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Liang S, Bai Y, Zhang J, Wang A, Li J, Diao K, He Y. The added value of coronary CTA in chronic total occlusion percutaneous coronary intervention: a systematic review and meta-analysis. Eur Radiol 2024; 34:4041-4052. [PMID: 37951854 DOI: 10.1007/s00330-023-10341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES To systematically investigate and summarize the utility of coronary computed tomographic angiography (CCTA) in the management of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI). METHODS The authors searched the four databases between 2005 and 2023 for studies investigating the role of CCTA and invasive coronary angiograms (ICA) images when used as the pre-procedural tool for CTO-PCI. Efficacy and safety of CCTA in CTO-PCI treatment as a pre-procedural assessment tool was evaluated. RESULTS Forty-seven studies were finally chosen for this systematic review. CCTA had a high degree of agreement with ICA when applied for J-CTO scoring system. A J-CTO (Multicenter CTO Registry in Japan) score > 3, together with calcification, occlusion length ≥ 20 mm, blunt stump, and bending > 45° were shared imaging risk factors on both ICA and CCTA for technique failure and guidewire crossing over 30 min. Additionally, negative remodeling and multiple diseased vessel were significant indicators on CCTA. Although patients with pre-procedural CCTA showed a trend of higher success rate and easier guidewire crossing, and CCTA showed a slightly higher predictive accuracy for process success, no significant improvement in post-PCI major adverse cardiac events of using CCTA for assessment has been achieved. CONCLUSIONS CCTA is a safe and effective pre-operative tool of CTO-PCI. Except for the shared imaging risk factors with ICA for a hard CTO-PCI including calcification, occlusion length ≥ 20 mm, blunt stump, bending > 45°, and J-CTO score > 3, factors like negative remodeling and multiple diseased vessel were also recognized as significant pre-operative assessment indicators on CCTA. CLINICAL RELEVANCE STATEMENT A pre-procedural assessment based on coronary computed tomographic angiography has the potential to aid in the management of chronic total occlusion percutaneous coronary intervention. KEY POINTS • A coronary computed tomographic angiography-based pre-procedural assessment can help chronic total occlusion-percutaneous coronary intervention management. • The recognized high-risk features detected via coronary computed tomographic angiography and invasive coronary angiograms are comparable in detecting difficult lesions and chronic total occlusion-percutaneous coronary intervention failure. • Coronary computed tomographic angiography has an additional value to be a safe and effective pre-procedural assessment tool for chronic total occlusion-percutaneous coronary intervention.
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Affiliation(s)
- Shichu Liang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, Sichuan, China
| | - Yanlin Bai
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, Sichuan, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Aijie Wang
- Department of Radiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, Sichuan, China
| | - Jing Li
- Research Center of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyue Diao
- Department of Radiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, Sichuan, China.
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, Sichuan, China.
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Ricottini E, Coletti F, Nusca A, Cocco N, Corlianò A, Appetecchia A, Melfi R, Mangiacapra F, Gallo P, Rinaldi R, Grigioni F, Ussia GP. Coronary Chronic Total Occlusion Revascularization: When, Who and How? J Clin Med 2024; 13:1943. [PMID: 38610708 PMCID: PMC11012595 DOI: 10.3390/jcm13071943] [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: 02/27/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Coronary chronic total occlusions (CTO) are an increasingly frequent entity in clinical practice and represent a challenging percutaneous coronary intervention (PCI) scenario. Despite data from randomized trials that have not yet demonstrated a clear benefit of CTO recanalization, the widespread of CTO-PCI has substantially increased. The improvement in operators' techniques, equipment, and training programs has led to an improvement in the success rate and safety of these procedures, which will represent an important field of future development of PCI. The present review will summarize clinical outcomes and technical and safety issues of CTO revascularization with the aim to guide clinical daily cath-lab practice.
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Affiliation(s)
- Elisabetta Ricottini
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Federica Coletti
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Annunziata Nusca
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Nino Cocco
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Andrea Corlianò
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Alessandro Appetecchia
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Rosetta Melfi
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Fabio Mangiacapra
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Paolo Gallo
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Raffaele Rinaldi
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Francesco Grigioni
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Gian Paolo Ussia
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
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Cilia L, Megaly M, Davies R, Tehrani BN, Batchelor WB, Truesdell AG. A non-interventional cardiologist's guide to coronary chronic total occlusions. Front Cardiovasc Med 2024; 11:1350549. [PMID: 38380179 PMCID: PMC10876789 DOI: 10.3389/fcvm.2024.1350549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Coronary chronic total occlusions (CTO) are present in up to one-third of patients with coronary artery disease (CAD). It is thus essential for all clinical cardiologists to possess a basic awareness and understanding of CTOs, including optimal evaluation and management. While percutaneous coronary intervention (PCI) for CTO lesions has many similarities to non-CTO PCI, there are important considerations pertaining to pre-procedural evaluation, interventional techniques, procedural complications, and post-procedure management and follow-up unique to patients undergoing this highly specialized intervention. Distinct from other existing topical reviews, the current manuscript focuses on key knowledge relevant to non-interventional cardiologists.
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Affiliation(s)
- Lindsey Cilia
- Virginia Heart, Falls Church, VA, United States
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Michael Megaly
- Willis Knighton Medical Center, Shreveport, LA, United States
| | | | - Behnam N. Tehrani
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Wayne B. Batchelor
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Alexander G. Truesdell
- Virginia Heart, Falls Church, VA, United States
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
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4
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La Scala E, Peyre JP, Maupas E. Effect of preoperative coronary CT for planning of percutaneous coronary intervention for complex chronic total occlusion (CTS-C-CTOPCI): study protocol for an open-label randomised controlled trial. Trials 2023; 24:560. [PMID: 37644573 PMCID: PMC10463280 DOI: 10.1186/s13063-023-07458-y] [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: 03/21/2022] [Accepted: 06/13/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Treatment of chronic total occlusion (CTO) by percutaneous coronary intervention (PCI) is associated with the difficulty of guidewire manipulation through the occluded segment, particularly when there is hard tissue due to calcification. The purpose of this randomised controlled trial is to determine whether improved planning of CTO-PCI using coronary computed tomographic angiography (CCTA) (versus conventional angiography) increases success rates of wire crossing in ≤ 60 min in difficult cases. METHODS This is a randomised controlled open-label multi-centre trial in a superiority framework with 1:1 allocation ratio. Participants (n = 130) will be randomised into two groups: the study group who will receive standard of care with the addition of preoperative coronary computed tomographic angiography (CT group), and the control group that will receive standard of care (angiography group). The primary endpoint will be the rate of successful wire crossing in ≤ 60 min in complex CTO (J-CTO ≥ 2). Wire crossing will be considered successful if TIMI flow 3 is restored and residual stenosis is < 30%. The safety endpoint will be mortality due to the intervention or major adverse cardiac events (MACE). Secondary endpoints are success rates at any time; total time of PCI; time of wire crossing; rate of PCI complications; radiation levels during PCI; volume of iodine contrast medium administered; and cost of the PCI. DISCUSSION This randomised trial will provide insight into whether pre-procedural CCTA as opposed to conventional angiography for planning of CTO-PCI yield higher success rates of wire crossing in ≤ 60 min. Potential benefits of CCTA include shorter successful procedure times of CTO-PCI leading to less irradiation and contrast medium with lower complication rates. TRIAL REGISTRATION Clinical Trials.gov NCT04549896. Registered on December 21, 2021.
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Affiliation(s)
- Eugenio La Scala
- ELSAN Group, Polyclinique Les Fleurs, 332 avenue Frédéric Mistral, Ollioules, 83190, France.
| | - Jean-Pascal Peyre
- ELSAN Group, Clinique Rhône Durance, 1750 chemin du Lavarin, Avignon, 84000, France
| | - Eric Maupas
- ELSAN Group, Hôpital Privé Les Franciscaines, 3 Rue Jean Bouin, Nîmes, 30000, France
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Tsai TY, Kageyama S, Ramponi F, Narula J, Taylor C, Updegrove A, Garg S, Onuma Y, Serruys PW, Puskas J. Complex coronary artery disease revascularization planning with computed tomography and 3-dimensional hologram. JTCVS Tech 2023; 20:96-98. [PMID: 37555049 PMCID: PMC10405190 DOI: 10.1016/j.xjtc.2023.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Tsung-Ying Tsai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Shigetaka Kageyama
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Fabio Ramponi
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY
| | - Jagat Narula
- The University of Texas Health Science Center at Houston, Houston, Tex
| | | | | | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
- Department of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Yoshinobu Onuma
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Patrick W. Serruys
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY
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6
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Mashayekhi KA, Pyxaras SA, Werner GS, Galassi AR, Garbo R, Boudou N, Leibundgut G, Avran A, Bryniarski L, Bufe A, Sianos G, Di Mario C. Contemporary issues of percutaneous coronary intervention in heavily calcified chronic total occlusions: an expert review from the European CTO Club. EUROINTERVENTION 2023; 19:e113-e122. [PMID: 36971414 PMCID: PMC10240733 DOI: 10.4244/eij-d-22-01096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/22/2023] [Indexed: 06/07/2023]
Abstract
Severe calcification is frequent in coronary chronic total occlusions (CTO), and its presence has been associated with increased procedural complexity and poor long-term outcomes following percutaneous coronary intervention (PCI) in an already challenging anatomical setting. The diagnostic characterisation of heavily calcified CTOs using non-invasive and invasive imaging tools can lead to the application of different therapeutic options during CTO PCI, in order to achieve adequate lesion preparation and optimal stent implantation. In this expert review, the European Chronic Total Occlusion Club provides a contemporary, methodological approach, specifically addressing heavily calcified CTOs, suggesting an integration of evidence-based diagnostic methods to tailored, up-to-date percutaneous therapeutic options.
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Affiliation(s)
- Kambis A Mashayekhi
- MediClin Heart Center Lahr, Lahr, Germany
- Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | | | - Gerald S Werner
- Medizinische Klinik I (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Alfredo R Galassi
- U.O.C. Cardiologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza (ProMISE) "G. D'Alessandro", A.O.U. Policlinico Paolo Giaccone, Università degli Studi, Palermo, Italy
| | - Roberto Garbo
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Nicolas Boudou
- Interventional Cardiology, Clinique Saint Augustin, Bordeaux, France
| | - Gregor Leibundgut
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Alexandre Avran
- Department of Interventional Cardiology, Clinique Louis Pasteur, Essey-lès-Nancy, France
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Alexander Bufe
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
| | - Georgios Sianos
- 1st Cardiology Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
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Panuccio G, Skurk C, Landmesser U, Abdelwahed YS. Double "full moon" CTO plaque detected by computed tomography could predict high-grade debulking techniques: A case-report. Clin Case Rep 2023; 11:e7325. [PMID: 37215968 PMCID: PMC10196417 DOI: 10.1002/ccr3.7325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/24/2023] Open
Abstract
Circular heavily calcified "Full Moon" plaques relevance for CTO-PCI remains unclear. This case shows a patient with double "Full Moon" plaques-CTO. Cardiac tomography identified these lesions and allowed to provide adequate debulking equipment. "Full Moon" plaques could predict CTO-PCI complexity. CT can identify these lesions and help planning CTO-PCI for increasing success rates.
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Affiliation(s)
- Giuseppe Panuccio
- Department of Cardiology, Angiology and Intensive Care MedicineDeutsches Herzzentrum der Charité BerlinBerlinGermany
- Department of Medical and Surgical SciencesMagna Graecia UniversityCatanzaroItaly
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care MedicineDeutsches Herzzentrum der Charité BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research)BerlinGermany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care MedicineDeutsches Herzzentrum der Charité BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research)BerlinGermany
- Berlin Institute of Health (BIH)BerlinGermany
| | - Youssef S. Abdelwahed
- Department of Cardiology, Angiology and Intensive Care MedicineDeutsches Herzzentrum der Charité BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research)BerlinGermany
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Kostantinis S, Simsek B, Karacsonyi J, Rempakos A, Alaswad K, Megaly M, Krestyaninov O, Khelimskii D, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Patel MP, Mahmud E, Koutouzis M, Tsiafoutis I, Gorgulu S, Elbarouni B, Nicholson W, Jaber W, Rinfret S, Abi Rafeh N, Goktekin O, ElGuindy AM, Allana SS, Rangan BV, Sandoval Y, Burke MN, Brilakis ES. Impact of proximal cap ambiguity on the procedural techniques and outcomes of chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO Registry. Catheter Cardiovasc Interv 2023; 101:737-746. [PMID: 36740235 DOI: 10.1002/ccd.30580] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Proximal cap ambiguity is a key parameter in the global chronic total occlusion (CTO) percutaneous coronary intervention (PCI) crossing algorithm. METHODS We examined the baseline characteristics and procedural outcomes of 9718 CTO PCIs performed in 9498 patients at 41 US and non-US centers between 2012 and 2022. RESULTS Proximal cap ambiguity was present in 35% of CTO lesions. Patients whose lesions had proximal cap ambiguity were more likely to have had prior coronary artery bypass graft surgery (37% vs. 24%; p < 0.001). Lesions with proximal cap ambiguity were more complex with higher J-CTO score (3.1 ± 1.0 vs. 2.0 ± 1.2; p < 0.001) and lower technical (79% vs. 90%; p < 0.001) and procedural (77% vs. 89%; p < 0.001) success rates compared with nonambiguous CTO lesions. The incidence of major adverse cardiovascular events (MACE) was higher in cases with proximal cap ambiguity (2.5% vs. 1.7%; p < 0.001). The retrograde approach was more commonly used among cases with ambiguous proximal cap (50% vs. 21%; p < 0.001) and was more likely to be the final successful crossing strategy (29% vs. 13%; p < 0.001). The antegrade dissection and re-entry (ADR) "move-the-cap" techniques were also more common among cases with proximal cap ambiguity. CONCLUSIONS Proximal cap ambiguity in CTO lesions is associated with higher utilization of the retrograde approach and ADR, lower technical and procedural success rates, and higher incidence of in-hospital MACE.
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Affiliation(s)
- Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Michael Megaly
- Henry Ford Cardiovascular Division, Detroit, Minnesota, USA
| | | | | | | | | | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | | | | | | | | | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Di Mario C, Mashayekhi KA, Garbo R, Pyxaras SA, Ciardetti N, Werner GS. Recanalisation of coronary chronic total occlusions. EUROINTERVENTION 2022; 18:535-561. [PMID: 36134683 DOI: 10.4244/eij-d-21-01117] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators in this demanding, rapidly evolving field of interventional cardiology.
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Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Kambis A Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Roberto Garbo
- GVM Care & Research, Maria Pia Hospital, Turin, Italy
| | | | - Niccolò Ciardetti
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Gerald S Werner
- Department of Cardiology, Klinikum Darmstadt GmbH, Darmstadt, Germany
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10
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Werner GS, Brilakis ES. Chronic Total Coronary Occlusion. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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11
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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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Wu EB, Brilakis ES, Mashayekhi K, Tsuchikane E, Alaswad K, Araya M, Avran A, Azzalini L, Babunashvili AM, Bayani B, Behnes M, Bhindi R, Boudou N, Boukhris M, Bozinovic NZ, Bryniarski L, Bufe A, Buller CE, Burke MN, Buttner A, Cardoso P, Carlino M, Chen JY, Christiansen EH, Colombo A, Croce K, de Los Santos FD, de Martini T, Dens J, di Mario C, Dou K, Egred M, Elbarouni B, ElGuindy AM, Escaned J, Furkalo S, Gagnor A, Galassi AR, Garbo R, Gasparini G, Ge J, Ge L, Goel PK, Goktekin O, Gonzalo N, Grancini L, Hall A, Hanna Quesada FL, Hanratty C, Harb S, Harding SA, Hatem R, Henriques JPS, Hildick-Smith D, Hill JM, Hoye A, Jaber W, Jaffer FA, Jang Y, Jussila R, Kalnins A, Kalyanasundaram A, Kandzari DE, Kao HL, Karmpaliotis D, Kassem HH, Khatri J, Knaapen P, Kornowski R, Krestyaninov O, Kumar AVG, Lamelas PM, Lee SW, Lefevre T, Leung R, Li Y, Li Y, Lim ST, Lo S, Lombardi W, Maran A, McEntegart M, Moses J, Munawar M, Navarro A, Ngo HM, Nicholson W, Oksnes A, Olivecrona GK, Padilla L, Patel M, Pershad A, Postu M, Qian J, Quadros A, Rafeh NA, Råmunddal T, Prakasa Rao VS, Reifart N, Riley RF, Rinfret S, Saghatelyan M, Sianos G, Smith E, Spaedy A, Spratt J, Stone G, Strange JW, Tammam KO, Thompson CA, Toma A, Tremmel JA, Trinidad RS, Ungi I, Vo M, Vu VH, Walsh S, Werner G, Wojcik J, Wollmuth J, Xu B, Yamane M, Ybarra LF, Yeh RW, Zhang Q. Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:840-853. [PMID: 34412818 DOI: 10.1016/j.jacc.2021.05.055] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/16/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.
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Affiliation(s)
- Eugene B Wu
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong.
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology, II University Heart Center Freiburg, Bad Krozingen, Germany
| | | | - Khaldoon Alaswad
- Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Henry Ford Health System, Wayne State University, Detroit, Michigan, USA
| | - Mario Araya
- Clinica Alemana, Hospital Militar de Santiago, Santiago, Chile
| | | | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Ravinay Bhindi
- Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Nicolas Boudou
- Interventional Cardiology, Clinique Saint Augustin, Bordeaux, France
| | - Marouane Boukhris
- Cardiology Department, Abderrahment Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | | | - Leszek Bryniarski
- II Department of Cardiology and Cardiovascular Interventions, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Alexander Bufe
- Heart Center Krefeld, University Witten/Herdecke, Witten, Germany
| | - Christopher E Buller
- Teleflex, Markham, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | - Pedro Cardoso
- Santa Maria University Hospital, Lisbon Academic Medical Centre and Centro Cardiovascular da Universidade de Lisboa, Lisbon, Portugal
| | - Mauro Carlino
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Ji-Yan Chen
- Guangdong General Hospital, Guangdong, China
| | | | - Antonio Colombo
- Cardiology, Humanitas University, Humanitas IRCCS, Rozzano, Milan, Italy
| | - Kevin Croce
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | - Carlo di Mario
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Kefei Dou
- Research Center for Coronary Heart Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Mohaned Egred
- Freeman Hospital & Newcastle University, Newcastle upon Tyne, UK
| | - Basem Elbarouni
- St. Boniface Hospital & University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Javier Escaned
- Hospital Clinico San Carlos, IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Sergey Furkalo
- National Institute of Surgery and Transplantology NAMS, Kiev, Ukraine
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Alfredo R Galassi
- Cardiovascular Medicine Department of PROMISE University of Palermo, Palermo, Italy
| | - Roberto Garbo
- Maria Pia Hospital, GVM Care & Research, Turin, Italy
| | - Gabriele Gasparini
- Department of Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pravin Kumar Goel
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | | | - Nieves Gonzalo
- Interventional Cardiology, Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Allison Hall
- Eastern Health/Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | | | | | - Stefan Harb
- Medical University of Graz, University Heart Center, Graz, Austria
| | - Scott A Harding
- Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Raja Hatem
- Hôpital du Sacré-Coeur de Montréal Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Angela Hoye
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
| | | | - Farouc A Jaffer
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Risto Jussila
- Interventional Cardiology, Helsinki Heart Hospital, Helsinki, Finland
| | - Artis Kalnins
- Clinic of Cardiovascular Diseases, Riga East Clinical University Hospital, Riga, Latvia
| | | | - David E Kandzari
- Piedmont Heart Institute and Cardiovascular Services, Atlanta, Georgia, USA
| | - Hsien-Li Kao
- Department of Internal Medicine, Cardiology Division, Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Hussien Heshmat Kassem
- Kasr Alainy Medical School, Cairo University, Cairo, Egypt, and Fujairah Hospital, Ministry of Health, Fujairah, United Arab Emirates
| | | | - Paul Knaapen
- Heart Center of the Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - A V Ganesh Kumar
- Department of Cardiology, Dr. L.H. Hiranandani Hospital, Mumbai, India
| | - Pablo Manuel Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina, and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Thierry Lefevre
- Institut Cardiovasculaire Paris Sud, Hôpital Prive Jacques Cartier, Massy, France
| | - Raymond Leung
- C.K. Hui Heart Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Yu Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Sidney Lo
- Department of Cardiology, Liverpool Hospital and The University of New South Wales, Sydney, Australia
| | | | - Anbukarasi Maran
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | | | - Jeffrey Moses
- NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Muhammad Munawar
- Binawaluya Cardiac Center and Department of Cardiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, and Department of Cardiology, Faculty of Medicine, Universitas Gadjahmada, Yogyakarta, Indonesia
| | - Andres Navarro
- Hospital de los Valles, Hospital de Especialidades Eugenio Espejo, Universidad San Francisco de Quito, Quito, Ecuador
| | - Hung M Ngo
- Choray University Hospital, Hochiminh City, Vietnam
| | | | - Anja Oksnes
- Heart Department, Haukeland University Hospital, Bergen, Norway
| | | | - Lucio Padilla
- Department of Interventional Cardiology and Endovascular Therapeutics, ICBA, Instituto Cardiovascular, Buenos Aires, Argentina
| | - Mitul Patel
- Division of Cardiovascular Medicine, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Ashish Pershad
- Chandler Regional Medical Center, Chandler, Arizona, USA
| | - Marin Postu
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases "Prof Dr C.C. Iliescu," Bucharest, Romania
| | - Jie Qian
- Beijing Fuwai Hospital, Beijing, China
| | - Alexandre Quadros
- Interventional Cardiology Division and Post Graduate Course of Cardiology, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nidal Abi Rafeh
- St. George Hospital University Medical Center, Beirut, Lebanon, and North Oaks Healthcare System, Hammond, Louisiana, USA
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Nicolaus Reifart
- Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany
| | - Robert F Riley
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | | | | | | | - Elliot Smith
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | | | - James Spratt
- St. George's University Hospital NHS Foundation Trust, London, UK
| | - Gregg Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julian W Strange
- Bristol Royal Infirmary, University Hospital Bristol NHS Trust, Bristol, UK
| | - Khalid O Tammam
- Department at the International Medical Center, Jeddah, Saudi Arabia
| | | | - Aurel Toma
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | | | - Imre Ungi
- University of Szeged, Department of Invasive Cardiology, Szeged, Hungary
| | - Minh Vo
- Royal Columbian Hospital, Vancouver, British Columbia, Canada
| | - Vu Hoang Vu
- Heart Center University Medical Center, Ho Chi Minh City, Vietnam
| | - Simon Walsh
- Belfast Health and Social Care Trust, Belfast, UK
| | - Gerald Werner
- Medizinische Klinik I Klinikum Darmstadt, Darmstadt, Germany
| | - Jaroslaw Wojcik
- Hospital of Invasive Cardiology IKARDIA, Nałęczów/Lublin, Poland
| | - Jason Wollmuth
- Providence Heart and Vascular Institute, Portland, Oregon, USA
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Qi Zhang
- Shanghai East Hospital, Tongji University, Shanghai, China
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13
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Sadamatsu K, Okutsu M, Sumitsuji S, Kawasaki T, Nakamura S, Fukumoto Y, Tsujita K, Sonoda S, Kobayashi Y, Ikari Y. Practical utilization of cardiac computed tomography for the success in complex coronary intervention. Cardiovasc Interv Ther 2021; 36:178-189. [PMID: 33428155 DOI: 10.1007/s12928-020-00751-6] [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] [Received: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022]
Abstract
Percutaneous coronary intervention (PCI) for complex lesions is still technically demanding and is associated with less favorable procedural parameters such as lower success rate, longer procedural time, higher contrast volume and unexpected complications. Because the conventional angiographic analysis is limited by the inability to visualize the plaque information and the occluded segment, cardiac computed tomography has evolved as an adjunct to invasive angiography to better characterize coronary lesions to improve success rates of PCI. Adding to routine image reconstructions by coronary computed tomography angiography, the thin-slab maximum intensity projection method, which is a handy reconstruction technique on an ordinary workstation, could provide easy-to-understand images to reveal the anatomical characteristics and the lumen and plaque information simultaneously, and then assist to build an in-depth strategy for PCI. Especially in the treatment of chronic total occlusion lesion, these informations have big advantages in the visualization of the morphologies of entry and exit, the occluded segment and the distribution of calcium compared to invasive coronary angiography. Despite of the additional radiation exposure, contrast use and cost for cardiac computed tomography, the precise analysis of lesion characteristics would consequently improve the procedural success and prevent the complication in complex PCI.
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Affiliation(s)
- Kenji Sadamatsu
- Department of Cardiovascular Medicine, Omuta City Hospital, 2-19-1 Takarazaka-machi, Omuta, Fukuoka, 836-8567, Japan.
| | - Masaaki Okutsu
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Satoru Sumitsuji
- Department of Cardiology for International Education and Research, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomohiro Kawasaki
- Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, Kurume, Japan
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan
| | - Shinjo Sonoda
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environ- Mental Health, Kitakyushu, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University, Kanagawa, Japan
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14
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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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15
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Velagapudi P, Abbott JD, Mamas M, Blankstein R, Chatzizisis YS, Brilakis ES, Jaffer FA. Role of Coronary Computed Tomography Angiography in Percutaneous Coronary Intervention of Chronic Total Occlusions. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-09541-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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16
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Werner GS, Yaginuma K. Editorial: The Ostial Chronic Total Occlusion - A Special Animal. CARDIOVASCULAR REVASCULARIZATION MEDICINE 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] [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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