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Garbo R, Arioti M, Leoncini M. Power Flush, a novel bail-out technique for stumpless aorto-ostial CTOs. A case-based approach. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 40S:282-287. [PMID: 35193832 DOI: 10.1016/j.carrev.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Aorto-ostial coronary artery flush chronic total occlusions are a challenging subset of lesion with peculiar characteristic: the near complete lack of guiding catheter support, the presence of a thicker layer of muscular fibers and a greater collagen and calcium content, responsible for balloon dilatation's resistance and greater recoil tendency. We introduce a novel bailout technique to overcome retrograde wire failure in accessing aorta, a variation of the Carlino technique which we named Power Flush. MATERIALS AND METHODS Power Flush consists in a forceful injection of contrast dye directly through the guiding catheter positioned against the aortic wall in correspondence to the coronary ostium location, to gain access to the extra-plaque space and proceed with the vessel's recanalization. In one case we used a further iteration named Nick And Flush, in which a preliminary nicking of the aortic wall with a penetrative wire was done before the Power Flush. RESULTS We hereby present three cases of aorto-ostial right coronary artery flush chronic total occlusions. In two of them we utilized the Power Flush technique, in one case we employed its variant Nick And Flush. We were successful in all cases and no complication occurred. CONCLUSIONS In this kind of lesions Power Flush and Nick And Flush are effective bailout techniques to overcome retrograde wire failure to reach aorta.
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Affiliation(s)
- Roberto Garbo
- Maria Pia Hospital - GVM, Strada Comunale di Mongreno 180, 10132 Turin, TO, Italy
| | - Manfredi Arioti
- SSD Cardiologia Interventistica, Ospedale di Sanremo. Via G. Borea 56, 18038 Sanremo, IM, Italy
| | - Massimo Leoncini
- SSD Cardiologia Interventistica, Ospedale di Sanremo. Via G. Borea 56, 18038 Sanremo, IM, Italy.
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2
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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. Impacto de la adherencia a un algoritmo híbrido para la selección de la estrategia inicial de cruce en la intervención coronaria percutánea de oclusiones crónicas. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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3
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Rathore S, Khanra D, Galassi AR, Boukhris M, Tsuchikane E, Dens J, Mashayekhi K, Grantham JA, Brilakis ES, Karmpaliotis D, Werner GS. Procedural characteristics and outcomes following chronic total occlusion coronary intervention: pooled analysis from 5 registries. Expert Rev Cardiovasc Ther 2021; 19:929-938. [PMID: 34714700 DOI: 10.1080/14779072.2021.1997590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recent improvements in clinical skills, technology, and hardware have resulted in improved success rates with chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We performed a study level pooled analysis from the five largest registries of percutaneous coronary intervention (PCI) of CTO. RESEARCH DESIGN AND METHODS We conducted pooled analysis of 9500 patients in registries and data on procedural characteristics, technical success, and MACCE was collected. RESULTS A total of 9500 patients were included in the analysis. Mean age was 65.4 years with previous CABG in 24.8%, reattempt procedure in 24.8% and mean JCTO score was 2.2. Final wiring strategy in hybrid algorithm-based registries was AWE in 40.8-58%, Retrograde in 24-35%, ADR in 16-25% and in Expert JCTO and EURO CTO was AWE in 72-75% and retrograde in 25-28%. Technical success was achieved in 87.8%. In hospital MACCE was 2.5% (95% CI: 1.8- 3.4%), mortality 0.44% (95% CI: 0.23-0.84%), stroke 0.2% (95% CI: 0.1-0.3%); myocardial infraction 1.6% (95% CI: 1.1-2.2%); and cardiac tamponade 0.8% (95% CI: 0.5 to 1.3%). CONCLUSION CTO PCI is currently performed with high technical success rates and low complication rates in experienced hands utilizing various techniques.
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Affiliation(s)
- Sudhir Rathore
- Department Of Cardiology, Frimley Health NHS Foundation Trust, Surrey, UK
| | - Dibbendu Khanra
- Department Of Cardiology, New Cross Hospital, Wolverhampton, UK
| | | | | | - Etsuo Tsuchikane
- Department Of Cardiology, Toyohashi Heart Centre, Toyohashi, Japan
| | - Joseph Dens
- Department Of Cardiology, Ziekenhuis Oost-Limburg, Belgium
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - J Aaron Grantham
- Department Of Cardiology, University of Missouri Kansas City and Mid America Heart Institute, Kansas City, Missouri, USA
| | - Emmanouil S Brilakis
- Department Of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
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Aljabbary T, Katyukha A, Elbaz-Greener G, Gressmann K, Bagai A, Graham JJ, Vijayaraghavan R, Kalra S, Vo M, Wijeysundera HC. Overview of Contemporary Chronic Total Occlusion Percutaneous Coronary Intervention Techniques: A Narrative Systematic Review. CJC Open 2021; 3:1273-1281. [PMID: 34888507 PMCID: PMC8636234 DOI: 10.1016/j.cjco.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/31/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite the abundance of coronary chronic total occlusions (CTO) percutaneous coronary intervention (PCI) studies, the literature is not easy to digest for both general PCI operators and CTO PCI specialists because of the many varied terms used for approaches and inconsistency in terminology. This inconsistency makes it challenging to understand the advantages and disadvantages of these different approaches and, most importantly, their downstream clinical outcomes. Accordingly, we conducted a systematic review of all published studies on CTO PCI to describe techniques and algorithms used in the last decade to provide an overview on the efficacy and safety of contemporary CTO PCI techniques. METHODS We performed a comprehensive search of the PubMed, EMBASE, and the Cochrane library databases for manuscripts about PCI of CTOs. We included studies published between the years 2005 and 2019. We categorized studies into those using a single approach (antegrade, retrograde) and those with a prespecified algorithm (ie, hybrid approach). RESULTS Fifty-five observational studies including 28,907 patients who underwent CTO were included in this review. CTO PCI generally carries low risk of major procedural complications, with angiographic success rates being higher in studies that used an algorithmic vs single technical approach. CONCLUSIONS This systematic review highlights the wide variation in definitions and practices in CTO PCI and calls for standardization in terminology and practice.
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Affiliation(s)
- Talal Aljabbary
- Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Andriy Katyukha
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Akshay Bagai
- Terrence Donnelly Heart Center, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - John J. Graham
- Terrence Donnelly Heart Center, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | | | - Sanjog Kalra
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Minh Vo
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Harindra C. Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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5
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Lim DZ, Mitreski G, Maingard J, Kutaiba N, Hosking N, Jhamb A, Ranatunga D, Kok HK, Chandra RV, Brooks M, Barras C, Asadi H. The smart angiography suite. J Neurointerv Surg 2021; 14:neurintsurg-2021-017383. [PMID: 34266908 DOI: 10.1136/neurintsurg-2021-017383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Dee Zhen Lim
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Goran Mitreski
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Julian Maingard
- Department of Radiology, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Numan Kutaiba
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Nicole Hosking
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Ashu Jhamb
- Department of Radiology, St Vincent's Health, Fitzroy, Victoria, Australia
| | - Dinesh Ranatunga
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Hong Kuan Kok
- Department of Radiology, Northern Health, Epping, Victoria, Australia.,School of Medicine, Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Ronil V Chandra
- Department of Radiology, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mark Brooks
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia.,School of Medicine, Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Christen Barras
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Hamed Asadi
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia.,School of Medicine, Deakin University Faculty of Health, Burwood, Victoria, Australia
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6
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Fu M, Chang S, Ge L, Huang D, Yao K, Zhang F, Qin Q, Ma J, Qian J, Ge J. Reattempt Percutaneous Coronary Intervention of Chronic Total Occlusions after Prior Failures: A Single-Center Analysis of Strategies and Outcomes. J Interv Cardiol 2021; 2021:8835104. [PMID: 33935602 PMCID: PMC8079192 DOI: 10.1155/2021/8835104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 03/24/2021] [Accepted: 04/09/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The initial recanalization rate of coronary chronic total occlusions (CTOs) is >85% when performed by experienced operators, but only 10% of prior failed CTO patients receive reattempted recanalization. This retrospective study analyzed the success rate and strategies used in reattempt percutaneous coronary intervention (PCI) of CTOs after prior failures. METHODS Overall, 206 patients with 212 CTOs were enrolled. All patients with prior recanalization failures received reattempt PCIs from January 2015 to March 2019 at Zhongshan Hospital, Fudan University. Data on clinical factors (age, sex, comorbidities, left ventricular ejection fraction, history of cigarette usage, and revascularization), angiographic characteristics of CTOs (target lesion, Japanese Chronic Total Occlusion (J-CTO) score, the morphology of CTO lesions, and collateral channel scale), strategies (procedural approach and use of devices), and major adverse events were obtained and analyzed. RESULTS The mean age of enrolled patients was 60.96 ± 12.36 years, with a male predominance of 90.3%. Of the patients, 47.1% had a prior myocardial infarction and 70.4% underwent stent implantation previously, while the in-stent occlusion rate was 6.6%. CTOs were primarily localized in the left anterior descending artery (43.9%) and the right coronary artery (43.9%). 80.7% of lesions were classified as very difficult (J-CTO score ≥3), and the overall success rate was 81.1%. In multivariable regression analysis, J-CTO score, collateral channel scale, application of coronary multispiral computed tomography angiography, dual injection, intravascular ultrasound, active greeting technique, parallel wiring, and CTO morphology were predictors of recanalization success. There were no significant differences in rates of procedural complications between the final recanalization success and failure groups. CONCLUSIONS Recanalization of complex CTOs is associated with high success rate and low complication rates when performed by high-volume CTO operators and after multiple reattempts.
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Affiliation(s)
- Mingqiang Fu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Shufu Chang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Lei Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Dong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Kang Yao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Qing Qin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
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7
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Thompson CA. The Hybrid Approach and Its Variations for Chronic Total Occlusion Percutaneous Coronary Intervention. Interv Cardiol Clin 2020; 10:87-91. [PMID: 33223110 DOI: 10.1016/j.iccl.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Selected patients with coronary chronic total occlusion (CTO) benefit with respect to symptoms, quality of life, ischemia reduction, and potentially longevity among other benefits. CTO lesions tend to be the most technically challenging for practicing interventional cardiologists to deliver a successful and safe result and clinical experience for a given patient. The Hybrid algorithm for CTO percutaneous coronary intervention and the subsequent subalgorithms for focused technical challenges have a standardized process and provide a consistent platform for optimized patient care, medical education, and clinical investigation in patients challenged with total occlusion and complex coronary disease.
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Affiliation(s)
- Craig A Thompson
- Interventional Cardiology, NYU Langone Health System, New York City, NY, USA; Cardiac Catheterization Laboratories, NYU Langone Health System, New York City, NY, USA; Cardiac Catheterization Laboratories, NYU Langone-Tisch Hospital, New York City, NY, USA; New York University School of Medicine, New York City, NY, USA.
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8
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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] [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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Liu MJ, Chen CF, Gao XF, Liu XH, Xu YZ. In-hospital outcomes of chronic total occlusion percutaneous coronary intervention in patients with and without prior coronary artery bypass graft: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e19977. [PMID: 32501965 PMCID: PMC7306325 DOI: 10.1097/md.0000000000019977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/04/2020] [Accepted: 03/21/2020] [Indexed: 12/29/2022] Open
Abstract
The clinical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in prior coronary artery bypass graft (pCABG) patients have been investigated; however, the results are inconsistent.The present meta-analysis compared the clinical outcomes of CTO PCI in patients with and without prior CABG (nCABG). The endpoints included technical success, procedural success, all-cause mortality, myocardial infarction (MI), major bleeding, coronary perforation, pericardial tamponade, emergency CABG, and vascular access complication.A total of 7 studies comprising of 11099 patients were included in this meta-analysis. The results showed that compared to nCABG patents, pCABG patients were associated with lower technical success (82.3% versus 87.8%; OR, 0.60; 95% CI, 0.53-0.68; P < .00001; I = 0%) and procedural success (80.4% versus 86.2%; OR, 0.61; 95% CI, 0.53-0.70; P < .00001; I = 10%); a higher risk of all-cause mortality (OR, 2.95; 95% CI, 1.56-5.57; P = 0.0008; I = 0%), MI (OR, 2.30; 95% CI, 1.40-3.80; P = .001; I = 5%), and coronary perforation (OR, 2.16; 95% CI, 1.51-3.08; P < 0.0001; I = 52%). On the other hand, the risk of pericardial tamponade (OR, 0.42; 95% CI, 0.15-1.18; P = .10; I = 21%), major bleeding (OR, 1.51; 95% CI, 0.90-2.53; P = .11; I = 0%), vascular access complication (OR, 1.50; 95% CI, 0.93-2.41; P = .10; I = 0%), and emergency CABG (OR, 0.99; 95% CI, 0.25-3.91; P = .99; I = 0%) was similar in both groups.Compared to nCABG patients, pCABG patients had lower CTO PCI success rates, higher rates of in-hospital mortality, MI, and coronary perforation, and similar risk of pericardial tamponade and vascular complication rates.
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10
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The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry. JACC Cardiovasc Interv 2018; 11:1325-1335. [PMID: 29706508 DOI: 10.1016/j.jcin.2018.02.036] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/12/2018] [Accepted: 02/27/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to determine the techniques and outcomes of hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a diverse group of patients and operators on 2 continents. BACKGROUND CTO PCI has been evolving with constant improvement of equipment and techniques. METHODS Contemporary outcomes of CTO PCI were examined by analyzing the clinical, angiographic, and procedural characteristics of 3,122 CTO interventions performed in 3,055 patients at 20 centers in the United States, Europe, and Russia. RESULTS The mean age was 65 ± 10 years, and 85% of the patients were men, with high prevalence of diabetes (43%), prior myocardial infarction (46%), prior coronary artery bypass graft surgery (33%), and prior PCI (65%). The CTO target vessels were the right coronary artery (55%), left anterior descending coronary artery (24%), and left circumflex coronary artery (20%). The mean J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores were 2.4 ± 1.3 and 1.3 ± 1.0, respectively. The overall technical and procedural success rate was 87% and 85%, respectively, and the rate of in-hospital major complications was 3.0%. The final successful crossing strategy was antegrade wire escalation in 52.0%, retrograde in 27.1%, and antegrade dissection re-entry in 20.9%; >1 crossing strategy was required in 40.9%. Median contrast volume, air kerma radiation dose, and procedure and fluoroscopy time were 270 ml (interquartile range: 200 to 360 ml), 2.9 Gy (interquartile range: 1.7 to 4.7 Gy), 123 min (interquartile range: 81 to 188 min) and 47 min (interquartile range: 29 to 77 min), respectively. CONCLUSIONS CTO PCI is currently being performed with high success and acceptable complication rates among various experienced centers in the United States, Europe, and Russia. (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO]; NCT02061436).
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11
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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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12
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High Stakes: CTO-PCI in the Post-CABG Patient. Can J Cardiol 2018; 34:238-240. [PMID: 29475529 DOI: 10.1016/j.cjca.2017.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 11/21/2022] Open
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Brilakis ES, Krestyaninov O. Wanted: Expert operators for coronary chronic total occlusion interventions. Catheter Cardiovasc Interv 2018; 91:180-181. [PMID: 29405599 DOI: 10.1002/ccd.27513] [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] [Received: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 11/12/2022]
Abstract
Coronary chronic total occlusions can be recanalized by expert operators with high success and acceptable complication rates. Developing a procedural plan (using the hybrid or another algorithm) is critical for success. Live case demonstrations appear safe and can be of high educational value. The key factor for achieving good outcomes in chronic total occlusion interventions remains operator expertise. Development of more expert operators will improve the treatment options for this challenging group of lesions and patients.
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Affiliation(s)
- Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Oleg Krestyaninov
- Ministry of Health of Russian Federation, Meshalkin Siberian Federal Biomedical Research Center, Novosibirsk, Russian Federation
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