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Zhang S, Hu G, Zhang B, Li Y, Li B, Liu Z, Ma P, Qiu Y, Xu Q. Successful true cavity pathfinding with balloon assisted CTO with bifurcation lesions: Two case reports. Medicine (Baltimore) 2024; 103:e37404. [PMID: 38552077 PMCID: PMC10977579 DOI: 10.1097/md.0000000000037404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/07/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Coronary artery disease is a prevalent global cardiovascular ailment, with percutaneous coronary intervention (PCI) standing out as a crucial method for relieving symptoms and enhancing the quality of life in patients with coronary heart disease. However, the presence of concurrent chronic total occlusion (CTO) and bifurcation lesions within coronary arteries elevates the complexity and treatment risks, especially when the entry point of the CTO is ambiguous. OBJECTIVE This study aims to present an innovative approach for treating CTO complicated with bifurcation lesions, focusing on true cavity pathfinding assisted by a balloon. METHODS Two cases of CTO patients with concomitant bifurcation lesions are described. One case involves CTO of the left anterior descending artery) combined with anterior non-angle trigeminal lesions, while the other entails CTO of the posterior left artery combined with posterior angle trigeminal lesions. True lumen identification using a balloon and subsequent opening of the CTO blood vessel were performed in both cases. RESULTS In both cases, the true lumen was successfully located with the assistance of a balloon, leading to the successful opening of the CTO blood vessel. This approach not only simplified the procedure but also reduced procedural difficulty and associated risks of complications compared to traditional guide wire operations. CONCLUSION The application of true cavity pathfinding assisted by a balloon offers a novel and effective strategy for managing CTO complicated with bifurcation lesions. The method simplifies the procedure, decreases procedural difficulty, and lowers the risk of complications associated with guide wire operations. However, further studies and long-term follow-up data are warranted to validate the reliability and long-term efficacy of this innovative approach.
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Affiliation(s)
- Shichang Zhang
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Guangxin Hu
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Botao Zhang
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yinping Li
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ben Li
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhijun Liu
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ping Ma
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yumin Qiu
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Qingbin Xu
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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Ungureanu C, Cocoi M, Colletti G, Avran A. Successful treatment by recross IVUS-guided reentry in coronary total occlusion: STRIVE-CTO. Catheter Cardiovasc Interv 2024; 103:68-79. [PMID: 37971155 DOI: 10.1002/ccd.30904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/14/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
Complex coronary total occlusion (CTO) lesions percutaneous treatment, especially in contexts where traditional antegrade strategies have failed and retrograde approaches are unsuitable, due to lack of interventional collaterals or high risk of complications, presents a considerable challenge for interventional cardiologists. Antegrade dissection reentry has historically offered a bailout strategy in cases with unsuccessful antegrade wire escalation. Nevertheless, the technique-whether employing dual-lumen microcatheters or dedicated reentry devices, such as Stingray-encounters several limitations, particularly when the delivery of the system is not possible, or extraplaque large hematomas, which complicates reentry. This paper introduces an innovative technique combining the use of the Recross MC Dual Microcatheter with real-time intravascular ultrasound guidance for refined re-wiring in CTO interventions. This approach facilitates accurate reentry zone selection and ensures precise, controlled puncturing into the true lumen, thereby enabling safe and predictable CTO recanalization.
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Affiliation(s)
| | - Mihai Cocoi
- Department of Cardiovascular, Institutul Inimii, Cluj, Romania
| | - Giuseppe Colletti
- Department of Cardiovascular, Clinique Saint Joseph, Vivalia, Arlon, Belgium
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Wang T, Guan H, Tian T, Guan C, Bai Y, Hu Y, Yuan J, Qiao S, Xu B, Yang W. Thirty-day and 5-year results of percutaneous coronary intervention for in-stent restenotic chronic total occlusion lesions: Data from 2,659 consecutive patients. Catheter Cardiovasc Interv 2021; 97 Suppl 2:1016-1024. [PMID: 33666337 DOI: 10.1002/ccd.29585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To investigate the procedure success rate and clinical outcomes of in-stent restenotic chronic total occlusion (ISR-CTO) percutaneous coronary intervention (PCI). BACKGROUND Few studies have reported the short- and long-term clinical outcomes of ISR-CTO PCI. METHOD Patients who underwent ISR-CTO (n = 212) or de-novo CTO (n = 2,447) PCI at Fuwai Hospital from 2010 to 2013 were enrolled. Thirty-day and 5-year clinical outcomes were analyzed. The primary outcome was the incidence of all-cause death, myocardial infarction (MI), and heart failure at follow-up. The secondary outcome was the recanalization result (reasonable, suboptimal, or failed recanalization). RESULTS ISR-CTO PCI had a higher rate of suboptimal recanalization than de-novo CTO PCI (p < .01). The syntax score before PCI (odds ratio (OR): 1.06; 95% confidence interval (CI): 1.02-1.10; p = .002) and occlusion length ≥ 20 mm (OR: 2.70:95% CI: 1.46-4.98; p = .001) were predictors of suboptimal recanalization in ISR-CTO PCI. Cardiac death (p = .03) and 30-day all-cause mortality (p = .05) were higher among patients who underwent ISR-CTO PCI. The ISR-CTO group had a higher rate of MI (p = .07) at 5 years. Suboptimal recanalization (hazard ratio: 2.56; 95% CI: 1.13-5.83; p = .025) was an independent predictor of long-term major adverse events in ISR-CTO. CONCLUSIONS Suboptimal recanalization, 30-day cardiac death, and long-term MI rates are higher for ISR-CTO PCI than de-novo CTO PCI. Suboptimal recanalization is an independent predictor of long-term major adverse events after ISR-CTO PCI.
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Affiliation(s)
- Tianjie Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Guan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Tian
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changdong Guan
- Department of Catheterization Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yinxiao Bai
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Hu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiansong Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Catheterization Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixian Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Intravascular Ultrasound in Chronic Total Occlusion Percutaneous Coronary Intervention: Solving Ambiguity and Improving Durability. Interv Cardiol Clin 2021; 10:75-85. [PMID: 33223109 DOI: 10.1016/j.iccl.2020.09.006] [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
Chronic total occlusions remain among the most technically challenging lesions to treat percutaneously. Limitations of 2-dimensional angiography may further hinder successful treatment of these lesions. Intrasvascular ultrasound has a key role in percutaneous recanalization for a chronic total occlusion by providing key lesion characteristics, facilitating guidewire crossing, elucidating the intraplaque or extralaque path of the guidewire, optimizing lesion preparation, guiding stenting and identifying suboptimal results. Live visualization of the guidewire during crossing may reduce extraplaque wire tracking. This review describes the practical uses of intravascular imaging for commonly encountered scenarios when treating chronic total occlusions.
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Factors associated with antegrade true-sub-true phenomenon in percutaneous coronary intervention for chronic total occlusion. PLoS One 2020; 15:e0232158. [PMID: 32330197 PMCID: PMC7182222 DOI: 10.1371/journal.pone.0232158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background Recently, the importance of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) has been emphasized with greater success rates. In the antegrade wire based approach, it is generally considered that the guidewire would not advance from the subintimal space to the intimal space without dissection re-entry device. However, it is sometimes observed by intravascular ultrasound (IVUS) that the guidewire within the subintimal space advanced into the distal true lumen. The purpose of this study was to investigate specific conditions or characteristics which were associated with “antegrade true-sub-true” phenomenon in CTO-PCI. Methods We retrospectively reviewed consecutive 320 CTO lesions that underwent CTO-PCI in our institution. Among them, 16 lesions in which the IVUS confirmed the “antegrade true-sub-true” phenomenon were categorized as the true-sub-true group, whereas 27 lesions that resulted in unsuccessful CTO-PCI were categorized as the unsuccessful group. We compared the clinical, lesion, and procedural characteristics between the true-sub-true group and the unsuccessful group. Results The prevalence of bifurcation with abrupt type in CTO exit-sites was significantly higher in the true-sub-true group in comparison to the unsuccessful group (75.0% vs. 25.9%, p = 0.002). The multivariate logistic regression analysis revealed that bifurcation with abrupt type in CTO exit-site (OR 8.017; 95%CI: 1.484–43.304; p = 0.016) was independent predictor of the antegrade true-sub-true phenomenon. Conclusions In CTO-PCI, the antegrade true-sub-true phenomenon is rare, but can be a last chance for successful PCI. Bifurcation with abrupt type in CTO exit-site was significantly associated with the antegrade true-sub-true phenomenon.
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Okamura A, Iwakura K, Iwamoto M, Nagai H, Sumiyoshi A, Tanaka K, Tanaka T, Inoue K, Koyama Y, Fujii K. Tip Detection Method Using the New IVUS Facilitates the 3-Dimensional Wiring Technique for CTO Intervention. JACC Cardiovasc Interv 2020; 13:74-82. [DOI: 10.1016/j.jcin.2019.07.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/25/2019] [Accepted: 07/30/2019] [Indexed: 11/17/2022]
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Retrograde Approach for a Failed Antegrade PCI: Watch Out for the Back Door. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:86-90. [PMID: 31358398 DOI: 10.1016/j.carrev.2019.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 11/20/2022]
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Liao ZY, Lin SC. A Novel Strategy for Chronic Total Occlusion of the Stumpless Ostial Left Anterior Descending Artery. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:198-203. [PMID: 30765685 PMCID: PMC6698060 DOI: 10.12659/ajcr.913417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Despite improvements in percutaneous coronary intervention (PCI) devices and operator expertise, coronary chronic total occlusion (CTO) poses a management dilemma for interventional cardiologists. Occasionally, in CTO lesions and in bifurcation lesions with severe curvature and stenosis, wires cannot be introduced into the main artery, although wiring into the side branch is possible. We herein report a case of stumpless ostial left anterior descending artery (LAD) CTO that was successfully treated with a novel strategy. CASE REPORT A 64-year-old female with symptoms of heart failure was admitted to our hospital. Coronary angiography showed CTO of the stumpless ostial LAD. The patient had invisible and continuous collaterals; therefore, we used the antegrade approach for CTO access. However, the wire could be guided only in the direction of the diagonal branch due to a severe angulation at the CTO exit site, despite successful wire crossing into the CTO lesion. We attempted intravascular ultrasound-guided direct wire entry technique to obtain additional information about the occlusion cap location and to assist in negotiating the wire into the true lumen. The guidewire (Conquest pro) could cross the lesion after several approaches and successfully advance the device over the wire through the occluded segment after the modified See-saw wiring technique was employed. CONCLUSIONS This method appears to be a promising novel strategy for difficult and complex lesions when performing CTO revascularization.
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Affiliation(s)
- Zhen-Yu Liao
- Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Fu Jen Catholic University Ph.D. Program in Nutrition and Food Science, Taipei, Taiwan
| | - Shen-Chang Lin
- Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Xenogiannis I, Tajti P, Karmpaliotis D, Garbo R, Gagnor A, Burke MN, Brilakis ES. Intravascular Imaging for Chronic Total Occlusion Intervention. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9471-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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