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Tanaka H, Tsuchikane E, Kishi K, Okada H, Oikawa Y, Ito Y, Muramatsu T, Yoshikawa R, Kawasaki T, Okamura A, Sumitsuji S, Muto M, Katoh O. Retrograde Coronary Chronic Total Occlusion Intervention (JR-CTO) Score: From the Japanese CTO-PCI Expert Registry. JACC Cardiovasc Interv 2024; 17:1374-1384. [PMID: 38703149 DOI: 10.1016/j.jcin.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Despite the effectiveness of the retrograde approach for chronic total occlusion (CTO) lesions, there are no standardized tools to predict the success of retrograde percutaneous coronary intervention (PCI). OBJECTIVES The aim of this study was to develop a prediction tool to identify CTO lesions that will achieve successful retrograde PCI. METHODS This study evaluated data from 2,374 patients who underwent primary retrograde CTO-PCI and were enrolled in the Japanese CTO-PCI Expert Registry between January 2016 and December 2022 (NCT01889459). All observations were randomly assigned to the derivation and validation cohorts at a 2:1 ratio. The prediction score for guidewire failure in retrograde CTO-PCI was determined by assigning 1 point for each factor and summing all accrued points. RESULTS The JR-CTO score (moderate-severe calcification, tortuosity, Werner collateral connection grade ≤1, and nonseptal collateral channel) demonstrated a C-statistic for guidewire failure of 0.72 (95% CI: 0.67-0.76) and 0.71 (95% CI: 0.64-0.77) in the derivation and validation cohorts, respectively. Patients with lower scores had higher guidewire and technical success rates and decreased guidewire crossing time and procedural time (P < 0.01). CONCLUSIONS The JR-CTO (Japanese Retrograde Chronic Total Occlusion) score, a simple 4-item score that predicts successful guidewire crossing in patients undergoing retrograde CTO-PCI, has the potential to support clinical decision-making for the retrograde approach.
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Affiliation(s)
| | | | | | | | | | - Yoshiaki Ito
- Saiseikai Yokohama-City Eastern Hospital, Kanagawa, Japan
| | | | | | | | | | - Satoru Sumitsuji
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Makoto Muto
- Saitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan
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2
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Condos G, Kearney KE, Lombardi WL, Azzalini L. Complex Retrograde Chronic Occlusion Percutaneous Coronary Intervention via a Gastroepiploic Artery Graft. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S283-S287. [PMID: 37210219 DOI: 10.1016/j.carrev.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/01/2023] [Indexed: 05/22/2023]
Abstract
Surgical bypass grafts are commonly used retrograde conduits to facilitate chronic total occlusion (CTO) percutaneous coronary intervention (PCI). While extensive experience exists using saphenous vein grafts as retrograde conduits in CTO PCI, information on the utilization of arterial grafts is more limited. In particular, the gastroepiploic artery (GEA) is a very uncommonly used arterial graft in contemporary bypass surgery and its role for retrograde CTO recanalization has received little study. We describe a case of right coronary artery CTO that was recanalized using the retrograde approach via a GEA graft to the posterior descending artery and highlight the specific challenges of this approach.
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Affiliation(s)
- Gregory Condos
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - William L Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
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3
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Li QY, Lin XL, Li FQ, Cheng ZC, Tian JY, Zhao DH, Lau WB, Liu JH, Fan Q. A Chinese scoring system for predicting successful retrograde collateral traverse in patients with chronic total coronary occlusion. BMC Cardiovasc Disord 2023; 23:380. [PMID: 37516887 PMCID: PMC10386207 DOI: 10.1186/s12872-023-03405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 07/18/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Retrograde approach technique has been challenging in percutaneous coronary interventional treatment of chronic total occlusion (CTO) coronary disease. The present study endeavors to determine a novel Chinese scoring system for predicting successful collateral channels traverse via retrograde approach. METHODS The demographic characteristics and angiographic characteristics of 309 CTO patient were analyzed by univariable and multivariable analysis for selecting potential predictors. And the nomogram was used to establish the scoring system. Then it was evaluated by the internal and external validation. RESULTS The predictors of Age, Connections between collateral channels and recipient vessels, and Channel Tortuosity (ACT) were identified with univariable and multivariable analysis and employed to the ACT score system. With acceptable calibrations, the area under curve of the scoring system and the external validation were 0.826 and 0.816 respectively. Based on score, the predictors were divided into three risk categories and it showed a consistent prediction power in the validation cohort. CONCLUSIONS The novel Chinese ACT score is a reliable tool for predicting successful retrograde collateral traverse.
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Affiliation(s)
- Qiu Yu Li
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Xiao Long Lin
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Fan Qi Li
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Zi Chao Cheng
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Jia Yu Tian
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Dong Hui Zhao
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Wayne Bond Lau
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Jing Hua Liu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Qian Fan
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China.
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4
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Mattesini A, Demola P, Parikh SA, Secco GG, Pighi M, Di Mario C. Material Selection. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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5
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Xu R, Shi Y, Chang S, Qin Q, Li C, Fu M, Ge L, Qian J, Ma J, Ge J. Outcomes of contemporary versus conventional reverse controlled and antegrade and retrograde subintimal tracking in chronic total occlusion revascularization. Catheter Cardiovasc Interv 2021; 99:226-233. [PMID: 34787375 DOI: 10.1002/ccd.30018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/17/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) lesions remain technically challenging for percutaneous coronary intervention (PCI). The introduction of a retrograde approach has allowed marked improvement in the success rate of CTO recanalization. Reverse controlled anterograde and retrograde sub-intimal tracking (reverse CART) is the predominant retrograde wire crossing technique and can be broadly classified into three categories: (1) conventional (2) contemporary and (3) extended. The present study aimed to compare the safety and efficacy of conventional and contemporary reverse CART techniques. METHODS From March 2015 to May 2020, 303 patients achieving successful retrograde guidewire crossing with conventional or contemporary reverse CART during CTO PCI were included in the study. The patient characteristics, procedural outcomes and in-hospital and 1-year clinical events were compared between the conventional and contemporary groups. RESULTS The distributions of the baseline and angiographic characteristics were similar in both study arms, except the CTO lesions of the conventional group were more complex, as reflected by borderline significantly higher mean J-CTO scores (3.4 ± 0.7 vs. 3.3 ± 0.8; p = 0.059). Recanalization using contemporary reverse CART was associated with a short procedure time (189.8 ± 44.4 vs. 181.7 ± 37.3 min; p = 0.044) and decreased procedural complications, particularly target vessel perforation (3.6% vs. 0.6%; p = 0.063) and major side-branch occlusion (36.7% vs. 28.0%; p = 0.051). Technical and procedural success and the in-hospital and 1-year outcomes were not significantly different between the groups. CONCLUSIONS Contemporary reverse CART is associated with favorably high efficiency and low-complication rates and carries a comparable success rate and 1-year clinical outcomes as conventional reverse CART.
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Affiliation(s)
- Rende Xu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuekai Shi
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shufu Chang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qing Qin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mingqiang Fu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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6
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Sekiguchi M, Muramatsu T, Kishi K, Sumitsuji S, Okada H, Oikawa Y, Yoshikawa R, Kawasaki T, Tanaka H, Tsuchikane E. Occlusion patterns, strategies and procedural outcomes of percutaneous coronary intervention for in-stent chronic total occlusion. EUROINTERVENTION 2021; 17:e631-e638. [PMID: 33720017 PMCID: PMC9724848 DOI: 10.4244/eij-d-20-01151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In-stent chronic total occlusion (CTO) presents various occlusion patterns, which complicate percutaneous coronary intervention (PCI). AIMS The aim of the study was to investigate the initial outcome and strategy of PCI for in-stent CTO according to the angiographic occlusion patterns. METHODS This study assessed 791 in-stent CTOs from the Japanese CTO-PCI Expert Registry from 2015 to 2018. They were divided into four patterns: pattern A (n=419), CTO within the stent segment; pattern B (n=196), CTO beyond the distal edge; pattern C (n=85), CTO beyond the proximal edge; and pattern D (n=69) CTO beyond both the proximal and distal edges. RESULTS There were significant differences in the technical success rates (96.2%, 86.2%, 92.9%, and 75.4% for patterns A-D, respectively; p<0.001), guidewire crossing times (22 [interquartile range: 10-46], 52 [24-102], 40 [20-78], and 86 [45-127] min, respectively; p<0.001), and the rates of antegrade approach alone (90.9%, 61.2%, 67.1%, and 31.9%, respectively; p<0.001). CONCLUSIONS PCI for CTO within the stent segment was associated with excellent initial outcomes with the antegrade approach. However, PCI for CTO beyond both the proximal and distal edges was associated with the poorest outcomes, even with the bidirectional approach.
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Affiliation(s)
- Makoto Sekiguchi
- Department of Cardiology, Fukaya Red Cross Hospital, 5-8-1 Kamishiba-machi, Fukaya, Saitama, 366-0052, Japan
| | | | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Satoru Sumitsuji
- Department of Cardiology for International Education and Research, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Yuji Oikawa
- Department of Cardiology, The Cardiovascular Institute, Tokyo, Japan
| | | | | | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
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7
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Azzalini L, Carlino M. A new combined antegrade and retrograde approach for chronic total occlusion recanalization: Facilitated antegrade fenestration and re-entry. Catheter Cardiovasc Interv 2021; 98:E85-E90. [PMID: 33555088 DOI: 10.1002/ccd.29539] [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] [Received: 09/10/2020] [Revised: 12/07/2020] [Accepted: 01/17/2021] [Indexed: 11/08/2022]
Abstract
While antegrade techniques remain the cornerstone of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), operators have often to resort to the retrograde approach in complex occlusions. In particular, lesions with proximal cap ambiguity, unclear vessel course and/or poor distal landing zone are difficult to tackle with either antegrade wiring or antegrade dissection and re-entry (ADR), and often require the retrograde approach. After collateral channel crossing, the retrograde approach usually culminates with either reverse controlled antegrade and retrograde subintimal tracking (CART) or retrograde true lumen crossing. Both techniques usually involve the use of an externalization wire, which requires keeping a higher activate clotting time to prevent thrombosis of the retrograde channel and is potentially associated with risk for donor vessel injury. In 2018, we described antegrade fenestration and re-entry (AFR), a targeted ADR technique in which fenestrations between the false and true lumen are created by antegrade balloon dilatation in the extraplaque space at the level of the distal cap, which are subsequently engaged by a polymer-jacketed wire to achieve re-entry. We hypothesized that AFR can also expedite antegrade crossing of the CTO after a wire has reached the distal vessel in a retrograde fashion. In this report, we present two cases in which we successfully achieved antegrade CTO crossing with AFR following retrograde advancement of a guidewire to the distal cap, in new variant of the technique, which we called "facilitated AFR".
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Affiliation(s)
- Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mauro Carlino
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
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8
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Kalra S, Doshi D, Sapontis J, Kosmidou I, Kirtane AJ, Moses JW, Riley RF, Jones P, Nicholson WJ, Salisbury AC, Lombardi WL, McCabe JM, Pershad A, Hirai T, Hakemi E, Russo JJ, Prasad M, Ahmad Y, Hatem R, Gkargkoulas F, Spertus JA, Wyman RM, Jaffer F, Spaedy A, Cook S, Marso SP, Nugent K, Federici R, Yeh RW, Leon MB, Stone GW, Ali ZA, Parikh MA, Maehara A, Cohen DJ, Batres C, Grantham JA, Karmpaliotis D. Outcomes of retrograde chronic total occlusion percutaneous coronary intervention: A report from the OPEN-CTO registry. Catheter Cardiovasc Interv 2021; 97:1162-1173. [PMID: 32876381 DOI: 10.1002/ccd.29230] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/02/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We sought to assess in-hospital and long-term outcomes of retrograde compared with antegrade-only percutaneous coronary intervention for chronic total occlusion (CTO PCI). BACKGROUND Procedural and clinical outcomes following retrograde compared with antegrade-only CTO PCI remain unknown. METHODS Using the core-lab adjudicated OPEN-CTO registry, we compared the outcomes of retrograde to antegrade-only CTO PCI. Primary endpoints included were in-hospital major adverse cardiac and cerebrovascular events (MACCE) (all-cause death, stroke, myocardial infarction [MI], emergency cardiac surgery, or clinically significant perforation) and MACCE at 1-year (all-cause death, MI, stroke, target lesion revascularization, or target vessel reocclusion). RESULTS Among 885 single CTO procedures from the OPEN-CTO registry, 454 were retrograde and 431 were antegrade-only. Lesion complexity was higher (J-CTO score: 2.7 vs. 1.9; p < .001) and technical success lower (82.4 vs. 94.2%; p < .001) in retrograde compared with antegrade-only procedures. All-cause death was higher in the retrograde group in-hospital (2 vs. 0%; p = .003), but not at 1-year (4.9 vs. 3.3%; p = .29). Compared with antegrade-only procedures, in-hospital MACCE rates (composite of all-cause death, stroke, MI, emergency cardiac surgery, and clinically significant perforation) were higher in the retrograde group (10.8 vs. 3.3%; p < .001) and at 1-year (19.5 vs. 13.9%; p = .03). In sensitivity analyses landmarked at discharge, there was no difference in MACCE rates at 1 year following retrograde versus antegrade-only CTO PCI. Improvements in Seattle Angina Questionnaire Quality of Life scores at 1-year were similar between the retrograde and antegrade-only groups (29.9 vs 30.4; p = .58). CONCLUSIONS In the OPEN-CTO registry, retrograde CTO procedures were associated with higher rates of in-hospital MACCE compared with antegrade-only; however, post-discharge outcomes, including quality of life improvements, were similar between technical modalities.
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Affiliation(s)
- Sanjog Kalra
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Darshan Doshi
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Ioanna Kosmidou
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Ajay J Kirtane
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Jeffrey W Moses
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
- St. Francis Heart Center, St. Francis Hospital, Roslyn, New York
| | - Robert F Riley
- Heart and Vascular Institute, The Christ Hospital, Cincinnati, Ohio
| | - Philip Jones
- St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | | | - Adam C Salisbury
- St. Luke's Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri, Kansas City, Missouri
| | - William L Lombardi
- Department of Medicine, University of Washington Medical Center, Seattle, Washington
| | - James M McCabe
- Department of Medicine, University of Washington Medical Center, Seattle, Washington
| | - Ashish Pershad
- Department of Medicine, Banner University Medical Center, Phoenix, Arizona
| | - Taishi Hirai
- Department of Medicine, University of Missouri, Kansas City, Missouri
| | - Emad Hakemi
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
| | | | - Megha Prasad
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
| | - Yousif Ahmad
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
| | - Raja Hatem
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Fotis Gkargkoulas
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
| | - John A Spertus
- Department of Medicine, University of Missouri, Kansas City, Missouri
| | | | - Farouc Jaffer
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Stephen Cook
- Peacehealth Sacred Heart Medical Center, Springfield, Oregon
| | | | - Karen Nugent
- St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Martin B Leon
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ziad A Ali
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Manish A Parikh
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
- NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Akiko Maehara
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - David J Cohen
- Department of Medicine, University of Missouri, Kansas City, Missouri
| | - Candido Batres
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
| | - J Aaron Grantham
- St. Luke's Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri, Kansas City, Missouri
| | - Dimitri Karmpaliotis
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
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Retrograde Dissection and Reentry: Strategies: Common Pitfalls and Troubleshooting. Interv Cardiol Clin 2020; 10:51-64. [PMID: 33223106 DOI: 10.1016/j.iccl.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The retrograde dissection reentry (RDR) technique is often required to treat the most complex chronic total occlusions (CTOs). This involves a sequence of procedural steps with many potential pitfalls. Procedural planning, knowledge of the equipment, including task-specific wires and microcatheters, and the ability to systematically trouble shoot is necessary to achieve consistent success. With the combination of more complex anatomy and collateral crossing, RDR is associated with higher rates of procedural complications, which the CTO operator must be specifically trained to avoid and to manage.
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10
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Safety of Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients With Multi-Vesel Disease: Sub-Analysis of the Japanese Retrograde Summit Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 25:36-42. [PMID: 33127297 DOI: 10.1016/j.carrev.2020.10.007] [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: 07/25/2020] [Revised: 09/18/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has gradually increased thanks to the continuous development of devices and techniques. However, the impact of multi-vessel disease (MVD) on its success rate and safety is not well known. METHODS The clinical records of 5009 patients enrolled in the Japanese Retrograde Summit Registry and who had undergone PCI for CTO at 65 centers between 2012 and 2015 were reviewed. We compared the outcome for patients with and without MVD. RESULTS Two thousand nine hundred and seventy-eight patients (59%) had MVD. Although there was no significant difference in the J-CTO score between the two groups [MVD group 1.51 ± 1.07 vs. SVD group 1.48 ± 1.07, p = 0.48], the procedural success rate of CTO-PCI in the MVD group was significantly lower than that in the SVD group (87.2% vs. 90.2%, p = 0.001). However, occurrence of procedure-related adverse events (4% vs. 5%, p = 0.11), total fluoroscopy (70 ± 45 min vs. 69 ± 50 min, p = 0.75) and procedural time (154 ± 86 min vs. 151 ± 89 min, p = 0.36), and total amount of contrast media (219 ± 102 mL vs. 222 ± 105 mL, p = 0.33) did not differ between the two groups. CONCLUSIONS Although MVD had an impact on the success rate of CTO-PCI, it did not affect procedure-related adverse events.
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11
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Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention via Saphenous Vein Graft. JACC Cardiovasc Interv 2020; 13:517-526. [DOI: 10.1016/j.jcin.2019.10.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/16/2019] [Accepted: 10/10/2019] [Indexed: 11/22/2022]
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12
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Megaly M, Ali A, Saad M, Omer M, Xenogiannis I, Werner GS, Karmpaliotis D, Russo JJ, Yamane M, Garbo R, Gagnor A, Ungi I, Rinfret S, Pershad A, Wojcik J, Garcia S, Mashayekhi K, Sianos G, Galassi AR, Burke MN, Brilakis ES. Outcomes with retrograde versus antegrade chronic total occlusion revascularization. Catheter Cardiovasc Interv 2019; 96:1037-1043. [PMID: 31778041 DOI: 10.1002/ccd.28616] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/27/2019] [Accepted: 11/11/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate the outcomes of retrograde versus antegrade approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND The retrograde approach has increased the success rate of CTO PCI but has been associated with a higher risk for complications. METHODS We conducted a meta-analysis of studies published between 2000 and August 2019 comparing the in-hospital and long-term outcomes with retrograde versus antegrade CTO PCI. RESULTS Twelve observational studies (10,240 patients) met our inclusion criteria (retrograde approach 2,789 patients, antegrade approach 7,451 patients). Lesions treated with the retrograde approach had higher J-CTO score (2.8 vs. 1.9, p < .001). Retrograde CTO PCI was associated with a lower success rate (80.9% vs. 87.4%, p < .001). Both approaches had similar in-hospital mortality, urgent revascularization, and cerebrovascular events. Retrograde CTO PCI was associated with higher risk of in-hospital myocardial infarction (MI; odds ratio [OR] 2.37, 95% confidence intervals [CI] 1.7, 3.32, p < .001), urgent pericardiocentesis (OR 2.53, 95% CI 1.41-4.51, p = .002), and contrast-induced nephropathy (OR 2.12, 95% CI 1.47-3.08; p < .001). During a mean follow-up of 48 ± 31 months retrograde crossing had similar mortality (OR 1.79, 95% CI 0.84-3.81, p = .13), but a higher incidence of MI (OR 2.07, 95% CI 1.1-3.88, p = .02), target vessel revascularization (OR 1.92, 95% CI 1.49-2.46, p < .001), and target lesion revascularization (OR 2.08, 95% CI 1.33-3.28, p = .001). CONCLUSIONS Compared with antegrade CTO PCI, retrograde CTO PCI is performed in more complex lesions and is associated with a higher risk for acute and long-term adverse events.
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Affiliation(s)
- Michael Megaly
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.,Department of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Abdelrahman Ali
- Department of Medicine, Mercy Hospital and Medical Center, Chicago, Illinois
| | - Marwan Saad
- Division of Cardiovascular Medicine, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,Department of Cardiovascular Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - Mohamed Omer
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.,Department of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Gerald S Werner
- Medizinische Klinik I (Cardiology and Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany
| | | | - Juan J Russo
- Department of Cardiology, Columbia University, New York, New York
| | | | - Roberto Garbo
- Department of Invasive Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Imre Ungi
- Division of Invasive Cardiology, University of Szeged, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary
| | - Stephane Rinfret
- Division of Interventional Cardiology, McGill University Health Centre, Montreal, Canada
| | - Ashish Pershad
- Division of Cardiology, Banner-University Medical Center, Phoenix, Arizona
| | - Jaroslaw Wojcik
- Department of Cardiology, Hospital of Invasive Cardiology IKARDIA, Nałęczów, Poland
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Georgios Sianos
- First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Alfredo R Galassi
- Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
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Sekiguchi M, Muramatsu T, Kishi K, Muto M, Oikawa Y, Kawasaki T, Fujita T, Hamazaki Y, Okada H, Tsuchikane E. Assessment of reattempted percutaneous coronary intervention strategy for chronic total occlusion after prior failed procedures: Analysis of the Japanese CTO-PCI Expert Registry. Catheter Cardiovasc Interv 2019; 94:516-524. [PMID: 31062477 DOI: 10.1002/ccd.28315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/06/2019] [Accepted: 04/14/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We aimed to investigate strategies for reattempted percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs) by highly skilled operators after a failed attempt. BACKGROUND Development of complex techniques and algorithms has been standardized for CTO-PCI. However, there is no appropriate strategy for CTO-PCI after a failed procedure. METHOD From 2014 to 2016, the Japanese CTO-PCI Expert Registry included 4,053 consecutive CTO-PCIs (mean age: 66.8 ± 10.9 years; male: 85.6%; Japanese CTO [J-CTO] score: 1.92 ± 1.15). Initial outcomes and strategies for reattempted CTO-PCIs were evaluated and compared with first-attempt CTO-PCIs. RESULTS Reattempt CTO-PCIs were performed in 820 (20.2%) lesions. The mean J-CTO score of reattempt CTO-PCIs was higher than that of first-attempt CTO-PCIs (2.86 ± 1.03 vs. 1.68 ± 1.05, p < .001). The technical success rate of reattempt CTO-PCIs was lower than that of first-attempt CTO-PCIs (86.7% vs. 90.8%, p < .001). Regarding successful CTO-PCIs, the strategies comprised antegrade alone (reattempt: 36.1%, first attempt: 63.8%), bidirectional approach (reattempt: 54.4%, first attempt: 30.3%), and antegrade approach following a failed bidirectional approach (reattempt: 9.4%, first attempt: 5.4%). Parallel wire technique, intravascular ultrasound guide crossing, and bidirectional approach technique were frequently performed in reattempt CTO-PCIs. Reattempt CTO-PCIs showed higher rates of myocardial infarction (2.1% vs. 0.9%, p < .001) and coronary perforation (6.9% vs. 4.2%, p = .002) than first-attempt CTO-PCIs. CONCLUSIONS The technical success rate of reattempt CTO-PCIs is lower than that of first-attempt CTO-PCIs. However, using more complex strategies, the success rate of reattempt CTO-PCI can be improved by highly skilled operators.
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Affiliation(s)
- Makoto Sekiguchi
- Department of Cardiology, Fukaya Red Cross Hospital, Saitama, Japan
| | | | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Makoto Muto
- Department of Cardiology, Saitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan
| | - Yuji Oikawa
- Department of Cardiology, The Cardiovascular Institute, Tokyo, Japan
| | | | - Tsutomu Fujita
- Department of Cardiology, Sapporo Cardio Vascular Clinic and Sapporo Heart Center, Hokkaido, Japan
| | - Yuji Hamazaki
- Divison of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
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Huang CC, Lee CK, Meng SW, Hung CS, Chen YH, Lin MS, Yeh CF, Kao HL. Collateral Channel Size and Tortuosity Predict Retrograde Percutaneous Coronary Intervention Success for Chronic Total Occlusion. Circ Cardiovasc Interv 2019; 11:e005124. [PMID: 29311284 DOI: 10.1161/circinterventions.117.005124] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is little evidence on how to select an interventional collateral channel (CC) in retrograde chronic total occlusion (CTO) percutaneous coronary intervention. We aimed to identify independent angiographic predictors of CC tracking and technical success in retrograde CTO percutaneous coronary intervention. METHODS AND RESULTS From January 2012 to December 2015, a total of 216 consecutive retrograde CTO percutaneous coronary intervention attempts by a high-volume operator in a tertiary university-affiliated hospital were enrolled. The clinical, angiographic, and procedural details were collected. The characteristics analyzed included channel type, size, tortuosity, angle of attack, length to emerging point, and the Multicenter CTO Registry of Japan score. The Multicenter CTO Registry of Japan score was 4.2±0.8. A total of 242 CCs were attempted for intervention. CC tracking success rate was 83.5%, and the technical success rate (per CC) was 81.4%. The per-patient technical success rate was 91.2%, and the major procedural complication rate was 4.6%. The atrioventricular groove, epicardial, and septal CCs were used in 36 (14.9%), 84 (34.7%), and 122 (50.4%) tracking attempts, respectively. In multivariable analysis, only large channel size and lack of tortuosity were significant independent predictors of CC tracking and technical success. A new scoring system was developed, while large size was given 1 point and lack of tortuosity was given 2 points. The receiver-operating characteristic area by the new model to predict CC tracking and technical success were 0.800 and 0.752, respectively. CONCLUSIONS In retrograde CTO percutaneous coronary intervention, only size and tortuosity of a CC are independent angiographic predictors of CC tracking and technical success.
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Affiliation(s)
- Ching-Chang Huang
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Chih-Kuo Lee
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Shih-Wei Meng
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Chi-Sheng Hung
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Ying-Hsien Chen
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Mao-Shin Lin
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Chih-Fan Yeh
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Hsien-Li Kao
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.).
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15
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Matsuno S, Tsuchikane E, Harding SA, Wu EB, Kao HL, Brilakis ES, Mashayekhi K, Werner GS. Overview and proposed terminology for the reverse controlled antegrade and retrograde tracking (reverse CART) techniques. EUROINTERVENTION 2019; 14:94-101. [PMID: 29360064 DOI: 10.4244/eij-d-17-00867] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
During recent years, equipment and techniques for percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) have improved significantly. The retrograde approach remains critical to the improved success of CTO PCI. Currently, the reverse controlled antegrade and retrograde tracking (CART) technique has become the dominant retrograde wire crossing technique. In this article, we propose a standardised terminology and classification for this technique divided into three subtypes: a) conventional reverse CART, usually involving the use of large balloons on the antegrade wire to achieve re-entry within the CTO segment; b) "directed" reverse CART, which is characterised by small antegrade balloon size and more active, intentional vessel tracking and penetration with a controllable retrograde wire, still within the CTO segment; and c) "extended" reverse CART, in which the intimal/subintimal dissection is extended proximal or distal to the CTO segment, achieving re-entry outside the CTO segment. The proposed standardised terminology will facilitate the communication, teaching and adoption of the reverse CART techniques.
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Affiliation(s)
- Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
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16
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Kwon O, Lee PH, Lee SW, Lee JY, Kang DY, Ahn JM, Park DW, Kang SJ, Kim YH, Lee CW, Park SW, Park SJ. Retrograde approach for the percutaneous recanalisation of coronary chronic total occlusions: contribution to clinical practice and long-term outcomes. EUROINTERVENTION 2019; 15:e354-e361. [DOI: 10.4244/eij-d-18-00538] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Zhong X, Ge L, Ma J, Huang D, Yao K, Zhang F, Lu H, Yan Y, Huang Z, Qian J, Ge J. Microcatheter collateral channel tracking failure in retrograde percutaneous coronary intervention for chronic total occlusion: incidence, predictors, and management. EUROINTERVENTION 2019; 15:e253-e260. [PMID: 30946014 DOI: 10.4244/eij-d-18-01003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study sought to demonstrate the incidence, predictors, and management of microcatheter collateral channel (CC) tracking failure in retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions. METHODS AND RESULTS Prospectively collected data from 371 consecutive retrograde CTO-PCI procedures between March 2015 and January 2018 were retrospectively analysed. The incidence of initial microcatheter CC tracking failure was 22.5% in 280 procedures with wire CC tracking success. For septal collaterals, CC grade 0-1 collaterals (odds ratio [OR]: 8.3; p<0.001), channel entry angle <90° (OR: 13.0; p=0.001), channel exit angle <90° (OR: 44.3; p=0.004), and Finecross MG as initial microcatheter (OR: 2.7; p=0.032) were independently related to initial microcatheter CC tracking failure. Meanwhile, the only predictor for epicardial collaterals was CC 1 collaterals (OR: 26.9; p<0.001). Frequently applied solutions included microcatheter switching (61.9%), and microcatheter switching combined with GUIDEZILLA (14.3%) or anchoring balloon technique (6.3%). CONCLUSIONS Initial microcatheter CC tracking failure was found in nearly one quarter of procedures after wire CC tracking success. Independent angiographic predictors of initial microcatheter CC tracking failure included CC 0-1 collaterals, channel entry angle <90°, and channel exit angle <90° for septal collaterals, and CC 1 collaterals for epicardial collaterals.
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Affiliation(s)
- Xin Zhong
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
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18
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Comparison of the transradial and transfemoral approach in treatment of chronic total occlusions with similar lesion characteristics. Anatol J Cardiol 2019; 19:319-325. [PMID: 29724974 PMCID: PMC6280270 DOI: 10.14744/anatoljcardiol.2018.02779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective: There is limited data on the efficacy and the safety of the transradial approach (TRA) for percutaneous coronary intervention (PCI) of chronic total occlusion (CTO), particularly in comparison with the transfemoral approach (TFA) in lesions with similar complexity. Methods: We included 358 patients, who underwent elective CTO PCI between January 2012 and August 2017 and compared the radial (179 patients) and femoral (179 patients) approaches. The J-CTO score was similar in both groups (TRA, 2.5±1.3 vs. TFA, 2.8±1.4, n.s.). The endpoints analyzed included (i) the composite of all-cause death and nonfatal myocardial infarction (MI) and (ii) the composite safety endpoint of major adverse cardiovascular and cerebrovascular events (MACCEs), including death, MI, coronary perforation, contrast-induced nephropathy (CIN), bleeding at the vascular access site requiring transfusion, cardiac tamponade requiring pericardiocentesis, and periprocedural stroke. Results: Patients’ demographics, lesion location, lesion characteristics, and the proportion of antegrade vs. retrograde approach were similar in both groups. The procedural success rate of 96.4% in the radial group and 92.9% in the femoral group was comparable. The total fluoroscopy time (TRA, 42.4±15.7 min vs. TFA, 40.5±15.3 min, n.s.) and contrast medium use (TRA, 532.2±21.7 mL vs. TFA, 528.2±24.6 mL, n.s.) was similar in both groups. There was no in-hospital death or periprocedural MI in both groups. There were three coronary perforations in the TFA group, among them one with tamponade, and one coronary perforation the TRA group. Vascular access site complications (TRA, 0.01% vs. TFA, 0.02%) and CIN (TRA, 0.006% vs. TFA, 0.006%) were rare. One stroke as a result of the procedure was observed in the TFA group. No death was registered. Conclusion: The radial approach in CTO PCI was as fast and successful as the femoral approach, even in a complex lesion subset.
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19
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Wu K, Huang Z, Zhong Z, Liao H, Zhou Y, Luo B, Zhang B. Predictors, treatment, and long-term outcomes of coronary perforation during retrograde percutaneous coronary intervention via epicardial collaterals for recanalization of chronic coronary total occlusion. Catheter Cardiovasc Interv 2019; 93:800-809. [PMID: 30690863 DOI: 10.1002/ccd.28093] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate predictors, treatment, and long-term outcomes associated with coronary perforation (CP) in patients who underwent retrograde percutaneous coronary intervention (PCI) through epicardial collaterals for chronic total occlusion (CTO). BACKGROUND Data regarding CP during retrograde PCI through epicardial collaterals for CTO are scarce. METHODS We included 155 patients who underwent retrograde CTO PCI through epicardial collaterals at Guangdong Cardiovascular Institute from August 2011 to December 2017. The median follow-up was 2.5 years. Major adverse cardiac events (MACEs) were analyzed using the Kaplan-Meier method, and independent predictors of long-term MACE were determined using a multivariable Cox model. RESULTS CP occurred in 24 (15.5%) patients, with the frequency of Ellis classes 1 or 2 and 3 being 41.7% and 58.3%, respectively. Seven (4.5%) patients had tamponade, which was effectively managed using coil embolization and pericardiocentesis. Renal dysfunction (odds ratio [OR]: 5.27; 95% confidence interval [CI]: 1.47-18.88; P = 0.011), right coronary artery (RCA) CTO (OR: 4.34; 95% CI: 1.29-14.63; P = 0.018), and Epi-CTO score ≥ 2 (OR: 3.27; 95% CI: 1.12-9.58; P = 0.030) were independent predictors of CP. At the 7-year follow-up, 17 patients had MACE. Multivariable analysis revealed that CP was not associated with worse long-term clinical outcomes (hazard ratio: 1.55; 95% CI: 0.45-5.32, P = 0.484). CONCLUSIONS Retrograde CTO PCI through epicardial collaterals is at increased risk of CP, which is associated with renal dysfunction, RCA CTO, and Epi-CTO score ≥ 2. Prompt and proper management of CP is important. CP is not significantly associated with adverse clinical outcomes.
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Affiliation(s)
- Kaize Wu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Zehan Huang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Zhian Zhong
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Hongtao Liao
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Yi Zhou
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Bingzheng Luo
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Bin Zhang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
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Tajti P, Xenogiannis I, Chavez I, Gössl M, Mooney M, Poulose A, Sorajja P, Traverse J, Wang Y, Burke MN, Brilakis ES. Expecting the unexpected: preventing and managing the consequences of coronary perforations. Expert Rev Cardiovasc Ther 2018; 16:805-814. [DOI: 10.1080/14779072.2018.1533402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Peter Tajti
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ivan Chavez
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Mario Gössl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Michael Mooney
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Anil Poulose
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Jay Traverse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - M. Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
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21
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Affiliation(s)
- Peter Tajti
- Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN
- Department of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX
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22
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Dash D. Problems encountered in retrograde recanalization of coronary chronic total occlusion: Should we lock the backdoor in 2018? Indian Heart J 2018; 70:132-134. [PMID: 29455767 PMCID: PMC5903014 DOI: 10.1016/j.ihj.2017.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Debabrata Dash
- Thumbay Hospital, Ajman, UAE; Beijing Tiantan Hospital, Beijing, China.
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Karmpaliotis D, Karatasakis A, Alaswad K, Jaffer FA, Yeh RW, Wyman RM, Lombardi WL, Grantham JA, Kandzari DE, Lembo NJ, Doing A, Patel M, Bahadorani JN, Moses JW, Kirtane AJ, Parikh M, Ali ZA, Kalra S, Nguyen-Trong PKJ, Danek BA, Karacsonyi J, Rangan BV, Roesle MK, Thompson CA, Banerjee S, Brilakis ES. Outcomes With the Use of the Retrograde Approach for Coronary Chronic Total Occlusion Interventions in a Contemporary Multicenter US Registry. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003434. [PMID: 27307562 DOI: 10.1161/circinterventions.115.003434] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to examine the efficacy and safety of chronic total occlusion percutaneous coronary intervention using the retrograde approach. METHODS AND RESULTS We compared the outcomes of the retrograde versus antegrade-only approach to chronic total occlusion percutaneous coronary intervention among 1301 procedures performed at 11 experienced US centers between 2012 and 2015. The mean age was 65.5±10 years, and 84% of the patients were men with a high prevalence of diabetes mellitus (45%) and previous coronary artery bypass graft surgery (34%). Overall technical and procedural success rates were 90% and 89%, respectively, and in-hospital major adverse cardiovascular events occurred in 31 patients (2.4%). The retrograde approach was used in 539 cases (41%), either as the initial strategy (46%) or after a failed antegrade attempt (54%). When compared with antegrade-only cases, retrograde cases were significantly more complex, both clinically (previous coronary artery bypass graft surgery prevalence, 48% versus 24%; P<0.001) and angiographically (mean Japan-chronic total occlusion score, 3.1±1.0 versus 2.1±1.2; P<0.001) and had lower technical success (85% versus 94%; P<0.001) and higher major adverse cardiovascular events (4.3% versus 1.1%; P<0.001) rates. On multivariable analysis, the presence of suitable collaterals, no smoking, no previous coronary artery bypass graft surgery, and left anterior descending artery target vessel were independently associated with technical success using the retrograde approach. CONCLUSIONS The retrograde approach is commonly used in contemporary chronic total occlusion percutaneous coronary intervention, especially among more challenging lesions and patients. Although associated with lower success and higher major adverse cardiovascular event rates in comparison to antegrade-only crossing, retrograde percutaneous coronary intervention remains critical for achieving overall high success rates.
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Affiliation(s)
- Dimitri Karmpaliotis
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Aris Karatasakis
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Khaldoon Alaswad
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Farouc A Jaffer
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Robert W Yeh
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - R Michael Wyman
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - William L Lombardi
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - J Aaron Grantham
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - David E Kandzari
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Nicholas J Lembo
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Anthony Doing
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Mitul Patel
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - John N Bahadorani
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Jeffrey W Moses
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Ajay J Kirtane
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Manish Parikh
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Ziad A Ali
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Sanjog Kalra
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Phuong-Khanh J Nguyen-Trong
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Barbara A Danek
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Judit Karacsonyi
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Bavana V Rangan
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Michele K Roesle
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Craig A Thompson
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Subhash Banerjee
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Emmanouil S Brilakis
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.).
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Suzuki Y, Tsuchikane E, Katoh O, Muramatsu T, Muto M, Kishi K, Hamazaki Y, Oikawa Y, Kawasaki T, Okamura A. Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusion Performed by Highly Experienced Japanese Specialists. JACC Cardiovasc Interv 2017; 10:2144-2154. [DOI: 10.1016/j.jcin.2017.06.024] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/11/2017] [Accepted: 06/15/2017] [Indexed: 11/17/2022]
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25
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Nakachi T, Kohsaka S, Yamane M, Muramatsu T, Okamura A, Kashima Y, Matsuno S, Sakurada M, Kijima M, Tanabe M, Habara M. Impact of Hemodialysis on Procedural Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion: Insights From the Japanese Multicenter Registry. J Am Heart Assoc 2017; 6:JAHA.117.006431. [PMID: 29021271 PMCID: PMC5721853 DOI: 10.1161/jaha.117.006431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Among patients treated with percutaneous coronary intervention for chronic total occlusion (CTO‐PCI), patients on long‐term hemodialysis are at significantly high risk for cardiovascular mortality and morbidity. However, clinical or angiographic predictors that might aid in better patient selection remain unclear. We aimed to assess the acute impact of hemodialysis in patients who underwent CTO‐PCI. Methods and Results The Retrograde Summit registry is a multicenter, prospective registry of patients undergoing CTO‐PCI at 65 Japanese centers. Patient characteristics and procedural outcomes of 4749 patients were analyzed, according to the presence (n=313) or absence (n=4436) of baseline hemodialysis. A prediction model for technical failure among hemodialysis patients was also developed. The technical success rate of CTO‐PCI was significantly lower in hemodialysis than in nonhemodialysis patients (78.0% versus 89.1%, P<0.001). The rates of in‐hospital major adverse cardiac and cerebrovascular events were similar between the 2 groups (1.6% versus 0.9%, P=0.24). Irrespective of clinical/angiographic characteristics or previously developed scoring systems, hemodialysis independently predicted technical failure for CTO‐PCI. Among hemodialysis patients, predictors of technical failure were blunt stump (odds ratio 2.45, 95% confidence interval, 1.15–5.21, P=0.021), severe lesion calcification (odds ratio 2.50, 95% confidence interval, 1.19–5.24, P=0.015), and absence of diabetes mellitus (odds ratio 3.15, 95% confidence interval, 1.49–6.64, P=0.003). In hemodialysis patients without these predictors, the technical success rate was 96.2%. Conclusions Hemodialysis is significantly associated with technical failure. Contemporary CTO‐PCI seems feasible and safe in selected hemodialysis patients.
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Affiliation(s)
- Tatsuya Nakachi
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahisa Yamane
- Cardiology Department, Saitama Sekishinkai Hospital, Saitama, Japan
| | | | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshifumi Kashima
- Division of Cardiology, Sapporo Cardiovascular Clinic, Hokkaido, Japan
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Masami Sakurada
- Department of Cardiology, Tokorozawa Heart Center, Saitama, Japan
| | - Mikihiko Kijima
- Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
| | - Masaki Tanabe
- Department of Cardiology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | - Maoto Habara
- Department of Cardiology, Toyohashi Heart Center, Aichi, Japan
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Behnes M, Mashayekhi K. Chronic Total Occlusion (CTO): Scientific Benefit and Principal Interventional Approach. Interv Cardiol 2017. [DOI: 10.5772/intechopen.68303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Controlled antegrade intimal tracking with subintimal balloon inflation as a novel bailout technique for chronic total occlusion after failed intravascular ultrasound-guided parallel wire technique. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:521-525. [PMID: 28476438 DOI: 10.1016/j.carrev.2017.04.013] [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: 02/26/2017] [Accepted: 04/19/2017] [Indexed: 11/20/2022]
Abstract
Failure to cross with a guidewire is the most common reason for failure of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). In cases of CTO PCI with no interventional collaterals, an intravascular ultrasound (IVUS)-guided parallel wire technique is usually the last-resort procedure. Failure of this technique sometimes causes enlarged subintimal space, resulting in procedure failure. We present a successful second attempt at left anterior descending artery CTO PCI with no interventional collaterals. After IVUS-guided parallel wire technique failed with an enlarged subintimal space, successful antegrade wire crossing was achieved using controlled antegrade intimal tracking with balloon inflation in the subintimal space to deflect a second wire. This technique may be useful as a bailout strategy in otherwise-failed CTO PCI with an enlarged subintimal space.
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Dautov R, Urena M, Nguyen C, Gibrat C, Rinfret S. Safety and effectiveness of the surfing technique to cross septal collateral channels during retrograde chronic total occlusion percutaneous coronary intervention. EUROINTERVENTION 2017; 12:e1859-e1867. [DOI: 10.4244/eij-d-16-00650] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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29
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A pitfall in selecting promising septal collateral channels in percutaneous coronary intervention with a retrograde approach. Res Cardiovasc Med 2017. [DOI: 10.5812/cardiovascmed.39298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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30
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Ojeda S, Pan M, Gutiérrez A, Romero M, Chavarría J, de Lezo JS, Mazuelos F, Pardo L, Hidalgo F, Carrasco F, Segura J, Durán E, Ferreiro C, Sánchez JJ, Rodríguez S, Oneto J, de Lezo JS. Bifurcation lesions involved in the recanalization process of coronary chronic total occlusions: Incidence, treatment and clinical implications. Int J Cardiol 2016; 230:432-438. [PMID: 28041711 DOI: 10.1016/j.ijcard.2016.12.088] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/20/2016] [Accepted: 12/16/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The presence of a bifurcation (BL) in the context of a coronary chronic total occlusion (CTO) represents an additional difficulty. This study analyzes the incidence of BLs in CTO recanalization, the treatment, predictors of bifurcation technical success and their clinical impact. METHODS AND RESULTS BLs with a side branch (SB) ≥2.0mm located proximally, distally or within the occluded segment were observed in 130 (33%) of 391 CTO. Provisional stenting was the strategy more frequently used (94%). Bifurcation success (stenosis <30% in main vessel and TIMI flow III in both branches) was achieved in 105 patients (81%). In the remaining 25 (19%), the TIMI flow at the SB was <III. Predictors of bifurcation success were baseline SB wiring (OR 0.01, 95% CI: 0.001-0.09; p<0.01), the absence of dissection across the bifurcation (OR 0.10, 95% CI: 0.02-0.49; p<0.01) and non-true BLs (OR 0.16, 95% CI: 0.04-0.68; p<0.05). Regarding in-hospital results, patients with final TIMI flow <III at the SB had a higher incidence of periprocedural MI (32% vs 4.8%; p<0.01). Subsequently, the rate of MI was higher in patients with CTO-BLs than in those without BLs. At follow-up, there were no differences in the event rate between CTO-BLs and non CTO-BLs (7.7% vs 9.5%, p=ns) CONCLUSIONS: BLs in CTO is a frequent finding and could be approached as regular bifurcations. The primary success was low and this was associated with a higher incidence of periprocedural MI. Baseline SB wiring was a powerful predictor of technical success.
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Affiliation(s)
- Soledad Ojeda
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
| | - Manuel Pan
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | | | - Miguel Romero
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Jorge Chavarría
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Javier Suárez de Lezo
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Francisco Mazuelos
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Laura Pardo
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Francisco Hidalgo
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Francisco Carrasco
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - José Segura
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Enrique Durán
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Carlos Ferreiro
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - José J Sánchez
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Sara Rodríguez
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Jesús Oneto
- Jerez Hospital, Department of Cardiology, Jerez de la Frontera, Spain
| | - Jose Suárez de Lezo
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
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Teramoto T, Tsuchikane E, Yamamoto M, Matsuo H, Kawase Y, Suzuki Y, Kanou S, Shimura T, Sato H, Habara M, Nasu K, Kimura M, Kinoshita Y, Terashima M, Matsubara T, Suzuki T. Successful revascularization improves long-term clinical outcome in patients with chronic coronary total occlusion. IJC HEART & VASCULATURE 2016; 14:28-32. [PMID: 28616560 PMCID: PMC5454156 DOI: 10.1016/j.ijcha.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/16/2016] [Indexed: 11/18/2022]
Abstract
Background Following the development of breakthrough techniques for percutaneous coronary intervention (PCI) in the treatment of chronic total occlusions (CTO), the initial success rate of PCI in CTO lesions (CTO-PCI) has improved; however, there are few reports regarding the effects of successful CTO revascularization on long-term mortality in Japan. The aim of this study was to compare the long-term clinical outcomes of patients with successful versus failed CTO recanalization and to identify related factors. Methods and results From all PCI procedures performed in our hospital between 2006 and 2013, CTO-PCIs were extracted and classified into two groups: PCI success (n = 656 patients) and PCI failure (n = 82 patients). Patients with successful procedures only on a second attempt, CTO-PCI in small branches, or CTOs in more than one vessel were excluded. Survival was determined from a telephone interview or the consultation history in the outpatient clinic. Initial angiographic success was achieved in 88.9% of the patients. A Kaplan–Meier plot with log-rank analysis showed that cumulative all-cause death was significantly lower in the success group than in the failure group (p = 0.0003; average follow-up duration in success group vs. failure group was 1531.3 ± 33.5 vs. 1565.3 ± 97.5 days, p = 0.7). Moreover, the rate of evident cardiac death was significantly lower in the success group than in the failure group (3.5% [23/656] vs. 15.9% [13/82], p < 0.0001). Conclusions This study suggests that successful revascularization in patients with CTO improves their long-term clinical outcomes.
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Affiliation(s)
- Tomohiko Teramoto
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Masanori Yamamoto
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Yoriyasu Suzuki
- Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Seiji Kanou
- Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Tetsurou Shimura
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Hirotomo Sato
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Maoto Habara
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Kenya Nasu
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Masashi Kimura
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Yoshihisa Kinoshita
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Mitsuyasu Terashima
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Tetsuo Matsubara
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Takahiko Suzuki
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
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Parikh SA, Pighi M, Di Mario C. Material Selection. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sahil A. Parikh
- Harrington Heart & Vascular Institute; Case Western Reserve University School of Medicine; Cleveland OH USA
| | - Michele Pighi
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London UK
| | - Carlo Di Mario
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London UK
- National Heart & Lung Institute; Imperial College London; UK
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[Chronic coronary occlusions : When and how should revascularization be performed?]. Herz 2016; 41:585-590. [PMID: 27484494 DOI: 10.1007/s00059-016-4464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronic occlusion of coronary arteries also known as chronic total occlusions (CTO) are found in approximately 20 % of patients undergoing percutaneous coronary interventions (PCI) and in approximately 50 % of patients after coronary artery bypass grafts (CABG). As a result of technical advancements in retrograde recanalization techniques specialized centers can now achieve success rates of over 85 %, regardless of the CTO anatomy. Given the complexity of retrograde CTO techniques, a consensus paper issued by the Euro CTO Club requires interventional cardiologists to have sufficient experience in antegrade approaches (>300 antegrade CTO cases and >50 per year) with an additional training program (25 retrograde cases each as first and second operating surgeon) before becoming a qualified independent retrograde surgeon. The increased investment in time and technical resources can only be justified if the patient has a clear clinical benefit. This technical advancement and the progressively clearer evidence that complete revascularization can be achieved in patients with multivessel coronary artery disease have attracted growing interest in recent years from interventional cardiologists in the recanalization of CTO.
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Christopoulos G, Kandzari DE, Yeh RW, Jaffer FA, Karmpaliotis D, Wyman MR, Alaswad K, Lombardi W, Grantham JA, Moses J, Christakopoulos G, Tarar MNJ, Rangan BV, Lembo N, Garcia S, Cipher D, Thompson CA, Banerjee S, Brilakis ES. Development and Validation of a Novel Scoring System for Predicting Technical Success of Chronic Total Occlusion Percutaneous Coronary Interventions: The PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Score. JACC Cardiovasc Interv 2016; 9:1-9. [PMID: 26762904 DOI: 10.1016/j.jcin.2015.09.022] [Citation(s) in RCA: 240] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/10/2015] [Accepted: 09/10/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This study sought to develop a novel parsimonious score for predicting technical success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) performed using the hybrid approach. BACKGROUND Predicting technical success of CTO PCI can facilitate clinical decision making and procedural planning. METHODS We analyzed clinical and angiographic parameters from 781 CTO PCIs included in PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) using a derivation and validation cohort (2:1 sampling ratio). Variables with strong association with technical success in multivariable analysis were assigned 1 point, and a 4-point score was developed from summing all points. The PROGRESS CTO score was subsequently compared with the J-CTO (Multicenter Chronic Total Occlusion Registry in Japan) score in the validation cohort. RESULTS Technical success was 92.9%. On multivariable analysis, factors associated with technical success included proximal cap ambiguity (beta coefficient [b] = 0.88), moderate/severe tortuosity (b = 1.18), circumflex artery CTO (b = 0.99), and absence of "interventional" collaterals (b = 0.88). The resulting score demonstrated good calibration and discriminatory capacity in the derivation (Hosmer-Lemeshow chi-square = 2.633; p = 0.268, and receiver-operator characteristic [ROC] area = 0.778) and validation (Hosmer-Lemeshow chi-square = 5.333; p = 0.070, and ROC area = 0.720) subset. In the validation cohort, the PROGRESS CTO and J-CTO scores performed similarly in predicting technical success (ROC area 0.720 vs. 0.746, area under the curve difference = 0.026, 95% confidence interval = -0.093 to 0.144). CONCLUSIONS The PROGRESS CTO score is a novel useful tool for estimating technical success in CTO PCI performed using the hybrid approach.
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Affiliation(s)
- Georgios Christopoulos
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Robert W Yeh
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | - Georgios Christakopoulos
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Muhammad Nauman J Tarar
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bavana V Rangan
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Daisha Cipher
- College of Health Innovation, University of Texas at Arlington, Arlington, Texas
| | | | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emmanouil S Brilakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
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Suzuki Y, Muto M, Yamane M, Muramatsu T, Okamura A, Igarashi Y, Fujita T, Nakamura S, Oida A, Tsuchikane E. Independent predictors of retrograde failure in CTO-PCI after successful collateral channel crossing. Catheter Cardiovasc Interv 2016; 90:E11-E18. [DOI: 10.1002/ccd.26785] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/11/2016] [Accepted: 08/19/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Yoriyasu Suzuki
- Division of Cardiovascular Medicine; Nagoya Heart Center; Aichi Japan
| | - Makoto Muto
- Division of Cardiology; Saitama Prefecture Cardiovascular and Respiratory Center; Saitama Japan
| | - Masahisa Yamane
- Cardiology Department; Saitama Sekishinkai Hospital; Saitama Japan
| | - Toshiya Muramatsu
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Atsunori Okamura
- Division Of Cardiology; Sakurabashi-Watanabe Hospital; Osaka Japan
| | - Yasumi Igarashi
- Cardiovascular Center; Japan Community Health care Organization Hokkaido Hosptal; Hokkaido Japan
| | - Tsutomu Fujita
- Division of Cardiology; Sapporo Cardiovascular Clinic; Hokkaido Japan
| | | | - Akitsugu Oida
- Department of Cardiology; Takase Clinic; Gunma Japan
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Implantation meets intervention: retrograde wiring for coronary vein angioplasty during CRT implantation. Clin Res Cardiol 2016; 105:1051-1053. [PMID: 27576560 DOI: 10.1007/s00392-016-1032-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
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Nakabayashi K, Okada H, Oka T. The use of a cutting balloon in contemporary reverse controlled antegrade and retrograde subintimal tracking (reverse CART) technique. Cardiovasc Interv Ther 2016; 32:263-268. [PMID: 27401920 DOI: 10.1007/s12928-016-0410-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/04/2016] [Indexed: 11/26/2022]
Abstract
The key concept of reverse controlled antegrade and retrograde tracking (CART) technique is retrograde puncture with a tapered wire to an antegrade balloon (contemporary reverse CART) or new connections between the antegrade and retrograde subintimal space (classical reverse CART). In our case, a 75-year-old man with severe chronic total occlusion of the right coronary artery, reverse CART with conventional balloons could not be accomplished. Externalization wiring was completed by contemporary reverse CART using a cutting balloon as an antegrade balloon to improve the fenestration force of the retrograde guidewire. Thus, the use of a cutting balloon for contemporary reverse CART might be promising.
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Affiliation(s)
- Keisuke Nakabayashi
- Department of Cardiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan.
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Toshiaki Oka
- Department of Cardiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
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Mashayekhi K, Behnes M, Valuckiene Z, Bryniarski L, Akin I, Neuser H, Neumann FJ, Reifart N. Comparison of the ipsi-lateral versus contra-lateral retrograde approach of percutaneous coronary interventions in chronic total occlusions. Catheter Cardiovasc Interv 2016; 89:649-655. [PMID: 27377426 DOI: 10.1002/ccd.26611] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/22/2016] [Accepted: 05/02/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Retrograde recanalization of coronary chronic total occlusions (CTO) via contralateral (CL) collateral connections (CCs) is successful in 60-70% of patients in whom conventional antegrade approach fails or is unpromising. This study describes our experience with retrograde CTO-PCI via ipsi-lateral (IL) CCs in patients with unfavorable CL CCs. METHODS Between January 2013 and September 2015, 392 consecutive CTO procedures were performed by two high volume CTO-operators and the relevant data were fed into an online registry (ERCTO® EuroCTO-club). Most patients (222/392; 57%) were approached antegradely, whereas 43% were attempted retrogradely (170/392). After exclusion of all procedures performed via bypass-grafts (n = 12), PCI via CL CCs, the CL-group (n = 114/158; 72%), was compared with the IL-group that was attempted via IL CCs (n = 44/158; 28%). RESULTS Both groups were similar with respect to risk factors and morphologic criteria of CTO-severity. The initial primary strategy was successful in 78% in the CL-group and in 68% in the IL-group. In both patient groups, the initial strategy had to be switched in five patients from CL toward IL (4.4%, n = 5/114) and from IL to CL (11.3% n = 5/44). The rate of major complications was 7% (CL) and 5% (IL), respectively (n.s.). After retrograde failure and cross-over to an antegrade controlled re-entry strategy the overall success rates increased to 92% (CL) and 93% (IL). CONCLUSIONS In experienced hands retrograde CTO-PCI via IL CCs appears as safe and successful as the CL approach. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kambis Mashayekhi
- Internal Medicine Clinic II, Helios Vogtland Klinikum Plauen, Plauen, Germany.,Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Zivile Valuckiene
- Internal Medicine Clinic II, Helios Vogtland Klinikum Plauen, Plauen, Germany.,Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Leszek Bryniarski
- Department of Cardiology, Interventional Electrocardiology and Hypertension; Institute of Cardiology, Jagiellonian University Medical College, Krakau, Poland
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hans Neuser
- Internal Medicine Clinic II, Helios Vogtland Klinikum Plauen, Plauen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany
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Tamburino C, Capranzano P. Retrograde Approach for Chronic Total Occlusion Percutaneous Coronary Intervention: The Paradox of Choice. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.004023. [PMID: 27307563 DOI: 10.1161/circinterventions.116.004023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Corrado Tamburino
- From the Cardiovascular Department, Ferrarotto Hospital, University of Catania, Italy.
| | - Piera Capranzano
- From the Cardiovascular Department, Ferrarotto Hospital, University of Catania, Italy
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McEntegart MB, Badar AA, Ahmad FA, Shaukat A, MacPherson M, Irving J, Strange J, Bagnall AJ, Hanratty CG, Walsh SJ, Werner GS, Spratt JC. The collateral circulation of coronary chronic total occlusions. EUROINTERVENTION 2016; 11:e1596-603. [PMID: 27056120 DOI: 10.4244/eijv11i14a310] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Despite advances in understanding the physiological role of collaterals in coronary chronic total occlusions (CTOs), collateral anatomy remains poorly defined. Our aim was to define the anatomy and interventional utility of collaterals within a large population of patients with CTOs. METHODS AND RESULTS We studied the coronary angiograms of 481 patients with 519 CTOs at six centres in the U.K. over four years. Detailed angiographic analysis was performed by interventional cardiologists specialising in CTO percutaneous coronary intervention (PCI). All visible collaterals with a collateral connection (CC) grade ≥1 were recorded. A subgroup of CTOs (n=277) was assessed for interventional capability, defined as whether the collateral supply was able to facilitate retrograde access. We described 45 different collateral patterns: 20 in right coronary artery (RCA), 13 in left anterior descending (LAD), and 12 in circumflex artery CTOs. Septal collaterals from the LAD to the right posterior descending artery (RPDA), and from the posterior descending artery to the LAD were most common, and most often considered as having "interventional capability". CONCLUSIONS This is the largest analysis of collateral circulation anatomy in a population of patients with CTOs. We anticipate that these data will be of significant benefit in angiographic analysis and procedure planning for CTO PCI.
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Chai WL, Agyekum F, Zhang B, Liao HT, Ma DL, Zhong ZA, Wang PN, Jin LJ. Clinical Prediction Score for Successful Retrograde Procedure in Chronic Total Occlusion Percutaneous Coronary Intervention. Cardiology 2016; 134:331-9. [DOI: 10.1159/000444181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/21/2016] [Indexed: 11/19/2022]
Abstract
Objective: To develop and validate a prediction score for a successful retrograde procedure in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: A total of 228 CTO lesions in 223 patients who underwent PCI by retrograde approach were analyzed. All subjects were randomly grouped to a derivation set and a validation set at a ratio of 2:1. A successful retrograde procedure was set as the end point. Each of the identified predictors for the end point by logistic regression was assigned 1 point and summed. Results: Independent predictors of a successful retrograde procedure were Werner's score [odds ratio (OR) 4.841, 95% confidence interval (CI) 1.952-12.005, p = 0.001], diameter of distal CTO segment (OR 5.263, 95% CI 2.067-13.398, p < 0.001) and tortuous collateral (type b; OR 0.119, 95% CI 0.032-0.444, p = 0.002). The predictive model developed in the derivation set stratified the difficulty of achieving a successful retrograde procedure into 4 grades - very difficult (10.5%), difficult (23.7%), intermediate (50.7%) and easy (15.1%) - and was demonstrated significantly in the validation set: very difficult (15.8%), difficult (18.4%), intermediate (47.4%) and easy (18.4%). The area under the receiver-operating characteristic curve was 0.832 ± 0.042 for the derivation set and 0.912 ± 0.041 for the validation set with an almost equal performance. Conclusions: According to the experience of our center, this model performed excellently in predicting the difficulty in achieving a successful retrograde procedure.
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Visualization of collateral channels with coronary computed tomography angiography for the retrograde approach in percutaneous coronary intervention for chronic total occlusion. J Cardiovasc Comput Tomogr 2016; 10:128-34. [DOI: 10.1016/j.jcct.2016.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 12/01/2015] [Accepted: 01/05/2016] [Indexed: 11/22/2022]
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Shammas NW, Shammas GA, Robken J, Harris T, Madison A, Dinklenburg C, Shammas AN, Harb C, Jerin M. The learning curve in treating coronary chronic total occlusion early in the experience of an operator at a tertiary medical center: The role of the hybrid approach. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:15-8. [DOI: 10.1016/j.carrev.2015.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/25/2015] [Accepted: 09/30/2015] [Indexed: 11/16/2022]
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Tanaka H, Morino Y, Abe M, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, Kato K, Shibata Y, Hiasa Y, Doi O, Yamashita T, Morimoto T, Hinohara T, Fujii T, Mitsudo K. Impact of J-CTO score on procedural outcome and target lesion revascularisation after percutaneous coronary intervention for chronic total occlusion: a substudy of the J-CTO Registry (Multicentre CTO Registry in Japan). EUROINTERVENTION 2016; 11:981-8. [DOI: 10.4244/eijv11i9a202] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Habara M, Tsuchikane E, Muramatsu T, Kashima Y, Okamura A, Mutoh M, Yamane M, Oida A, Oikawa Y, Hasegawa K. Comparison of percutaneous coronary intervention for chronic total occlusion outcome according to operator experience from the Japanese retrograde summit registry. Catheter Cardiovasc Interv 2015; 87:1027-35. [DOI: 10.1002/ccd.26354] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/30/2015] [Accepted: 11/15/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Maoto Habara
- Department of Cardiovascular Medicine; Toyohashi Heart Center; Aichi Japan
| | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine; Toyohashi Heart Center; Aichi Japan
| | - Toshiya Muramatsu
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Yoshifumi Kashima
- Division of Cardiology; Sapporo CardioVascular Clinic; Hokkaido Japan
| | - Atsunori Okamura
- Division of Cardiology; Sakurabashi-Watanabe Hospital; Osaka Japan
| | - Makoto Mutoh
- Division of Cardiology; Saitama Prefecture Cardiovascular and Respiratory Center; Saitama Japan
| | - Masahisa Yamane
- Cardiology Department; Saitama Sekishinkai Hospital; Saitama Japan
| | - Akitsugu Oida
- Department of Cardiology; Takase Clinic; Gunma Japan
| | - Yuji Oikawa
- Department of Cardiovascular; the Cardiovascular Institute; Tokyo Japan
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Okamura A, Yamane M, Muto M, Matsubara T, Igarashi Y, Nakamura S, Muramatsu T, Fujita T, Oida A, Tsuchikane E. Complications during retrograde approach for chronic coronary total occlusion: Sub-analysis of Japanese multicenter registry. Catheter Cardiovasc Interv 2015; 88:7-14. [DOI: 10.1002/ccd.26317] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 09/16/2015] [Accepted: 10/09/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Atsunori Okamura
- Division of Cardiology; Sakurabashi Watanabe Hospital; Osaka Japan
| | - Masahisa Yamane
- Cardiology Department; Saitama Sekishinkai Hospital; Saitama Japan
| | - Makoto Muto
- Division of Cardiology; Saitama Prefecture Cardiovascular and Respiratory Center; Saitama Japan
| | | | - Yasumi Igarashi
- Japan Community Health Care Organization Hokkaido Hospital; Cardiovascular Center; Hokkaido Japan
| | | | - Toshiya Muramatsu
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Tsutomu Fujita
- Division of Cardiology; Sapporo CardioVascular Clinic; Hokkaido Japan
| | - Akitsugu Oida
- Department of Cardiology; Takase Clinic; Gunma Japan
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Bijuklic K, Schwencke C, Schofer J. Recanalization of chronic total coronary occlusions--high success rate despite a restrictive use of the retrograde approach. Catheter Cardiovasc Interv 2015; 87:E183-91. [PMID: 26424467 DOI: 10.1002/ccd.26168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 07/27/2015] [Indexed: 11/10/2022]
Abstract
AIM The retrograde approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is increasingly being used as a first-line intervention despite a higher radiation exposure, contrast volume, and a higher major adverse cardiac event (MACE) rate compared with the antegrade approach. It was aimed to evaluate the overall success rate of CTO-PCI over time when the retrograde approach was restrictively used only after a failed antegrade attempt. METHODS AND RESULTS In a prospective single operator registry from January 2008 to December 2012 about 436 consecutive patients underwent a CTO-PCI. Mean age was 63.4 ± 10.3 years, and 86% were male. The overall success rate improved significantly over time [68% (first quartile) to 91% (fourth quartile), P < 0.001] due to a significant increase of the antegrade success rate. This could be achieved by a retrograde approach of less than 20% with no change over time. The overall in-hospital MACE rate was 0.69% with no difference between antegrade and retrograde procedures. CONCLUSIONS A high CTO-PCI success rate of above 90% could be achieved with a restrictive use of the retrograde technique.
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Affiliation(s)
- Klaudija Bijuklic
- Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany
| | - Carsten Schwencke
- Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany
| | - Joachim Schofer
- Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany
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Real-World Use and Appropriateness of Coronary Interventions for Chronic Total Occlusion (from a Japanese Multicenter Registry). Am J Cardiol 2015; 116:858-64. [PMID: 26183792 DOI: 10.1016/j.amjcard.2015.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 06/10/2015] [Accepted: 06/10/2015] [Indexed: 12/14/2022]
Abstract
Little is known about the outcomes and indications of chronic total occlusion percutaneous coronary intervention (CTO-PCI), other than in high-volume centers. We sought to provide a real-world overview of the clinical outcomes and appropriateness of PCI for CTO. The analysis included 4,950 consecutive PCIs for nonacute indications registered in the multicenter Japanese PCI registry in collaboration with the US National Cardiovascular Data Registry (Cath-PCI). Data included demographics, clinical outcomes (procedural success and complication rates), and the indication appropriateness, based on the 2012 appropriate use criteria for revascularization. The overall procedural success and major adverse cardiac event rates of 501 cases with CTO-PCI (10.1%) were 76% and 3.2%, respectively. Based on the criteria, mapping failures occurred in 2,521 procedures; the remaining 2,429 PCIs were successfully mapped. The CTO-PCIs were performed for more appropriate indications than PCIs for lesions without CTO. The rate of inappropriate indications was significantly lower in CTO-PCIs than in non-CTO-PCIs (23.0% vs 31.4%, p = 0.04). Only 17% of CTO-PCIs were directly assigned to CTO-specific scenarios because such scenarios are only intended for "Lone" CTO; the rest of the CTO-PCI cases were secondarily mapped to non-CTO-specific scenarios. In conclusion, as many as 10% of the elective PCIs were performed for CTO lesions in a contemporary multicenter Japanese PCI registry; CTO-PCI was associated with lower procedural success and higher complication rates than non-CTO-PCI. Its indication was relatively appropriate; however, our findings emphasize the need for more rigorous evaluation in terms of the present insufficient CTO-related clinical scenarios.
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Utility of the SYNTAX score in predicting outcomes after coronary intervention for chronic total occlusion. Herz 2015; 40:1090-6. [PMID: 26135461 DOI: 10.1007/s00059-015-4323-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 04/13/2015] [Accepted: 05/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) lesions are a challenging issue. When dealing with complex CTO lesions in patients undergoing percutaneous coronary intervention (PCI), it is important to evaluate not only the CTO lesion itself but also atherosclerotic lesions of the whole coronary artery tree. The utility of the SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Trial) score in patients with CTO undergoing PCI is unclear. METHODS This retrospective study included 304 consecutive patients with CTO lesions who underwent PCI. Primary endpoints were procedural failure and major adverse cardiac events (MACE) within 30 days. The SYNTAX and J-CTO (Multicenter CTO Registry in Japan) scores were assessed before the procedures, and patients were divided into two groups according to SYNTAX criteria: high (> 22; n = 158) and low (≤ 22; n = 146) SYNTAX scores. RESULTS Procedural success was achieved in 252 patients (82.9 %). Patients with a high SYNTAX score had significantly lower procedural success than those with a low SYNTAX score (74.7 % versus 91.8 %, p < 0.0001). There were 13 MACE (8.2 %) in patients with high SYNTAX scores and two MACE (1.4 %) in those with low scores. The SYNTAX and J-CTO scores had odds ratios of 3.33 (95 %CI, 1.44-7.74) and 3.64 (95 %CI, 1.24-10.66) for procedural failure. A higher SYNTAX score (> 22) was also an independent predictor of 30-day MACE after PCI (odds ratio = 4.80, 95 %Cl 1.03-22.42). CONCLUSION The SYNTAX score is predictive of procedural failure, as is the J-CTO score. Furthermore, a higher SYNTAX score is strongly associated with an increased risk of 30-day MACE. The SYNTAX score is useful for clinical decision making when treating patients with complex CTO lesions.
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Ojeda S, Pan M, Romero M, Suárez de Lezo J, Mazuelos F, Segura J, Espejo S, Morenate C, Blanco M, Martín P, Medina A, Suárez de Lezo J. Outcomes and computed tomography scan follow-up of bioresorbable vascular scaffold for the percutaneous treatment of chronic total coronary artery occlusion. Am J Cardiol 2015; 115:1487-93. [PMID: 25851795 DOI: 10.1016/j.amjcard.2015.02.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 11/27/2022]
Abstract
Everolimus-eluting bioresorbable vascular scaffold (BVS) implantation in chronic total occlusion (CTO) could provide theoretical advantages at follow-up compared with metallic stents. This study aimed to assess the feasibility of BVS use for the percutaneous treatment of CTO by analyzing clinical outcomes and patency at midterm follow-up. From February 2013 to June 2014, 42 patients with 46 CTOs were treated by BVS implantation. Once the guidewire reached the distal lumen, all the occluded segments were predilated. Postdilation was performed in all patients. A multislice computed tomography was scheduled for all patients at 6 months. The mean age was 58 ± 9 years, 41 (98%) were men and 14 (33%) diabetic. The target vessel was predominantly the left anterior descending artery (22, 48%). According to the Japanese-CTO score, 21 CTOs (46%) were difficult or very difficult. Most cases were treated with an anterograde strategy (34 lesions, 74%). A hybrid procedure with a drug-eluting stent at the distal segment was the applied treatment in 7 CTOs (15%). The mean scaffold length was 43 ± 21 mm. Technical success was achieved in 45 lesions (98%), and 1 patient (2.4%) presented a non-Q periprocedural myocardial infarction. Re-evaluation was obtained in all patients at 6 ± 1 months. Two re-occlusions and a focal restenosis were identified. After 13 ± 5 months of follow-up, there were 2 repeat revascularizations (4.8%). Neither death nor myocardial infarction was documented. In conclusion, BVS for CTO seems to be an interesting strategy with a high rate of technical success and low rate of cardiac events at midterm follow-up in selected patients.
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