter-uncrossable lesions in retrograde chronic total occlusion percutaneous coronary intervention. Int J Cardiovasc Imaging 2024:10.1007/s10554-024-03068-0. [PMID: 38407725 DOI: 10.1007/s10554-024-03068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND It is not uncommon to encounter retrograde microcatheter-uncrossable lesions in retro-recanalization of Chronic Total Occlusion (CTO) cases, existing solutions were time-consuming or complicated to operate. Therefore, the present study aimed to propose and evaluate the feasibility, safety of a novel technique termed Active Pulling retrograde microcatheter crossing Technique (APT) during retrograde CTO percutaneous coronary intervention (PCI). METHODS We retrospectively collected retrograde CTO-PCI cases from February 2017 to April 2023, only cases with the retrograde wire successfully crossed the CTO lesion were analyzed. The baseline clinical characteristics, angiographic characteristics, procedural details, and in-hospital major adverse cardiac events (MACEs) were compared. RESULTS A total of 80 CTO cases were divided into the APT group and the non-APT group according to whether the APT was applied in the procedure. The APT group had a higher rate of device success than the non-APT group (100% vs. 85%, P = 0.013), with shorter duration (5.3 ± 3.8 vs. 18.6 ± 5.9 min, P < 0.001) and a smaller number of retrograde microcatheters were used (P < 0.001). In the APT group, the average air kerma radiation exposure was lower (2.7 ± 1.2 vs. 4.3 ± 1.7 Gy, P < 0.001), the fluoroscopy time (69.0 ± 15.0 vs. 88.1 ± 18.9 min, P < 0.001) and the procedure time (116.2 ± 22.2 vs. 131.6 ± 28.7 min, P = 0.009) was shorter than the non-APT group. The technical success rate of both groups reached 100% while the procedure success rate was higher in the APT group than the non-APT group (100% vs. 85%, P = 0.13). CONCLUSIONS The APT is an easy and safe technique that can greatly improve procedural efficiency without adding other instruments, and allows the retrograde microcatheter to quickly crossing the CTO body after successful retrograde wire externalization.
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Affiliation(s)
- Hongmin Zhu
- Jiangxi Medical College, Nanchang University, Nanchang, 330046, Jiangxi, China
- Department of Cardiology, Jiangxi provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, No. 256, Fenghebei Avenue, Honggutan District, Nanchang, 330006, Jiangxi, China
| | - Xinyong Cai
- Department of Cardiology, Jiangxi provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, No. 256, Fenghebei Avenue, Honggutan District, Nanchang, 330006, Jiangxi, China
| | - Yuliang Zhan
- Department of Cardiology, Jiangxi provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, No. 256, Fenghebei Avenue, Honggutan District, Nanchang, 330006, Jiangxi, China
| | - Lang Hong
- Department of Cardiology, Jiangxi provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, No. 256, Fenghebei Avenue, Honggutan District, Nanchang, 330006, Jiangxi, China.
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Pisa FR, Spinella G, Pane B, Pratesi G. Use of target vessel ballooning to facilitate endovascular treatment in the case of branched endovascular aneurysm repair with a retrograde approach. J Vasc Surg Cases Innov Tech 2023; 9:101330. [PMID: 37885793 PMCID: PMC10598395 DOI: 10.1016/j.jvscit.2023.101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/31/2023] [Indexed: 10/28/2023] Open
Abstract
A case of a new technique for branched endovascular aneurysm repair with a retrograde approach and ostial stenosis of the target vessel is reported. An angioplasty balloon was placed within the target vessel and used to give added stability to catheter advancement to place the stiff guidewire needed for placement of a bridging stent graft. In brief, a standard guidewire was first placed inside the target vessel through the retrograde approach. Next, the balloon was placed from outside the stent graft, again through a contralateral retrograde approach. Then, the angioplasty balloon was inflated, and a support catheter was advanced to the balloon and then slowly deflated to allow the catheter to advance. Finally, the stiff guidewire was placed. Subsequently, the bridging stent was placed and deployed. This technique is feasible and can be used in selected cases to use a retrograde approach when ostial stenosis of the target vessel is present.
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Affiliation(s)
- Fabio Riccardo Pisa
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Giovanni Spinella
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bianca Pane
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni Pratesi
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Condos G, Kearney KE, Lombardi WL, Azzalini L. Complex Retrograde Chronic Occlusion Percutaneous Coronary Intervention via a Gastroepiploic Artery Graft. Cardiovasc Revasc Med 2023; 53S:S283-S287. [PMID: 37210219 DOI: 10.1016/j.carrev.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/01/2023] [Indexed: 05/22/2023]
Abstract
Surgical bypass grafts are commonly used retrograde conduits to facilitate chronic total occlusion (CTO) percutaneous coronary intervention (PCI). While extensive experience exists using saphenous vein grafts as retrograde conduits in CTO PCI, information on the utilization of arterial grafts is more limited. In particular, the gastroepiploic artery (GEA) is a very uncommonly used arterial graft in contemporary bypass surgery and its role for retrograde CTO recanalization has received little study. We describe a case of right coronary artery CTO that was recanalized using the retrograde approach via a GEA graft to the posterior descending artery and highlight the specific challenges of this approach.
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Affiliation(s)
- Gregory Condos
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - William L Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
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Li QY, Lin XL, Li FQ, Cheng ZC, Tian JY, Zhao DH, Lau WB, Liu JH, Fan Q. A Chinese scoring system for predicting successful retrograde collateral traverse in patients with chronic total coronary occlusion. BMC Cardiovasc Disord 2023; 23:380. [PMID: 37516887 PMCID: PMC10386207 DOI: 10.1186/s12872-023-03405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 07/18/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Retrograde approach technique has been challenging in percutaneous coronary interventional treatment of chronic total occlusion (CTO) coronary disease. The present study endeavors to determine a novel Chinese scoring system for predicting successful collateral channels traverse via retrograde approach. METHODS The demographic characteristics and angiographic characteristics of 309 CTO patient were analyzed by univariable and multivariable analysis for selecting potential predictors. And the nomogram was used to establish the scoring system. Then it was evaluated by the internal and external validation. RESULTS The predictors of Age, Connections between collateral channels and recipient vessels, and Channel Tortuosity (ACT) were identified with univariable and multivariable analysis and employed to the ACT score system. With acceptable calibrations, the area under curve of the scoring system and the external validation were 0.826 and 0.816 respectively. Based on score, the predictors were divided into three risk categories and it showed a consistent prediction power in the validation cohort. CONCLUSIONS The novel Chinese ACT score is a reliable tool for predicting successful retrograde collateral traverse.
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Affiliation(s)
- Qiu Yu Li
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Xiao Long Lin
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Fan Qi Li
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Zi Chao Cheng
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Jia Yu Tian
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Dong Hui Zhao
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Wayne Bond Lau
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Jing Hua Liu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Qian Fan
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China.
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Miyashita H, Tobita K, Uchida S, Koyama E, Tamaki Y, Yamashita T, Saito S. A case of chronic total occlusion in popliteal artery recanalized by double snare piercing technique. CVIR Endovasc 2023; 6:34. [PMID: 37347446 DOI: 10.1186/s42155-023-00380-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Although majority of cases with chronic total occlusion (CTO) in femoro-popliteal lesion were treated with antegrade approach only, some lesions require alternative approach due to its complexity. Bi-directional approach is useful on endovascular therapy (EVT) for CTO; however guidewire passage through the lesion is impossible in some challenging cases. The present case shows a successful re-entry technique utilizing two snare catheters from an antegrade and retrograde access site (double snare piecing technique). CASE PRESENTATION A 79-year-old woman with right leg intermittent claudication (Rutherford category IV), who had undergone unsuccessful EVT for popliteal CTO, required another EVT for the worsening symptom. Following the failed conventional crossing technique (wire knuckle technique, intravascular-ultrasound-guided wiring, and controlled antegrade and retrograde subintimal tracking technique), two snare catheters were placed and the snare loops were pierced by a puncture needle percutaneously. After an 0.014 wire was inserted into the needle, the needle was withdrawn. The wire was pulled from the retrograde side and was externalized. Then, the antegrade snare catheter was pulled and externalized, to make the wire across the lesion. After that, a microcatheter was advanced along the externalized wire from the retrograde side and cross the lesion. The wire was replaced with a new wire, which completely created pull-through system. After the hemostasis by balloon inflation and lesion preparation, this procedure was completed with an endoluminal-covered stent and two inter-woven stents. The re-entry site was covered by the inter-woven stent. Her symptoms improved after the procedure, and the lesion has not developed restenosis at 2-years follow-up. CONCLUSIONS This re-entry technique of puncturing two snare loops (double snare piercing technique) might be effective for achieving successful passage through challenging femoropopliteal CTO cases.
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Affiliation(s)
- Hirokazu Miyashita
- Department of Cardiology, Heart Center, Shonan Kamakura General Hospital, Okamoto 1370-1, 2478533, Kamakura, Japan
| | - Kazuki Tobita
- Department of Cardiology, Heart Center, Shonan Kamakura General Hospital, Okamoto 1370-1, 2478533, Kamakura, Japan.
| | - Syuhei Uchida
- Department of Cardiology, Heart Center, Shonan Kamakura General Hospital, Okamoto 1370-1, 2478533, Kamakura, Japan
| | - Eiji Koyama
- Department of Cardiology, Heart Center, Shonan Kamakura General Hospital, Okamoto 1370-1, 2478533, Kamakura, Japan
| | - Yusuke Tamaki
- Department of Cardiology, Heart Center, Shonan Kamakura General Hospital, Okamoto 1370-1, 2478533, Kamakura, Japan
| | - Takayoshi Yamashita
- Department of Cardiology, Heart Center, Shonan Kamakura General Hospital, Okamoto 1370-1, 2478533, Kamakura, Japan
| | - Shigeru Saito
- Department of Cardiology, Heart Center, Shonan Kamakura General Hospital, Okamoto 1370-1, 2478533, Kamakura, Japan
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Simonetti FM, Algeri P, Ferrante I, Pirola S, Carnelli M, Patanè L, Fierro G, Frigerio L. Placenta Accreta Spectrum Disorders: How to reduce maternal transfusion? A center experience on extraperitoneal retrograde hysterectomy. Eur J Obstet Gynecol Reprod Biol 2023; 287:148-154. [PMID: 37336161 DOI: 10.1016/j.ejogrb.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Placenta Accreta Spectrum disorders (PASd) refer to the range of pathologic adherence of placenta associated with high maternal morbidity and mortality due to severe and sometimes life-threatening hemorrhage at the time of delivery. The aim of this study is to describe the surgical technique of extraperitoneal retrograde hysterectomy, which has allowed a reduction of blood transfusions compared to patients who underwent classical post-partum hysterectomy. STUDY DESIGN We collected data from twelve patients with antenatal diagnosis of PASd treated between 2018 and 2021 with an extra-peritoneal hysterectomy using a posterior retrograde approach and we compared them to patients who underwent classical hysterectomy for suspected PASd, treated between 2007 and 2017. RESULTS The classical hysterectomy group presented a higher frequency of blood and plasma transfusion compared to the extraperitoneal hysterectomy group. In particular, classical hysterectomy resulted in an independent risk factor for transfusion, with an increment of 6.6 times of risk. CONCLUSION Even if future studies are required, we think that extraperitoneal hysterectomy could be a safe option in case of PASd, considering that classical hysterectomy compared to this approach increases, in our population, the risk of blood and plasma transfusion.
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Affiliation(s)
| | - Paola Algeri
- Department of obstetrics and Gynecology, ASST Bergamo Est, Seriate (BG), Italy.
| | - Ilaria Ferrante
- Department of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Serena Pirola
- Department of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Carnelli
- Department of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luisa Patanè
- Department of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giulia Fierro
- Department of Emergency and Intensive Care, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luigi Frigerio
- Department of Obstetrics and Gynecology, Policlinico San Pietro, Ponte San Pietro (BG), Italy
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Uno T, Shojima M, Oyama Y, Yamane F, Matsuno A. Retrograde endovascular revascularization for chronic total occlusion of the internal carotid artery: a case report. Acta Neurochir (Wien) 2022; 164:1015-1019. [PMID: 34014378 PMCID: PMC8967802 DOI: 10.1007/s00701-021-04875-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022]
Abstract
Endovascular revascularization of a chronically occluded internal carotid artery (ICA) is challenging because the occlusive segment can be long and tortuous. A case is presented of a successful recanalization of a chronically occluded ICA by retrograde passing of a guidewire from the intracranial ICA to the cervical ICA via the posterior communicating artery. This case suggests that a retrograde approach for reopening an occluded artery may be useful during neurovascular interventions, similar to percutaneous coronary interventions. In this patient, daily transient ischemic attacks disappeared after successful recanalization of the ICA.
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Affiliation(s)
- Takeshi Uno
- Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
| | - Masaaki Shojima
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, Japan
| | - Yuta Oyama
- Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Fumitaka Yamane
- Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Akira Matsuno
- Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
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8
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Kumar P, Jino B, Shafeeq A, Roy S, Rajendran M, Villoth SG. Retrograde chronic total occlusion percutaneous coronary intervention using single catheter: A single centre registry. Indian Heart J 2021; 73:434-439. [PMID: 34474754 PMCID: PMC8424288 DOI: 10.1016/j.ihj.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/02/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives To analyse the feasibility, safety and procedural outcomes of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) through retrograde approach using single catheter. Methods Our study was a retrospective observational study that enrolled patients who underwent retrograde CTO PCI using a single catheter between June 2016 and February 2020. Clinical success was defined as successful completion of CTO PCI without associated in-hospital major clinical complications like death, myocardial infarction, stroke or urgent revascularisation. Technical success was defined as successful completion of CTO PCI using single catheter and minimum diameter stenosis of <30% with thrombolysis in myocardial infarction (TIMI) flow grade 3, without significant side branch occlusion, flow-limiting dissection, distal embolization, or angiographic thrombus. Results Totally 102 patients underwent retrograde CTO PCI during the study period. Out of which, 15 cases were attempted using single catheter. Mean age of the population was 59.1 ± 8.9 years (males: 86.7%) and the left ventricular ejection fraction (LVEF) was (61% ± 9.1%). Mean number of diseased arteries was 2.1 ± 0.7, length of the CTO was 25.5 ± 7.4 mm and J-CTO score was 2.3 ± 0.7. We achieved a technical success rate of 73.3% using single catheter, and the overall clinical success (Including single catheter and ping pong) was obtained in 86.7% cases. One patient (6.7%) developed cardiac tamponade and none of study population required dialysis for contrast induced acute kidney injury (CI-AKI) Conclusions Retrograde CTO PCI using single catheter is a technically challenging procedure when compared with other CTO PCI. Our study demonstrated acceptable outcomes which is comparable to other antegrade and retrograde CTO PCI registries.
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Affiliation(s)
| | | | | | - Stalin Roy
- Meditrina hospital, Kollam, Kerala, India
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Sun K, Zhang H, Wang G. Bronchoscopic retrograde recanalization of complete tracheal obliteration after tracheostomy. Auris Nasus Larynx 2021; 49:1046-1050. [PMID: 34001393 DOI: 10.1016/j.anl.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/14/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
Complete tracheal obliteration after tracheostomy remains a considerable challenge for otolaryngologists and pulmonologists. Here, we report for the first time a novel method of interventional bronchoscopy to successfully recanalize complete tracheal obliteration. Three patients with suprastomal tracheal obliteration and tracheostomy dependence were referred to our center for further management. Using interventional bronchoscopy, a TBNA needle was retrogradely inserted from the stoma to locate the original passage through the occlusion, and then its stylet was left as a guide wire for the sequential dilations. Once the tracheal lumen was restored, endoprosthesis would be implanted to maintain the airway patency. All cases achieved successful recanalization with effortless breathing after the treatment and restored phonation. Bronchoscopic retrograde recanalization using a TBNA needle is a promising and effective treatment for complete tracheal obliteration.
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Affiliation(s)
- Kunyan Sun
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Beijing 100034, China
| | - Hong Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Beijing 100034, China
| | - Guangfa Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Beijing 100034, China.
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Xenogiannis I, Alaswad K, Krestyaninov O, Khelimskii D, Khatri JJ, Choi JW, Jaffer FA, Patel M, Mahmud E, Doing AH, Dattilo P, Koutouzis M, Tsiafoutis I, Uretsky B, Jefferson BK, Patel T, Jaber W, Samady H, Sheikh AM, Yeh RW, Tamez H, Elbarouni B, Love MP, Abi Rafeh N, Maalouf A, Fadi AJ, Toma C, Shah AR, Chandwaney RH, Omer M, Megaly MS, Vemmou E, Nikolakopoulos I, Rangan BV, Garcia S, Abdullah S, Banerjee S, Burke MN, Karmpaliotis D, Brilakis ES. Impact of adherence to the hybrid algorithm for initial crossing strategy selection in chronic total occlusion percutaneous coronary intervention. ACTA ACUST UNITED AC 2020; 74:1023-1031. [PMID: 33189636 DOI: 10.1016/j.rec.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/04/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES The hybrid algorithm was designed to assist with initial and subsequent crossing strategy selection in chronic total occlusion (CTO) percutaneous coronary interventions (PCIs). However, the success of the initially selected strategy has received limited study. METHODS We examined the impact of adherence to the hybrid algorithm recommendation for initial CTO crossing technique selection in 4178 CTO PCIs from a large multicenter registry. RESULTS The initial crossing strategy was concordant with the hybrid algorithm recommendation in 1833 interventions (44%). Patients in the concordant group had a similar age to those in the discordant group but a lower mean J-CTO score (2.0 ± 1.4 vs 2.8 ± 1.1; P < .01). The concordant group showed higher technical success with the first crossing strategy (68% vs 48%; P < .01) and higher overall technical success (88% vs 83%; P < .01) with no difference in the incidence of in-hospital major adverse events (1.8% vs 2.3%; P = .26). In multivariable analysis, after adjustment for age, prior myocardial infarction, prior PCI, prior coronary artery bypass grafting, J-CTO score, and scheduled CTO PCI, nonadherence to the hybrid algorithm was independently associated with lower technical success of the initial crossing strategy (odds ratio, 0.55; 95% confidence interval, 0.48-0.64; P < .01). CONCLUSIONS Adherence to the hybrid algorithm for initial crossing strategy selection is associated with higher CTO PCI success but similar in-hospital major adverse cardiac events.
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Affiliation(s)
- Iosif Xenogiannis
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, United States
| | | | | | | | - James W Choi
- Department of Cardiology, Baylor Heart and Vascular Hospital, Dallas, Texas, United States
| | - Farouc A Jaffer
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachussetts, United States
| | - Mitul Patel
- VA San Diego Healthcare System, La Jolla, California, United States
| | - Ehtisham Mahmud
- VA San Diego Healthcare System, La Jolla, California, United States
| | - Anthony H Doing
- Department of Cardiology, Medical Center of the Rockies, Loveland, Colorado, United States
| | - Phil Dattilo
- Department of Cardiology, Medical Center of the Rockies, Loveland, Colorado, United States
| | | | | | - Barry Uretsky
- Department of Cardiology, VA Central Arkansas Healthcare System, Little Rock, Arkansas, United States
| | - Brian K Jefferson
- Department of Cardiology, Tristar Centennial Medical Center, Nashville, Tennessee, United States
| | - Taral Patel
- Department of Cardiology, Tristar Centennial Medical Center, Nashville, Tennessee, United States
| | - Wissam Jaber
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, United States
| | - Habib Samady
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, United States
| | - Abdul M Sheikh
- Wellstar Health System, Marietta, Georgia, United States
| | - Robert W Yeh
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Hector Tamez
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Basem Elbarouni
- Department of Cardiology, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Michael P Love
- Department of Cardiology, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Nidal Abi Rafeh
- Department of Cardiology, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Assaad Maalouf
- Department of Cardiology, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Abou Jaoudeh Fadi
- Department of Cardiology, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Alpesh R Shah
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas, United States
| | | | - Mohamed Omer
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Michael S Megaly
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Evangelia Vemmou
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Ilias Nikolakopoulos
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Bavana V Rangan
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Santiago Garcia
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Shuaib Abdullah
- Department of Cardiology, VA North Texas Health Care System, Dallas, Texas, United States
| | - Subhash Banerjee
- Department of Cardiology, VA North Texas Health Care System, Dallas, Texas, United States
| | - M Nicholas Burke
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | | | - Emmanouil S Brilakis
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States.
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Niizeki T, Iwayama T, Kumagai Y, Ikeno E, Tsuchikane E. A case of right coronary artery chronic total occlusion with difficulty in retrograde system establishment. J Cardiol Cases 2020; 22:212-215. [PMID: 33133312 DOI: 10.1016/j.jccase.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/28/2020] [Accepted: 06/15/2020] [Indexed: 11/15/2022] Open
Abstract
Advances in microcatheters (MCs) enables the establishment of retrograde systems for the treatment of chronic total occlusion (CTO). However, there are still cases in which establishing a retrograde system is difficult because the guidewire or MC cannot pass through due to calcification, stenosis, or tortuosity. We present a case of a 56-year-old man with angina. Coronary angiography revealed a CTO of the right coronary artery (RCA). Although we started an antegrade approach at first, the guidewire went to subintimal lumen. We switched to a retrograde approach. Although the guidewire passed through posterolateral (PL) channel, the MC could not pass due to a stenosis at the junction of the main RCA trunk. Therefore, we negotiated the septal channel; however, it could only be guided in the peripheral direction. When the guidewire was more advanced in the peripheral direction, it crossed the guidewire that had previously passed through the PL channel. Then, when a balloon was delivered via the septal channel and trapped the guidewire from the PL channel, the MC was successfully delivered via the PL channel. After establishing the retrograde system, revascularization succeeded smoothly. In conclusion, this technique can be one option for the treatment of CTO patients. <Learning objective: Even if a guidewire passes retrogradely, the establishment of the retrograde system may be difficult in some cases since the microcatheter cannot pass retrogradely. This technique can be one of the effective options for the treatment of patients with chronic total occlusion when establishing a retrograde system is difficult.>.
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Affiliation(s)
- Takeshi Niizeki
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Tadateru Iwayama
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Yu Kumagai
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Eiichiro Ikeno
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
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12
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Zhang H, Li X, Niu L, Feng Y, Luo X, Zhang C, Zhang F. Effectiveness and long-term outcomes of different crossing strategies for the endovascular treatment of iliac artery chronic Total occlusions. BMC Cardiovasc Disord 2020; 20:431. [PMID: 33008293 PMCID: PMC7532591 DOI: 10.1186/s12872-020-01715-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/27/2020] [Indexed: 11/15/2022] Open
Abstract
Background The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and methods We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0 ± 11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR) and major adverse limb events (MALEs). Results Common iliac artery (CIA) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p = 0.005), while lesions in the CIA/ external iliac artery (EIA) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p = 0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.
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Affiliation(s)
- Huan Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Rd, Haidian District, Beijing, 100038, China
| | - Xiangtao Li
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Rd, Haidian District, Beijing, 100038, China
| | - Luyuan Niu
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Rd, Haidian District, Beijing, 100038, China
| | - Yaping Feng
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Rd, Haidian District, Beijing, 100038, China
| | - Xiaoyun Luo
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Rd, Haidian District, Beijing, 100038, China
| | - Changming Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Rd, Haidian District, Beijing, 100038, China
| | - Fuxian Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Rd, Haidian District, Beijing, 100038, China.
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Hayakawa N, Kodera S, Arakawa M, Kanda J. Successful re-entry using the outback® elite catheter via retrograde popliteal access with IVUS guidance for femoropopliteal occlusion: a case report. CVIR Endovasc 2020; 3:63. [PMID: 32889663 PMCID: PMC7474728 DOI: 10.1186/s42155-020-00156-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/02/2020] [Indexed: 11/27/2022] Open
Abstract
Background There are still cases that are difficult to treat for femoropopliteal chronic total occlusion (CTO). The Outback® Elite catheter is effective re-entry device to treat such kind of difficult cases, however, it might be difficult to use the Outback® Elite catheter antegradely in cases with severely calcified lesions. In this case, we performed EVT using the Outback Elite® catheter via the retrograde popliteal approach. Case presentation We report a case of a 77-year-old male with end-stage renal disease who presented with pain and cyanosis of his left foot. Control angiography showed total occlusion from the middle of the left superficial femoral artery to the proximal portion of the popliteal artery. The CTO lesion was severely calcified, which prevented the antegrade advancement of any guidewire. Retrograde popliteal puncture was performed with the patient in the supine position. After intentional retrograde subintimal wiring, the Outback® Elite catheter was advanced via the retrograde approach after the identification of a suitable re-entry site using intravascular ultrasound. After wire crossing, one nitinol stent was deployed and sufficient antegrade flow was achieved without any complications. Conclusions Using Outback® Elite from retrograde should be considered in cases where antegrade advancement fails and bidirectional wiring cannot pass through the CTO lesion.
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Affiliation(s)
- Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan.
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan
| | - Masataka Arakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Junji Kanda
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
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Werner GS, Yaginuma K. Editorial: The Ostial Chronic Total Occlusion - A Special Animal. Cardiovasc Revasc Med 2020; 21:666-667. [PMID: 32201211 DOI: 10.1016/j.carrev.2020.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Gerald S Werner
- Medizinische Klinik (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany.
| | - Kenji Yaginuma
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu, Chiba Prefecture, Japan
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Ojeda S, Luque A, Pan M, Bellini B, Xenogiannis I, Lostalo A, Montorfano M, Hidalgo F, Venuti G, La Manna A, Carlino M, Brilakis ES, Azzalini L. Percutaneous coronary intervention in aorto-ostial coronary chronic total occlusion: outcomes and technical considerations in a multicenter registry. ACTA ACUST UNITED AC 2020; 73:1011-1017. [PMID: 32146121 DOI: 10.1016/j.rec.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/15/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Percutaneous coronary intervention (PCI) for aorto-ostial chronic total coronary occlusion (CTO) can be a particularly challenging lesion subset. The aim of this study was to analyze the technical aspects and outcomes of aorto-ostial CTO PCI in a multicenter registry. METHODS Patients undergoing aorto-ostial CTO PCI at 4 centers between February 2013 and December 2018 were included. Success rates, as well as procedural aspects and outcomes, were analyzed. RESULTS A total of 103 patients were included. Mean age was 64±10 years and the mean J-CTO score was 3.1±1.1. Thirty-one lesions (30.4%) were flush ostial CTOs. Technical and procedural success were achieved in 79 (76.7%) and 78 (75.7%) of the patients, respectively. The retrograde approach was the most frequent successful crossing technique (n=49; 62.0%), especially in flush vs nonflush aorto-ostial CTOs (82.6% vs 53.5%; P=.02). The only variable independently associated with technical failure was the absence of interventional collaterals (OR, 12.38; 95%CI, 4.02-38.15; P <.001). Coronary perforation occurred in 4 patients (3.9%) requiring covered stent implantation (without subsequent cardiac tamponade) and 2 patients (1.9%) had a stroke (one of which was a transient ischemic attack). During a median follow-up of 31 months, 3 (2.9%) patients died from cardiovascular causes and 13 (12.6%) required repeat target vessel revascularization. CONCLUSIONS Aorto-ostial occlusions represent a challenging subset for PCI. However, an acceptable success rate with favorable outcomes during follow-up can be achieved by experienced operators. The presence of interventional collaterals allowing the use of the retrograde approach is key for achieving procedural success.
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Affiliation(s)
- Soledad Ojeda
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
| | - Aurora Luque
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Manuel Pan
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Barbara Bellini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Iosif Xenogiannis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, United States
| | - Adrián Lostalo
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Matteo Montorfano
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francisco Hidalgo
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Giuseppe Venuti
- Division of Cardiology, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Alessio La Manna
- Division of Cardiology, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, United States
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy; Cardiac Catheterization Laboratory, The Mount Sinai Hospital, New York, NY, United States
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16
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Higuchi S, Miura Y, Nishina Y, Koyama K, Kongoji K, Matsushita K, Soejima K. Successful contemporary reverse controlled antegrade and retrograde subintimal tracking without contrast medium: a case report. J Med Case Rep 2018; 12:390. [PMID: 30587222 PMCID: PMC6307242 DOI: 10.1186/s13256-018-1918-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 11/07/2018] [Indexed: 11/26/2022] Open
Abstract
Background Contrast-induced acute kidney injury is one of the common adverse events related to percutaneous coronary intervention and a predictor for worse outcome. In the setting of percutaneous coronary intervention for chronic total occlusion, large amounts of contrast medium, more than 200–400 mL, are generally injected. A higher dose of contrast medium causes contrast-induced acute kidney injury more frequently. Therefore, patients who undergo chronic total occlusion-percutaneous coronary intervention are at risk for contrast-induced acute kidney injury. Case presentation We present the case of a 77-year-old Japanese man with post-acute myocardial infarction angina pectoris, heart failure, and chronic kidney disease who underwent percutaneous coronary intervention for chronic total occlusion in his right coronary artery. In the procedure, the retrograde wire was a visible penetration mark that made contrast medium unnecessary. Contemporary reverse controlled antegrade and retrograde subintimal tracking was successfully achieved and stents were implanted without contrast medium. Contrast medium was injected two times after stent implantation to confirm coronary flow and no perforation. The total amount of contrast medium was only 8 mL for chronic total occlusion-percutaneous coronary intervention. Conclusion Chronic total occlusion-percutaneous coronary intervention with contemporary reverse controlled antegrade and retrograde subintimal tracking without contrast medium may be safe and feasible in selected patients. Electronic supplementary material The online version of this article (10.1186/s13256-018-1918-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Satoshi Higuchi
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-0004, Japan.
| | - Yusuke Miura
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-0004, Japan
| | - Yoshio Nishina
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-0004, Japan
| | - Kohei Koyama
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-0004, Japan
| | - Ken Kongoji
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-0004, Japan
| | - Kenichi Matsushita
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-0004, Japan
| | - Kyoko Soejima
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-0004, Japan
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17
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Dash D. A step-by-step guide to mastering retrograde coronary chronic total occlusion intervention in 2018: The author's perspective. Indian Heart J 2018; 70 Suppl 3:S446-S455. [PMID: 30595306 PMCID: PMC6310897 DOI: 10.1016/j.ihj.2018.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022] Open
Abstract
Chronic total occlusion remains one of the most challenging subsets and represents the "last frontier" of percutaneous coronary intervention. Retrograde recanalization is one of the most significant amendments of the technique and has become an important complement to the classical antegrade approach. It yields a high success rate even in most complex patients. With emergence of important iterations, this approach has become safer, faster, and more successful. The author proposes a step-by-step guide to the retrograde approach with alternatives to various steps for operators wishing to embark on this strategy.
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Affiliation(s)
- Debabrata Dash
- Thumbay Hospital, Ajman, United Arab Emirates; Beijing Tiantan Hospital, Beijing, China.
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18
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Tanabe G, Oikawa Y, Yajima J, Matsuno S, Kano H, Yamashita T. Retrograde parallel wire technique using a dual lumen catheter can be useful for percutaneous coronary intervention with chronic total occlusion. J Cardiol Cases 2018; 17:25-28. [PMID: 30279847 DOI: 10.1016/j.jccase.2017.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/19/2017] [Accepted: 08/24/2017] [Indexed: 11/29/2022] Open
Abstract
The patient was a 61-year-old male with chronic total occlusion (CTO) of the right coronary artery (RCA). We performed percutaneous coronary intervention (PCI) to RCA-CTO with the bidirectional approach via the left anterior descending artery. In retrograde approach, the first wire entered the false lumen at the segment of severe stenosis of the CTO distal site. We performed parallel wire technique using a dual lumen catheter to avoid branch loss and succeeded to get the proximal true lumen through the second wire. When the first wire enters the false lumen, continued advancement of this wire easily should be avoided as it can collapse the true lumen and make reentry difficult. On top of that, in retrograde approach, it is difficult to perform parallel wire technique without using a dual lumen catheter. This case reveals that retrograde parallel wire technique using a dual lumen catheter is an extremely effective strategy to treat CTO. <Learning objective: The dual lumen catheter is one of the most helpful devices. However, in the field of percutaneous coronary intervention for chronic total occlusion (CTO-PCI), especially retrograde approach, the usage of them has not been established. Retrograde parallel wire technique using a dual lumen catheter may be useful for CTO-PCI.>.
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Affiliation(s)
- Gen Tanabe
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Junji Yajima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Hiroto Kano
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
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Yeshwant SC, Tsai MH, Jones BR, Hamlin MP, Bensimhon AD, Lustgarten DL. Iatrogenic type A aortic dissection during idiopathic ventricular tachycardia ablation. HeartRhythm Case Rep 2017; 3:396-399. [PMID: 28840108 PMCID: PMC5558166 DOI: 10.1016/j.hrcr.2017.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Srinath C Yeshwant
- Department of Internal Medicine, Division of Cardiology, University of Vermont College of Medicine, Burlington, Vermont
| | - Mitchell H Tsai
- Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont.,Department of Orthopaedics and Rehabilitation (by courtesy), University of Vermont College of Medicine, Burlington, Vermont
| | - Bradley R Jones
- Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont
| | - Mark P Hamlin
- Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont.,Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont
| | - Ariel D Bensimhon
- Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont
| | - Daniel L Lustgarten
- Department of Internal Medicine, Division of Cardiology, University of Vermont College of Medicine, Burlington, Vermont
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Raskin D, Khaitovich B, Balan S, Silverberg D, Halak M, Rimon U. The Aortic Bifurcation Angle as a Factor in Application of the Outback for Femoropopliteal Lesions in Ipsilateral Versus Contralateral Approaches. Cardiovasc Intervent Radiol 2018; 41:37-42. [PMID: 28762154 DOI: 10.1007/s00270-017-1761-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the technical success of the Outback reentry device in contralateral versus ipsilateral approaches for femoropopliteal arterial occlusion. MATERIALS AND METHODS A retrospective review of patients treated for critical limb ischemia (CLI) using the Outback between January 2013 and July 2016 was performed. Age, gender, length and site of the occlusion, approach site, aortic bifurcation angle, and reentry site were recorded. Calcification score was assigned at both aortic bifurcation and reentry site. Technical success was assessed. RESULTS During the study period, a total of 1300 endovascular procedures were performed on 489 patients for CLI. The Outback was applied on 50 femoropopliteal chronic total occlusions. Thirty-nine contralateral and 11 ipsilateral antegrade femoral were accessed. The device was used successfully in 41 patients (82%). There were nine failures, all in the contralateral approach group. Six due to inability to deliver the device due to acute aortic bifurcation angle and three due to failure to achieve luminal reentry. Procedural success was significantly affected by the aortic bifurcation angle (p = 0.013). CONCLUSION The Outback has high technical success rates in treatment of femoropopliteal occlusion, when applied from either an ipsi- or contralateral approach. When applied in contralateral access, acute aortic bifurcation angle predicts procedural failure.
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Hatano M, Ito M, Sugimoto H, Noda M, Hasegawa H, Yoshizaki T. Soft-wall reconstruction of the canal wall with retrograde bone work for pediatric cholesteatoma: Long-term results. Int J Pediatr Otorhinolaryngol 2016; 91:159-165. [PMID: 27863632 DOI: 10.1016/j.ijporl.2016.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/22/2016] [Accepted: 10/24/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To retrospectively evaluate the long-term results of surgery for retrograde bone work, using soft-wall reconstruction of the canal wall, for pediatric cholesteatoma. METHODS We retrospectively evaluated a series of 25 consecutive ears of 24 patients who were ≤16 years of age. All children underwent cholesteatoma surgery between October 2002 and August 2008. The type of cholesteatoma, the length of follow-up, the incidence of residual and recurrent cholesteatoma, postoperative hearing results, and the form of the reconstructed external canal wall and tympanic membrane were assessed. RESULTS There were 21 males and 3 females. The procedure was performed on both ears of one patient who had bilateral congenital cholesteatoma (CC). At the initial surgery, 16 cases (64%) had CC and nine (36%) had acquired cholesteatoma (AC). The mean age at surgery was 8.2 years and 10.4 years for CC and AC cases, respectively. The mean postoperative follow-up period after the initial surgery was 90 months for CC cases and 108 months for AC cases. Cholesteatoma recurrence occurred for 6% and 56% of cases with CC and AC, respectively. Successful serviceable hearing was achieved for 93.8% with CC and 100% with AC. Cases with inadequate hearing after surgery were characterized by disease extension to the mastoid and the protympanum. The long-term forms of the reconstructed external canal wall changed depending on their middle ear aeration. Some cases of tympanic membrane perforation and otitis media with effusion were occurred during the follow-up period. CONCLUSION Overall, the retrograde approach with soft-wall reconstruction of the canal wall achieved a low recurrence rate for cholesteatoma and good hearing outcomes during long-term follow-up for the pediatric case. However, in cases with eustachian tube dysfunction and/or cholesteatoma involving the protympanum, the hearing outcomes were less favorable.
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Affiliation(s)
- Miyako Hatano
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Makoto Ito
- Department of Pediatric Otolaryngology, Jichi Medical University, Tochigi Pediatric Medical Center, Tochigi, Japan
| | - Hisashi Sugimoto
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masao Noda
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroki Hasegawa
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tomokazu Yoshizaki
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
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22
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Konstantinidis NV, Sofidis G, Kolettas V, Karvounis H, Sianos G. Bifurcation CTO recanalization with contemporary antegrade and retrograde techniques in a patient with two chronically occluded coronary arteries. Hellenic J Cardiol 2016; 57:371-374. [DOI: 10.1016/j.hjc.2016.11.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 09/01/2016] [Indexed: 10/20/2022] Open
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23
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Dash D. Deja Vu of retrograde recanalization of coronary chronic total occlusion: A tale of a journey from Japan to India. Indian Heart J 2016; 68:584-5. [PMID: 27543488 DOI: 10.1016/j.ihj.2016.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 12/02/2022] Open
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Gasparini GL, Oreglia JA, Reimers B. A case of retrograde left main primary percutaneous coronary intervention during cardiogenic shock: The added value of performing coronary chronic total occlusion procedures. Int J Cardiol 2016; 215:396-8. [PMID: 27128569 DOI: 10.1016/j.ijcard.2016.03.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/20/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Gabriele L Gasparini
- Department of Invasive Cardiology, Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Jacopo A Oreglia
- Department of Invasive Cardiology, Luigi Sacco Hospital, Milan, Italy
| | - Bernhard Reimers
- Department of Invasive Cardiology, Humanitas Research Hospital, Rozzano, Milan, Italy
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25
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Talanas G, Garbo R. Importance of IVUS in the treatment with retrograde approach of a long in-stent chronic total occlusion of ostial right coronary artery: A case report. Cardiovasc Revasc Med 2016; 18:58-62. [PMID: 27387864 DOI: 10.1016/j.carrev.2016.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/16/2016] [Accepted: 05/31/2016] [Indexed: 11/19/2022]
Abstract
A 43year-old male, with a long history of coronary artery disease, was electively admitted to our institution because of dyspnea for moderate physical efforts (NYHA 2) related to an in-stent chronic total occlusion of ostial RCA and with demonstration of a significant area of inducible myocardial ischemia at stress echocardiography. After a gentle attempt of antegrade approach, the in-stent CTO of ostial RCA was successfully reopened with a retrograde approach using a knuckle technique. After IVUS evaluation which showed that the course of the retrograde guidewire was mostly within the stent strut circumference with the exception of the ostial RCA where the guidewire past between the stent and the vessel wall, implantation of 4 drug-eluting stent was performed from mid to ostial RCA with a good final result. The hospital stay was uneventful. At 6months clinical follow-up the patient was in good clinical condition. We discuss some aspects related to procedural technique, the importance of IVUS evaluation in the treatment of this patient.
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Affiliation(s)
- Giuseppe Talanas
- Division of Cardiology-Catheterization Laboratory, SS. Annunziata Hospital of Sassari, Sassari, Italy.
| | - Roberto Garbo
- Interventional Cardiology Unit, San Giovanni Bosco Hospital of Torino, Torino, Italy
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26
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Dash D. Guidewire crossing techniques in coronary chronic total occlusion intervention: A to Z. Indian Heart J 2016; 68:410-20. [PMID: 27316507 PMCID: PMC4912030 DOI: 10.1016/j.ihj.2016.02.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 01/29/2016] [Accepted: 02/24/2016] [Indexed: 11/18/2022] Open
Abstract
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) poses a management dilemma for the interventional cardiologist. Effective wiring technique is the key to success of PCI in CTO, which requires more patience and skill of the operator. The author herein intends to explore in detail the different wiring strategies such as antegrade approach, dissection and reentry, retrograde and hybrid approach. Hopefully, this review would enhance the understanding of this complex procedure and, consequently, promote safe and effective PCI.
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Affiliation(s)
- Debabrata Dash
- Interventional Cardiologist, S. L Raheja (A Fortis Associate) Hospital, Nanavati Superspeciality Hospital, Mumbai, India(1); Guest Professor of Cardiology, Beijing Tiantan Hospital, Beijing, China.
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27
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Vamsidhar A, Rajasekhar D, Vanajakshamma V. Transcatheter device closure of multiple defects in ruptured sinus of Valsalva aneurysm. Indian Heart J 2015; 67 Suppl 3:S74-7. [PMID: 26995440 DOI: 10.1016/j.ihj.2015.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 06/16/2015] [Indexed: 11/27/2022] Open
Abstract
Ruptured sinus of Valsalva aneurysm (SOVA) with multiple communications, ventricular septal defect, and aortic regurgitation are still best treated surgically. We report a case of 30-year-old male with right SOVA, with two communications with right ventricle. Both communications were successfully closed using antegrade and retrograde approaches, respectively.
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28
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Liu H, Yao K, Huang D, Qian J, Ge J. Retrograde percutaneous coronary intervention of native right coronary artery chronic total occlusion via left internal mammary artery graft. Int J Cardiol 2016; 205:86-88. [PMID: 26723006 DOI: 10.1016/j.ijcard.2015.11.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Haibo Liu
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China; Department of Cardiology, Yinzhou People's Hospital Affiliated with the Medical School of Ningbo University, 315040 Ningbo, PR China
| | - Kang Yao
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Dong Huang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Juying Qian
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China.
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China.
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29
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Miralles M, Candela E, Blanes E, Ribé L. Reverse Retrograde Approach: An Alternative Method for Ipsilateral Access to the Superficial Femoral Artery. EJVES Short Rep 2016; 30:7-9. [PMID: 28856293 PMCID: PMC5573112 DOI: 10.1016/j.ejvssr.2015.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 12/05/2015] [Accepted: 12/15/2015] [Indexed: 11/26/2022] Open
Abstract
Access for endovascular treatment of the superficial femoral artery (SFA) is usually gained through an antegrade approach from the ipsilateral common femoral artery (CFA), or by crossing over from the contralateral CFA. In this technical note, an alternative method, based on retrograde access of the ipsilateral iliac artery (IA), and conversion into an antegrade approach to the SFA, is described. Successful reverse ipsilateral catheterisation was obtained in 15/16 patients. Calcification of the CFA and IA required a crossover approach in one case. There were no complications related to the technique, except for moderate bleeding in relation to the deployment of a closure device.
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Affiliation(s)
- M Miralles
- Hospital Universitari I Politècnic La Fe, Department of Vascular Surgery, Bulevar Sur s/n, 46026 Valencia, Spain
| | - E Candela
- Hospital Universitari I Politècnic La Fe, Department of Vascular Surgery, Bulevar Sur s/n, 46026 Valencia, Spain
| | - E Blanes
- Hospital Universitari I Politècnic La Fe, Department of Vascular Surgery, Bulevar Sur s/n, 46026 Valencia, Spain
| | - L Ribé
- Hospital Universitari I Politècnic La Fe, Department of Vascular Surgery, Bulevar Sur s/n, 46026 Valencia, Spain
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30
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Yu HP, Huang CH, Hou SM, Hsiung MC, Tsai SK, Yin WH. Percutaneous transcatheter closure of mitral paravalvular leak via transarterial retrograde approach. J Geriatr Cardiol 2015; 12:683-6. [PMID: 26788047 DOI: 10.11909/j.issn.1671-5411.2015.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Repeat surgery has usually been considered the first choice to solve paravalvular leaks of prosthetic valves, but it carries a high operative risk, a high mortality rate and an increased risk for re-leaks. Percutaneous closure of such defects is possible, and different approaches and devices are used for this purpose. For mitral paravalvular leaks, constructing an arterio-venous wire loop for delivering the closure device through an antegrade approach is the most commonly used technique. Transcatheter closure can also be performed through a transapical approach or retrograde transfemoral arterial approach. We present a case of 68-year-old man with a mitral paravalvular leak that was successfully closed using an Amplatzer® Duct Occluder II, via retrograde transfemoral arterial approach under three-dimensional transesophageal echocardiographic guidance, without the use of a wire loop. The initial attempt to cross the paravalvular defect was unsuccessful, but the obstacle was finally overcome by introducing complex interventional techniques.
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31
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Saravana K, Tan YK, Kum S, Tang TY. The open retrograde approach as an alternative for failed percutaneous access for difficult below the knee chronic total occlusions-A case series. Int J Surg Case Rep 2015; 16:93-8. [PMID: 26439418 PMCID: PMC4643352 DOI: 10.1016/j.ijscr.2015.08.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 08/29/2015] [Indexed: 11/07/2022] Open
Abstract
Retrograde puncture via patent pedal vessels can be attempted in failed antegrade approach for infrapopliteal long chronic total occlusion. However in cases where the pedal vessels are unable to be visualized via duplex ultrasonography or fluoroscopy an open approach offers an additional option to a vascular surgeon for successful recanalization. Our case report highlights 3 cases where successful hybrid open retrograde approach was able to achieve recanalization of long chronic total occlusion. Presentation of cases The three cases in our series presented with critical limb ischaemia. All three cases had undergone duplex imaging of the affected arterial system. As the antegrade approach to cross the lesion failed a retrograde approach was attempted in all 3 cases. However when the usual modality of retrograde puncture via the use of ultrasound or fluoroscopy failed we proceeded with an open approach. Discussion Retrograde approach usually offers a better chance of successfully crossing a chronic total occlusion lesion. However puncturing a distal vessel successfully and traversing a catheter or guidewire across proves to be a challenge. An open approach offers an additional pathway for puncturing the target vessel when duplex imaging or fluoroscopic guidance fails. Conclusion Open approach is usually attempted as a last resort by many endovascular surgeons. However procedural time, contrast and radiation usage could have been cut short in cases where the distal target vessels pose a technical challenge for approach via a percutaneous method.
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Affiliation(s)
- K Saravana
- Vascular Unit, Changi General Hospital, Singapore.
| | - Y K Tan
- Vascular Unit, Changi General Hospital, Singapore
| | - S Kum
- Vascular Unit, Changi General Hospital, Singapore
| | - T Y Tang
- Vascular Unit, Changi General Hospital, Singapore
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Patel AN, Mittal S, Turan G, Winters AA, Henry TD, Ince H, Trehan N. REVIVE Trial: Retrograde Delivery of Autologous Bone Marrow in Patients With Heart Failure. Stem Cells Transl Med 2015. [PMID: 26217065 DOI: 10.5966/sctm.2015-0070] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
UNLABELLED Cell therapy is an evolving option for patients with end-stage heart failure and ongoing symptoms despite optimal medical therapy. Our goal was to evaluate retrograde bone marrow cell delivery in patients with either ischemic heart failure (IHF) or nonischemic heart failure (NIHF). This was a prospective randomized, multicenter, open-label study of the safety and feasibility of bone marrow aspirate concentrate (BMAC) infused retrograde into the coronary sinus. Sixty patients were stratified by IHF and NIHF and randomized to receive either BMAC infusion or control (standard heart failure care) in a 4:1 ratio. Accordingly, 24 subjects were randomized to the ischemic BMAC group and 6 to the ischemic control group. Similarly, 24 subjects were randomized to the nonischemic BMAC group and 6 to the nonischemic control group. All 60 patients were successfully enrolled in the study. The treatment groups received BMAC infusion without complications. The left ventricular ejection fraction in the patients receiving BMAC demonstrated significant improvement compared with baseline, from 25.1% at screening to 31.1% at 12 months (p=.007) in the NIHF group and from 26.3% to 31.1% in the IHF group (p=.035). The end-systolic diameter decreased significantly in the nonischemic BMAC group from 55.6 to 50.9 mm (p=.020). Retrograde BMAC delivery is safe. All patients receiving BMAC experienced improvements in left ventricular ejection fraction, but only those with NIHF showed improvements in left ventricular end-systolic diameter and B-type natriuretic peptide. These results provide the basis for a larger clinical trial in HF patients. SIGNIFICANCE This work is the first prospective randomized clinical trial using high-dose cell therapy delivered via a retrograde coronary sinus infusion in patients with heart failure. This was a multinational, multicenter study, and it is novel, translatable, and scalable. On the basis of this trial and the safety of retrograde coronary sinus infusion, there are three other trials under way using this route of delivery.
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Affiliation(s)
- Amit N Patel
- University of Utah, Salt Lake City, Utah, USA; Heart Institute, Medanta MediCity, Gurgoan, India; Department of Cardiology, Rostock University Hospital, Rostock, Germany; Cedars-Sinai Heart Institute, Los Angeles, California, USA; Vivantes Klinikum, Berlin, Germany
| | - Sanjay Mittal
- University of Utah, Salt Lake City, Utah, USA; Heart Institute, Medanta MediCity, Gurgoan, India; Department of Cardiology, Rostock University Hospital, Rostock, Germany; Cedars-Sinai Heart Institute, Los Angeles, California, USA; Vivantes Klinikum, Berlin, Germany
| | - Goekmen Turan
- University of Utah, Salt Lake City, Utah, USA; Heart Institute, Medanta MediCity, Gurgoan, India; Department of Cardiology, Rostock University Hospital, Rostock, Germany; Cedars-Sinai Heart Institute, Los Angeles, California, USA; Vivantes Klinikum, Berlin, Germany
| | - Amalia A Winters
- University of Utah, Salt Lake City, Utah, USA; Heart Institute, Medanta MediCity, Gurgoan, India; Department of Cardiology, Rostock University Hospital, Rostock, Germany; Cedars-Sinai Heart Institute, Los Angeles, California, USA; Vivantes Klinikum, Berlin, Germany
| | - Timothy D Henry
- University of Utah, Salt Lake City, Utah, USA; Heart Institute, Medanta MediCity, Gurgoan, India; Department of Cardiology, Rostock University Hospital, Rostock, Germany; Cedars-Sinai Heart Institute, Los Angeles, California, USA; Vivantes Klinikum, Berlin, Germany
| | - Hueseyin Ince
- University of Utah, Salt Lake City, Utah, USA; Heart Institute, Medanta MediCity, Gurgoan, India; Department of Cardiology, Rostock University Hospital, Rostock, Germany; Cedars-Sinai Heart Institute, Los Angeles, California, USA; Vivantes Klinikum, Berlin, Germany
| | - Naresh Trehan
- University of Utah, Salt Lake City, Utah, USA; Heart Institute, Medanta MediCity, Gurgoan, India; Department of Cardiology, Rostock University Hospital, Rostock, Germany; Cedars-Sinai Heart Institute, Los Angeles, California, USA; Vivantes Klinikum, Berlin, Germany
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33
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Ntatsios A, Smith WHT. Exit of CrossBoss between stent struts within chronic total occlusion to subintimal space: Completion of case via retrograde approach with rendezvous in coronary. J Cardiol Cases 2014; 9:183-186. [PMID: 30534320 DOI: 10.1016/j.jccase.2014.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/24/2013] [Accepted: 01/02/2014] [Indexed: 11/24/2022] Open
Abstract
We present a case of successful percutaneous revascularization of a chronic total coronary occlusion due to in-stent restenosis. The CrossBoss catheter (BridgePoint Medical, Minneapolis, MN, USA) was used initially because it is reported to be effective in this setting with a low risk of exiting occluded stents. To the best of our knowledge, this is the first reported case of a CrossBoss penetrating through stent struts into the subintimal space. The case was completed via the retrograde approach with 'rendezvous in coronary'. <Learning objective: Recognize the potential of the CrossBoss catheter to exit between stent struts within chronic total occlusions. Appreciate the need to check the position of the CrossBoss catheter with respect to stents within a chronic total occlusion. Identify the potential for 'rendezvous in coronary' within the subintimal space with the CrossBoss catheter and a retrograde guidewire.>.
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Affiliation(s)
- Antonios Ntatsios
- Department of Cardiology, Trent Cardiac Centre, City Campus, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - William Howard Thornton Smith
- Department of Cardiology, Trent Cardiac Centre, City Campus, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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