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Costa H, Espírito-Santo M, Bispo J, Guedes J, Mimoso J, Palmeiro H, Baptista Gonçalves R, Vinhas H. Clinical outcomes of percutaneous coronary intervention in chronic total occlusion in patients with type 2 diabetes mellitus. Rev Port Cardiol 2024; 43:167-174. [PMID: 38141872 DOI: 10.1016/j.repc.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 12/25/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Coronary chronic total occlusions (CTOs) are relatively common findings in patients with type 2 diabetes mellitus (T2DM). However, the indication for percutaneous coronary intervention (PCI) and its clinical benefit in these patients remain controversial. METHODS A single-center retrospective cohort study with prospectively collected outcomes was carried out with CTO patients undergoing PCI in 2019 and 2020. Patients were divided into two groups according to previous T2DM diagnosis (T2DM and non-T2DM). The primary outcome was recurrence of angina and/or heart failure symptoms and secondary outcomes were myocardial infarction and all-cause mortality. RESULTS A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65±11 years. The primary outcome (total symptom recurrence) occurred in 16.6% of the sample, with no difference between groups (non-T2DM 13.6% vs. T2DM 21.2%, p=0.194) in a two-year follow-up. Angina recurrence was significantly more frequent in T2DM patients (15.2%, p=0.043). The presence of T2DM was not an independent predictor of symptom recurrence (p=0.429, HR 1.37, 95% CI 0.62-2.98). Myocardial infarction and all-cause mortality were also not different between groups (T2DM 1.5%, p=0.786 and 4.5%, p=0.352, respectively, on survival analysis). Independent predictors of all-cause mortality were left ventricular function and creatine clearance (p=0.039, HR 0.92, 95% CI 0.85-0.99 and p=0.013, HR 0.96, 95% CI 0.93-0.99, respectively). CONCLUSIONS T2DM did not influence outcomes in CTO patients undergoing PCI, and its presence should not be a limiting factor in deciding on CTO revascularization.
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Affiliation(s)
- Hugo Costa
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal.
| | | | - João Bispo
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal
| | - João Guedes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal
| | - Jorge Mimoso
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal
| | - Hugo Palmeiro
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal
| | | | - Hugo Vinhas
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal
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Costa H, Espirito-Santo M, Bispo J, Guedes J, Mimoso J, Palmeiro H, Baptista Gonçalves R, Vinhas H. Clinical results of percutaneous coronary intervention in chronic total occlusions of the right coronary artery. Rev Port Cardiol 2024; 43:131-138. [PMID: 38244775 DOI: 10.1016/j.repc.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/21/2023] [Accepted: 07/26/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Coronary chronic total occlusions (CTOs) of the right coronary artery (RCA) are a relatively common finding in the context of coronary angiography. However, the benefit of revascularization remains controversial. METHODS A single-center retrospective cohort analysis prospectively collected outcomes of CTO patients undergoing percutaneous coronary intervention (PCI) in 2019 and 2020. Patients were divided into two groups according to the CTO vessel treated (left coronary artery [LCA]-CTO or RCA-CTO). The primary outcome was defined as the recurrence of angina and/or heart failure (HF) symptoms and secondary outcomes were myocardial infarction (MI) and all-cause mortality. RESULTS A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65±11 years. The primary outcome occurred in 28 (16.6%) patients and was significantly more frequent in RCA-CTO patients (19, 24.7%, p=0.010) in a mean follow-up of 18 months. This was mainly driven by recurrence of HF symptoms (12, 15.6%, p=0.013). Treated RCA-CTO was an independent predictor of the primary outcome (p=0.019, HR 2.66, 95% CI 1.17-6.05). MI and mortality rates were no different between groups (RCA-CTO with 1.3%, p=0.361 and 2.6%, p=0.673, respectively, on survival analysis). Left ventricular ejection fraction was an independent predictor of mortality (p=0.041, HR 0.93, 95% CI 0.87-0.99). CONCLUSIONS Revascularization of CTO lesions by PCI was associated with low rates of symptom recurrence, and clinical outcomes showed no differences regardless of which artery was treated. Recanalization of RCA-CTO was less beneficial in reducing the recurrence of HF symptoms.
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Affiliation(s)
- Hugo Costa
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.
| | | | - João Bispo
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - João Guedes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Jorge Mimoso
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Hugo Palmeiro
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | | | - Hugo Vinhas
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
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Denby K, Young L, Ellis S, Khatri J. Antegrade wire escalation in chronic total occlusions: State of the art review. Cardiovasc Revasc Med 2023; 55:88-95. [PMID: 37353443 DOI: 10.1016/j.carrev.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
Coronary chronic total occlusion percutaneous coronary intervention treatment algorithms have helped to standardize crossing strategy sequence to improve efficacy and efficiency of CTO interventions based on angiographic criteria. Unfortunately, advanced crossing techniques such as a retrograde and subintimal guidewire tracking and reentry that have accelerated procedural success in more difficult lesions are associated with higher major adverse cardiac event rates as compared with traditional antegrade and intimal guidewire tracking. In this regard, antegrade wire escalation (AWE) remains the most common CTO crossing strategy. In this state of the art review, we outline the techniques employed to maximize the clinical utility of AWE crossing strategy for both novice operators as well as those experienced with the advanced crossing strategies. For the less experienced operator, these techniques may provide a framework to treat more patients safely and effectively without the need to refer to a more advanced operator. Whereas these same techniques may be employed by an advanced operator to improve the technical success in procedures requiring more advanced crossing strategies.
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Affiliation(s)
- Kara Denby
- Interventional Cardiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America
| | - Laura Young
- Interventional Cardiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America
| | - Stephen Ellis
- Interventional Cardiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America
| | - Jaikirshan Khatri
- Interventional Cardiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America.
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Alawneh Y, Zhou JJ, Sewani A, Tahmasebi M, Roy TL, Kayssi A, Dueck AD, Wright GA, Tavallaei MA. Experimental Protocol and Phantom Design and Development for Performance Characterization of Conventional Devices for Peripheral Vascular Interventions. Ann Biomed Eng 2023:10.1007/s10439-023-03160-x. [PMID: 36808383 DOI: 10.1007/s10439-023-03160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023]
Abstract
Conventional catheter-based interventions for treating peripheral artery disease suffer high failure and complication rates. The mechanical interactions with the anatomy constrain catheter controllability, while their length and flexibility limit their pushability. Also, the 2D X-ray fluoroscopy guiding these procedures fails to provide sufficient feedback about the device location relative to the anatomy. Our study aims to quantify the performance of conventional non-steerable (NS) and steerable (S) catheters in phantom and ex vivo experiments. In a 10 mm diameter, 30 cm long artery phantom model, with four operators, we evaluated the success rate and crossing time in accessing 1.25 mm target channels, the accessible workspace, and the force delivered through each catheter. For clinical relevance, we evaluated the success rate and crossing time in crossing ex vivo chronic total occlusions. For the S and NS catheters, respectively, users successfully accessed 69 and 31% of the targets, 68 and 45% of the cross-sectional area, and could deliver 14.2 and 10.2 g of mean force. Using a NS catheter, users crossed 0.0 and 9.5% of the fixed and fresh lesions, respectively. Overall, we quantified the limitations of conventional catheters (navigation, reachable workspace, and pushability) for peripheral interventions; this can serve as a basis for comparison with other devices.
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Affiliation(s)
- Yara Alawneh
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - James J Zhou
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - Alykhan Sewani
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - Mohammadmahdi Tahmasebi
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - Trisha L Roy
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - Ahmed Kayssi
- Department of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Andrew D Dueck
- Department of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Graham A Wright
- University of Toronto, Toronto, ON, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - M Ali Tavallaei
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada.
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.
- Department of ECBE, Toronto Metropolitan University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
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Haraguchi T, Fujita T, Kashima Y, Tsujimoto M, Watanabe T, Sugie T, Hachinohe D, Kaneko U, Kobayashi K, Kanno D, Sato K. The "Direct tip injection in occlusive lesions (DIOL)" fashion. CVIR Endovasc 2021; 4:87. [PMID: 34905136 PMCID: PMC8671592 DOI: 10.1186/s42155-021-00276-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background The successful intervention for peripheral artery disease is limited by complex chronic total occlusions (CTOs). During CTO wiring, without the use of intravascular or extravascular ultrasound, the guidewire position is unclear, except for calcified lesions showing the vessel path. To solve this problem, we propose a novel guidewire crossing with plaque modification method for complex occlusive lesions, named the “Direct tip Injection in Occlusive Lesions (DIOL)” fashion. Main text The “DIOL” fashion utilizes the hydraulic pressure of tip injection with a general contrast media through a microcatheter or an over-the-wire balloon catheter within CTOs. The purposes of this technique are 1) to visualize the “vessel road” of the occlusion from expanding a microchannel, subintimal, intramedial, and periadventitial space with contrast agent and 2) to modify plaques within CTO to advance CTO devices safely and easily. This technique creates dissections by hydraulic pressure. Antegrade-DIOL may create dissections which extend to and compress a distal lumen, especially in below-the-knee arteries. A gentle tip injection with smaller contrast volume (1–2 ml) should be used to confirm the tip position which is inside or outside of a vessel. On the other hand, retrograde-DIOL is used with a forceful tip injection of moderate contrast volume up to 5-ml to visualize vessel tracks and to modify the plaques to facilitate the crossing of CTO devices. Case-1 involved a severe claudicant due to right superficial femoral artery occlusion. After the conventional bidirectional subintimal procedure failed, we performed two times of retrograde-DIOL fashion, and the bidirectional subintimal planes were successfully connected. After two stents implantation, a sufficient flow was achieved without complications and restenosis for two years. Case-2 involved multiple wounds in the heel due to ischemia caused by posterior tibial arterial occlusion. After the conventional bidirectional approach failed, retrograde-DIOL was performed and retrograde guidewire successfully crossed the CTO, and direct blood flow to the wounds was obtained after balloon angioplasty. The wounds heeled four months after the procedure without reintervention. Conclusions The DIOL fashion is a useful and effective method to facilitate CTO treatment.
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Affiliation(s)
- Takuya Haraguchi
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan.
| | - Tsutomu Fujita
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Yoshifumi Kashima
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Masanaga Tsujimoto
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Tomohiko Watanabe
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Takuro Sugie
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Daisuke Hachinohe
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Umihiko Kaneko
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Ken Kobayashi
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Daitaro Kanno
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Katsuhiko Sato
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
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Haraguchi T, Kashima Y, Tsujimoto M, Watanabe T, Shitan H, Sugie T, Hachinohe D, Kaneko U, Kobayashi K, Kanno D, Sato K, Fujita T. The "needle re-entry" technique for infrainguinal arterial calcified occlusive lesions. CVIR Endovasc 2021; 4:85. [PMID: 34894315 DOI: 10.1186/s42155-021-00274-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Vascular calcification is a predictor of poor clinical outcome during and after endovascular intervention. Guidewire crossing techniques and devices have been developed, but chronic total occlusions (CTOs) with severe calcification often prevent subintimal re-entry. We propose a novel guidewire crossing approach combined needle rendezvous with balloon snare technique, named the “needle re-entry” technique, for treatment of complex occlusive lesions. Main text A 73-year-old female with severe claudication in her right calf with ankle brachial index of 0.62, and a computed tomography angiogram showed a long occlusion with diffuse calcification in superficial femoral artery. She was referred to our department to have peripheral interventions. Since the calcified vascular wall of the lesion prevented the successful re-entry, the “needle re-entry” was performed. First, a retrograde puncture of the SFA, distally to the occlusion, was performed and an 0.018-in. guidewire with a microcatheter was inserted to establish a retrograde fashion. Second, an antegrade 5.0-mm balloon was advanced into a subintimal plane and balloon dilation at 6 atm was maintained. Third, an 18-gauge needle was antegradely inserted from distal thigh to the dilated 5.0-mm balloon. After confirming a balloon rupture by the needle penetration, we continued to insert the needle to meet the retrograde guidewire tip. Then, a retrograde 0.014-in. guidewire was carefully advanced into the needle hole, named the “needle rendezvous” technique. After further guidewire advancement to accomplish a guidewire externalization, the needle was removed. Finally, since the guidewire was passing through the 5.0-mm ruptured balloon, the balloon was withdrawn, and the guidewire was caught with the balloon and successfully advanced into the antegrade subintimal space, named the “balloon snare” technique. After the guidewire was advanced into the antegrade guiding sheath and achieved a guidewire externalization, an endovascular stent graft and an interwoven stent were deployed to cover the lesion. After postballoon dilation, an angiography showed a satisfactory result without complications. No restenosis, reintervention, and limb loss have been observed for one year follow-up period after this technique. Conclusions The “needle re-entry” technique is a useful guidewire crossing technique to revascularize femoropopliteal complex CTOs with severe calcification which prevent the achievement of guidewire crossing with the conventional procedures. Supplementary Information The online version contains supplementary material available at 10.1186/s42155-021-00274-y.
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Hirano S, Funatsu A, Nakamura S, Ikeda T. Endovascular therapy for severely calcified plaque at the superficial femoral artery using myocardial biopsy forceps. CVIR Endovasc 2021; 4:69. [PMID: 34524569 PMCID: PMC8443709 DOI: 10.1186/s42155-021-00257-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, the success rate of EVT for treating CTO of the SFA is high; however, EVT is still found to be insufficient in treating CTOs with severely calcified lesions. Even if the guidewire crosses the lesion, the calcifications may still cause difficulties during stent expansion. MAIN TEXT A 78-year-old male had been reported to have intermittent claudication with chronic total occlusion (CTO) of the right superficial femoral artery (SFA). Angiography revealed severely calcified plaque (Angiographic calcium score: Group4a [1]) at the ostium of the SFA. Stenting posed a risk of underexpansion, causing the plaque to shift to the deep femoral artery. we decided to remove the calcified plaque using biopsy forceps. After removing the extended calcified plaque, the guidewire could cross easily, and the self-expandable stent was well dilated without causing the plaque to shift to the DFA. CONCLUSIONS Biopsy forceps may be used in some endovascular cases to remove severely calcified lesions. To ensure the safety of the patient, the physician must be adept at performing this technique before attempting it.
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Affiliation(s)
- Shojiro Hirano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, 143-8540, Tokyo, Japan.
| | | | | | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine Graduate School of Medicine, Tokyo, Ota-ku, Japan
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Patrone L, Korosoglou G, Dharmarajah B, Theivacumar S, Antaredja M, Oberacker R, Tilemann L, Blessing E. Retrograde use of the Outback™ re-entry catheter in complex infrainguinal arterial recanalizations. J Vasc Surg 2021; 75:177-185.e1. [PMID: 34302937 DOI: 10.1016/j.jvs.2021.07.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 07/13/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Retrograde recanalizations gained increasing recognition in complex arterial occlusive disease. Re-entry devices are a well described adjunct for antegrade recanalizations. We present our experience with retrograde, infrainguinal recanalizations using the Outback™ re-entry catheter in challenging chronic total occlusions. MATERIALS AND METHODS We report data from a retrospective multicenter registry in complex retrograde recanalizations. Eligibility criteria included retrograde infrainguinal use of the Outback™ re-entry catheter where both conventional antegrade and retrograde recanalization had been unsuccessful. Procedural outcomes included technical success (defined as successful wire passage and delivery of adjunctive therapy with <30 % residual stenosis), safety (periprocedural complications, e.g. bleeding, vessel injury or occlusion of the artery at the re-entry site, and distal embolizations) and clinical outcome (amputation-free survival and freedom from clinically driven target lesion revascularization). RESULTS Forty-five consecutive patients underwent retrograde, infrainguinal recanalization attempts with the Outback™ re-entry catheter between February 2015 and August 2020. Thirty (67 %) patients had history of open vascular surgery in the index limb. In 4 patients, recanalizations were even more challenging due to previous surgical removal and/or ligation of the proximal segment of the superficial femoral artery. Retrograde access site of the Outback™ catheter was the femoropopliteal segment in 31 (69 %) patients and crural vessels in 14 (31 %) patients. The re-entry target sites were as follows: common femoral artery in 31 (69 %) patients, superficial femoral artery in 9 (20 %) patients, popliteal artery in 1 and below-the-knee arteries in 2 patients. In 4 patients, the needle of the re-entry device was targeted to an inflated balloon, inserted via the antegrade route. The Outback™ re-entry catheter was placed via a 6-French sheath in 19 (42 %) cases and sheathless in 26 (58 %) cases. Technical success was achieved in 41 (91 %) patients There were 2 instances of distal embolizations and 3 bleeding episodes. Amputation free survival was 100 % at 30 days and after 12 months, freedom from clinically driven target lesion revascularization (cd TLR) was 95 % at 30 days and 75 % at 12 months follow-up. Female sex was an independent predictor for cd TLR at 12 months follow-up. CONCLUSION Retrograde use of the Outback™ re-entry catheter in infra-inguinal chronic total occlusions provides an effective and safe endovascular adjunct, when conventional antegrade and retrograde recanalization attempts have failed.
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Zhu Y, Meng S, Chen M, Liu K, Jia R, Li H, Zhu H, Jin Z. Long-term prognosis of chronic total occlusion treated by successful percutaneous coronary intervention in patients with or without diabetes mellitus: a systematic review and meta-analysis. Cardiovasc Diabetol 2021; 20:29. [PMID: 33516214 PMCID: PMC7847176 DOI: 10.1186/s12933-021-01223-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Therefore, the purpose of our study was to investigate the clinical outcomes of CTO-PCI in patients with or without DM. Methods All relevant articles published in electronic databases (PubMed, Embase, and the Cochrane Library) from inception to August 7, 2020 were identified with a comprehensive literature search. Additionally, we defined major adverse cardiac events (MACEs) as the primary endpoint and used risk ratios (RRs) with 95% confidence intervals (CIs) to express the pooled effects in this meta-analysis. Results Eleven studies consisting of 4238 DM patients and 5609 non-DM patients were included in our meta-analysis. For DM patients, successful CTO-PCI was associated with a significantly lower risk of MACEs (RR = 0.67, 95% CI 0.55–0.82, p = 0.0001), all-cause death (RR = 0.46, 95% CI 0.38–0.56, p < 0.00001), and cardiac death (RR = 0.35, 95% CI 0.26–0.48, p < 0.00001) than CTO-medical treatment (MT) alone; however, this does not apply to non-DM patients. Subsequently, the subgroup analysis also obtained consistent conclusions. In addition, our study also revealed that non-DM patients may suffer less risk from MACEs (RR = 1.26, 95% CI 1.02–1.56, p = 0.03) than DM patients after successful CTO-PCI, especially in the subgroup with a follow-up period of less than 3 years (RR = 1.43, 95% CI 1.22–1.67, p < 0.0001). Conclusions Compared with CTO-MT alone, successful CTO-PCI was found to be related to a better long-term prognosis in DM patients but not in non-DM patients. However, compared with non-DM patients, the risk of MACEs may be higher in DM patients after successful CTO-PCI in the drug-eluting stent era, especially during a follow-up period shorter than 3 years.
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Affiliation(s)
- Yong Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Shuai Meng
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
| | - Maolin Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Kesen Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Ruofei Jia
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
| | - Hong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Huagang Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Zening Jin
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China.
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Kalogeropoulos AS, Alsanjari O, Davies JR, Keeble TR, Tang KH, Konstantinou K, Vardas P, Werner GS, Kelly PA, Karamasis GV. Impact of intravascular ultrasound on chronic total occlusion percutaneous revascularization. Cardiovasc Revasc Med 2021; 33:32-40. [PMID: 33461936 DOI: 10.1016/j.carrev.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
AIM We sought to investigate the impact of IVUS use on chronic total occlusion (CTO) PCI using data from a contemporary registry of consecutive patients and applying a propensity score matching analysis. METHODS AND RESULTS We evaluated 514 successful CTO-PCIs, median age: 67 years (IQR: 58-73), 83.5% males. IVUS-guided PCI was performed in 184 (35.8%) of cases. After using 1:1 propensity matching score analysis, two groups of 182 patients each (IVUS-guided vs. angiography-guided CTO-PCI group) were produced to form the study population. In the IVUS-guided group the median maximum stent diameter was larger and the median total stented segment was longer compared to the angiography-guided group [(3.5 mm, IQR: 3.0-4.0 vs. 3.2 mm, IQR: 3.0-3.5, p < 0.001) and (60.0 mm, IQR: 38.0-91.3 vs. 38.0 mm, IQR: 32.0-70.5, p < 0.001), respectively]. In the IVUS-guided group, retrograde recanalization was more frequently encountered compared to the angiography-guided PCI group (30.2% vs. 20.9%, p = 0.04). Procedural time was significantly longer in the IVUS-guided group, without any difference in fluoroscopy time, radiation dose and contrast volume. Multivariate linear regression analysis showed that IVUS use was the strongest independent factor associated with larger maximum diameter stents (p < 0.001) and a strong independent predictor for total stented segment length during CTO-PCI (p < 0.001). Up to 8 years follow-up, there was no difference in the incidence of the composite endpoint of all-cause death, cardiac death, myocardial infarction and target vessel revascularization between the IVUS-guided PCI and the angiography-guided PCI groups (hazard ratio: 13.7% vs. 15.9%, respectively, log-rank: p = 0.67, median follow-up time: 49.0 months, IQR: 33.0-67.0). CONCLUSIONS Use of IVUS in CTO-PCI was associated with larger stent diameter and longer stented segments. Despite more frequent use of IVUS in retrograde CTO-PCI, there was no difference in long-term adverse events between IVUS and angiography CTO-PCI groups; nevertheless, the study was not powered to assess clinical outcomes.
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Affiliation(s)
- Andreas S Kalogeropoulos
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom; Cardiology Department, Mitera General Hospital, Hygeia Group, Athens, Greece
| | - Osama Alsanjari
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom; School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Chelmsford & Cambridge, United Kingdom
| | - John R Davies
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom; School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Chelmsford & Cambridge, United Kingdom
| | - Thomas R Keeble
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom; School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Chelmsford & Cambridge, United Kingdom
| | - Kare H Tang
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Klio Konstantinou
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom; School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Chelmsford & Cambridge, United Kingdom
| | - Panagiotis Vardas
- Cardiology Department, Mitera General Hospital, Hygeia Group, Athens, Greece
| | - Gerald S Werner
- Medizinische Klinik I (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Paul A Kelly
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Grigoris V Karamasis
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom; School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Chelmsford & Cambridge, United Kingdom.
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11
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Gong X, Zhou L, Ding X, Li H, Chen H. A sex-stratified long-term clinical outcome analysis in coronary chronic total occlusion patients. Biol Sex Differ 2021; 12:9. [PMID: 33419425 PMCID: PMC7796539 DOI: 10.1186/s13293-020-00354-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background Differences in outcomes for women and men after percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) patients remain controversial. Herein, we compared the clinical outcomes by sex in CTO patients undergoing PCI. Methods A total of 563 consecutive patients (19% women) who were diagnosed with CTO at a single center in China from June 2017 to December 2019 were included in this study. Three hundred patients were revascularized by PCI, and 263 were not revascularized. The clinical outcomes of these patients stratified by sex were examined. The primary endpoints included the risk of major adverse cardiovascular and cerebrovascular events (MACCE); the secondary endpoint was cardiac death; hazard ratios were generated using multivariable Cox regression. Results Women represented 19% of the cohort (107/563 patients). Women have lower mean body mass index (BMI) and abdominal circumference compared with men; however, the proportion of hypertension, diabetes, and previous coronary heart disease is higher in female patients. At 2-year follow-up, there were no differences between men and women for MACCE (15.8% vs 20.6%, p = 0.234) and cardiac death (3.1% vs 5.6%, p = 0.202). Predictors of CTO recanalization revealed that age < 65 years, absence of prior CABG, no history of DM, and non-triple vessel were predictors of CTO recanalization. Sex did not predict recanalization in this regression model. Successful CTO PCI was associated with reduced MACCE. Conclusion Our study suggests an equal benefit of CTO recanalization with a marked reduction in MACCE in women and men alike. Further dedicated studies are needed to confirm these findings.
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Affiliation(s)
- Xuhe Gong
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Road 95 Yongan Xicheng District, Beijing, 100050, People's Republic of China
| | - Li Zhou
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Road 95 Yongan Xicheng District, Beijing, 100050, People's Republic of China
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Road 95 Yongan Xicheng District, Beijing, 100050, People's Republic of China
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Road 95 Yongan Xicheng District, Beijing, 100050, People's Republic of China.,Department of Internal Medicine, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, 100069, People's Republic of China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Road 95 Yongan Xicheng District, Beijing, 100050, People's Republic of China.
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12
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Gorenchtein M, Rajper N, Green P, Khullar P, Amoruso D, Bulacan CF, Kwan T, Puma J, Ratcliffe J. Transpedal approach for femoral-popliteal chronic total occlusions using the outback® elite re-entry device. CVIR Endovasc 2021; 4:9. [PMID: 33409988 PMCID: PMC7788134 DOI: 10.1186/s42155-020-00203-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background Transpedal access is increasingly utilized for the treatment of peripheral artery disease (PAD). Femoral-popliteal artery chronic total occlusions (CTOs) are some of the most difficult lesion subsets that sometimes require the use of re-entry support devices during percutaneous intervention. Limited data is available on the use of re-entry devices when treating femoral-popliteal CTOs via transpedal access. The aim of this study was to demonstrate the feasibility of using the Outback® Elite re-entry device for the treatment of femoral-popliteal CTOs via the transpedal approach in an outpatient based lab setting. Methods Seventeen patients presented with femoral-popliteal CTOs in which treatment required the use of the Outback® Elite re-entry device. All procedures were performed in a single outpatient based lab. Patients were followed at 1 week and 1 month post-procedure, with lower extremity arterial duplex ultrasound assessment during the 1 month follow-up. Results The average patient age was 78 years-old, with 71% being males. Most patients presented with Rutherford class IV symptoms. Procedural success was achieved in all patients with no requirement to convert to femoral artery access in any of the cases. No immediate post-procedural complications nor at any time during follow-up were observed. Ultrasonography at 1 month follow-up showed patent intervention sites and access site vessels in all patients. Conclusion The use of the Outback® Elite re-entry device for the treatment of femoral-popliteal CTOs via transpedal access is a feasible option and may have potential benefits by avoiding risks associated with traditional femoral artery access.
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Affiliation(s)
- Mike Gorenchtein
- Department of Cardiovascular Medicine, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Naveed Rajper
- Department of Cardiovascular Medicine, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip Green
- Department of Cardiovascular Medicine, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pankaj Khullar
- Department of Cardiovascular Medicine, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Amoruso
- Department of Cardiology, Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christian Franz Bulacan
- Department of Cardiovascular Medicine, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tak Kwan
- Department of Cardiovascular Medicine, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph Puma
- Department of Cardiovascular Medicine, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Justin Ratcliffe
- Department of Cardiovascular Medicine, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Khan MS, Sami F, Singh H, Ullah W, Al-Dabbas M, Changal KH, Mir T, Ali Z, Kabour A. Medical therapy vs early revascularization in diabetics with chronic total occlusions: A meta-analysis and systematic review. World J Cardiol 2020; 12:559-570. [PMID: 33312441 PMCID: PMC7701902 DOI: 10.4330/wjc.v12.i11.559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/30/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Management of chronic total occlusions (CTO) in diabetics is challenging, with a recent trend towards early revascularization [ER: Percutaneous coronary intervention (PCI) and bypass grafting] instead of optimal medical therapy (OMT). We hypothesize that ER improves morbidity and mortality outcomes in diabetic patients with CTOs as compared to OMT. AIM To determine the long term clinical outcomes and to compare morbidity and mortality between OMT and ER in diabetic patients with CTOs. METHODS Potentially relevant published clinical trials were identified in Medline, Embase, chemical abstracts and Biosis (from start of the databases till date) and pooled hazard ratios (HR) computed using a random effects model, with significant P value < 0.05. Primary outcome of interest was all-cause death. Secondary outcomes included cardiac death, prompt revascularization (ER) or repeat myocardial infarction (MI). Due to scarcity of data, both Randomized control trials and observational studies were included. 4 eligible articles, containing 2248 patients were identified (1252 in OMT and 1196 in ER). Mean follow-up was 45-60 mo. RESULTS OMT was associated with a higher all-cause mortality [HR: 1.70, 95% confidence interval (CI): 0.80-3.26, P = 0.11] and cardiac mortality (HR: 1.68, 95%CI: 0.96-2.96, P = 0.07). Results were close to significance. The risk of repeat MI was almost the same in both groups (HR: 0.97, 95%CI: 0.61-1.54, P = 0.90). Similarly, patients assigned to OMT had a higher risk of repeat revascularization (HR: 1.62, 95%CI: 1.36-1.94, P < 0.00001). Sub-group analysis of OMT vs PCI demonstrated higher all-cause (HR: 1.98, 95%CI: 1.36-2.87, P = 0.0003) and cardiac mortality (HR: 1.87, 95%CI: 0.96-3.62, P = 0.06) in the OMT group. The risk of repeat MI was low in the OMT group vs PCI (HR: 0.53, 95%CI: 0.31-0.91, P = 0.02). Data on repeat revascularization revealed no difference between the two (HR: 1.00, 95%CI: 0.52-1.93, P = 1.00). CONCLUSION In diabetic patients with CTO, there was a trend for improved outcomes with ER regarding all-cause and cardiac death as compared to OMT. These findings were reinforced with statistical significance on subgroup analysis of OMT vs PCI.
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Affiliation(s)
- Muhammad Shayan Khan
- Internal Medicine, Mercy Saint Vincent Medical Centre, Toledo, OH 43608, United States.
| | - Farhad Sami
- Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, 66202, United States
| | - Hemindermeet Singh
- Department of Cardiovascular Fellowship, Mercy St Vincent Medical Center and Hospital, Toledo, OH 43608, United States
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, Abington Township, Montgomery County, PA 19001, United States
| | - Ma'en Al-Dabbas
- Department of Cardiovascular Fellowship, Mercy St Vincent Medical Center and Hospital, Toledo, OH 43608, United States
| | - Khalid Hamid Changal
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH 43606, United States
| | - Tanveer Mir
- Internal Medicine, Detroit Medical Center, Detroit, MI 48201, United States
| | - Zain Ali
- Internal Medicine, Abington Jefferson Health, Philadelphia, PA 19001, United States
| | - Ameer Kabour
- Department of Cardiovascular Fellowship, Mercy St Vincent Medical Center and Hospital, Toledo, OH 43608, United States
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14
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Wyman RM. Antegrade Dissection and Reentry: Tools and Techniques. Interv Cardiol Clin 2021; 10:41-50. [PMID: 33223105 DOI: 10.1016/j.iccl.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The hybrid approach to chronic total occlusion percutaneous coronary intervention requires facility with antegrade and retrograde strategies to achieve high success rates in a time-efficient and safe manner. Antegrade dissection and reentry is an integral component of this approach but historically has been limited by low success rates and an inability to control the site of reentry. The advent of the BridgePoint device, and multiple iterations of technique in conjunction with its use, have markedly improved success rates and procedure efficiency.
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15
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Chen CY, Huang W, Liu J, Cao Y. Zero-contrast percutaneous coronary intervention for chronic total occlusions guided by intravascular ultrasound with ChromaFlo mode: a case report. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33442603 PMCID: PMC7793047 DOI: 10.1093/ehjcr/ytaa349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/08/2020] [Accepted: 09/04/2020] [Indexed: 11/14/2022]
Abstract
Background Contrast agent allergy may result in severe adverse events that prevent the use of percutaneous coronary intervention (PCI) in some patients, especially for those with complex lesions. Case summary We describe a 59-year-old man who presented with the multi-vessel disease and suffered from contrast allergy. The patient refused to have coronary artery bypass grafting surgery, thus two-stage PCI procedures without iodinated contrast media were performed after a detailed discussion with the heart team, including a chronic total occlusion (CTO) lesion in the proximal left anterior descending artery. The intravascular ultrasound (IVUS) was used for finding the entry point of the proximal fibre cap, and assessing the lesion, thereby marking the positions of the proximal and distal edges of the stent. After PCI, stent expansion and subtle edge dissection or incomplete apposition were confirmed by IVUS and ChromaFlo imaging. Zero-contrast PCI was done successfully without any complication. Discussion This case report illustrates the feasibility and safety of performing CTO-PCI without contrast agent in carefully and well prepared selected patients.
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Affiliation(s)
- Chen-Yang Chen
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Changsha, Hunan 410013, China
| | - Wei Huang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Changsha, Hunan 410013, China
| | - Jun Liu
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Changsha, Hunan 410013, China
| | - Yu Cao
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Changsha, Hunan 410013, China
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16
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Guo L, Wang J, Ding H, Meng S, Zhang X, Lv H, Zhong L, Wu J, Xu J, Zhou X, Huang R. Long-term outcomes of medical therapy versus successful recanalisation for coronary chronic total occlusions in patients with and without type 2 diabetes mellitus. Cardiovasc Diabetol 2020; 19:100. [PMID: 32622353 PMCID: PMC7335447 DOI: 10.1186/s12933-020-01087-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022] Open
Abstract
Background In this study, we compared the outcomes of medical therapy (MT) with successful percutaneous coronary intervention (PCI) in chronic total occlusions (CTO) patients with and without type 2 diabetes mellitus. Methods A total of 2015 patients with CTOs were stratified. Diabetic patients (n = 755, 37.5%) and non-diabetic patients (n = 1260, 62.5%) were subjected to medical therapy or successful CTO-PCI. We performed a propensity score matching (PSM) to balance the baseline characteristics. A comparison of the major adverse cardiac events (MACE) was done to evaluate long-term outcomes. Results The median follow-up duration was 2.6 years. Through multivariate analysis, the incidence of MACE was significantly higher among diabetic patients compared to the non-diabetic patients (adjusted hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.09–1.61, p = 0.005). Among the diabetic group, the rate of MACE (adjusted HR 0.61, 95% CI 0.42–0.87, p = 0.006) was significantly lower in the successful CTO-PCI group than in the MT group. Besides, in the non-diabetic group, the prevalence of MACE (adjusted HR 0.85, 95% CI 0.64–1.15, p = 0.294) and cardiac death (adjusted HR 0.94, 95% CI 0.51–1.70, p = 0.825) were comparable between the two groups. Similar results as with the early detection were obtained in propensity-matched diabetic and non-diabetic patients. Notably, there was a significant interaction between diabetic or non-diabetic with the therapeutic strategy on MACE (p for interaction = 0.036). Conclusions For treatment of CTO, successful CTO-PCI highly reduces the risk of MACE in diabetic patients when compared with medical therapy. However, this does not apply to non-diabetic patients.
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Affiliation(s)
- Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
| | - Junjie Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Huaiyu Ding
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Shaoke Meng
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Xiaoyan Zhang
- Department of Radiology, Fuyang Hospital of Anhui Medical University, Fuyang, People's Republic of China
| | - Haichen Lv
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Lei Zhong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Jian Wu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Jiaying Xu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Xuchen Zhou
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Rongchong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.,Department of Cardiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, People's Republic of China
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17
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Xenogiannis I, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Mahmud E, Choi JW, Burke MN, Doing AH, Dattilo P, Toma C, Uretsky B, Krestyaninov O, Khelimskii D, Holper E, Potluri S, Wyman RM, Kandzari DE, Garcia S, Koutouzis M, Tsiafoutis I, Khatri JJ, Jaber W, Samady H, Jefferson BK, Patel T, Moses JW, Lembo NJ, Parikh M, Kirtane AJ, Ali ZA, Gkargkoulas F, Tajti P, Hall AB, Rangan BV, Abdullah S, Banerjee S, Brilakis ES. Impact of concomitant treatment of non-chronic total occlusion lesions at the time of chronic total occlusion intervention. Int J Cardiol 2020; 299:75-80. [PMID: 31301862 DOI: 10.1016/j.ijcard.2019.06.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/27/2019] [Accepted: 06/27/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND During chronic total occlusion (CTO) percutaneous coronary intervention (PCI), sometimes non-CTO lesions are also treated. METHODS We compared the clinical and procedural characteristics and outcomes of CTO PCIs with and without concomitant treatment of a non-CTO lesion in a contemporary multicenter CTO registry. RESULTS Of the 3598 CTO PCIs performed at 21 centers between 2012 and 2018, 814 (23%) also included PCI of at least one non-CTO lesion. Patients in whom non-CTO lesions were treated were older (65 ± 10 vs. 64 ± 10 years, p = 0.03), more likely to present with an acute coronary syndrome (32% vs. 23%, p < 0.01), and less likely to undergo PCI of a right coronary artery (RCA) CTO (46% vs. 58%, p < 0.01). The most common non-CTO lesion location was the left anterior descending artery (31%), followed by the circumflex (29%) and the RCA (25%).Combined non-CTO and CTO-PCI procedures had similar technical (88% vs. 87%, p = 0.33) and procedural (85% vs. 85%, p = 0.74) success and major in-hospital complication rates (3.4% vs. 2.7%, p = 0.23), but had longer procedure duration (131 [88, 201] vs. 117 [75, 179] minutes, p < 0.01), higher patient air kerma radiation dose (3.0 [1.9, 4.8] vs. 2.8 [1.5, 4.6] Gray, p < 0.01) and larger contrast volume (300 [220, 380] vs. 250 [180, 350] ml, p < 0.01). CONCLUSIONS Combined CTO PCI with PCI of non-CTO lesions is associated with similar success and major in-hospital complication rates compared with cases in which only CTOs were treated, but requires longer procedure duration and higher radiation dose and contrast volume.
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Affiliation(s)
- Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | | | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego, La Jolla, CA, USA
| | - Ehtisham Mahmud
- VA San Diego Healthcare System and University of California San Diego, La Jolla, CA, USA
| | - James W Choi
- Baylor Heart and Vascular Hospital, Dallas, TX, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Phil Dattilo
- Medical Center of the Rockies, Loveland, CO, USA
| | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Barry Uretsky
- VA Central Arkansas Healthcare System, Little Rock, AR, USA
| | | | | | | | | | | | | | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, GA, USA
| | - Habib Samady
- Emory University Hospital Midtown, Atlanta, GA, USA
| | | | - Taral Patel
- Tristar Centennial Medical Center, Nashville, TN, USA
| | | | | | | | | | | | | | - Peter Tajti
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary
| | - Allison B Hall
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Bavana V Rangan
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shuaib Abdullah
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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18
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Xue Y, Zhou B, Wang W, Miao G, Zhang O, Zhou J, Geng Y, Zhai Y, Ren C, Zhang P. An application of RASER technique in the treatment of chronic total occlusion accompanied with stent fracture in right coronary artery: a case report. BMC Cardiovasc Disord 2019; 19:273. [PMID: 31783792 PMCID: PMC6883533 DOI: 10.1186/s12872-019-1258-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/13/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The interventional treatment of chronic total occlusion (CTO) with stent fracture as well as severe calcification was extremely difficult and no effective technique has been reported. CASE PRESENTATION A 50-year-old woman was hospitalized for angina, angiography revealed triple vessel disease, CTO accompanied with stent fracture in right coronary artery (RCA). Treatment using conventional coronary intervention was expected to be difficult. Therefore, we performed RASER technique, which was a combination of excimer laser coronary atherectomy (ELCA) with rotational atherectomy (RA), followed by the deployment of drug-eluting stents. Intravascular ultrasound (IVUS) revealed well attachment of the stents, the patient was discharged 3 days after the procedure and no recurrent chest discomfort was reported in a follow-up time of 10 months. CONCLUSION This case report provided a first report of RASER technique in the treatment of CTO with stent fracture and severe calcification.
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Affiliation(s)
- Yajun Xue
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China
| | - Boda Zhou
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China
| | - Weimin Wang
- Department of Cardiology, Peking University People's Hospital, Beijing, 010010, China
| | - Guobin Miao
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China
| | - Ou Zhang
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China
| | - Jie Zhou
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China
| | - Yu Geng
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China
| | - Yanlong Zhai
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China
| | - Chunhui Ren
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China
| | - Ping Zhang
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China.
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19
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Tian B, Jing QM, Wang B, Su YB. A new buddy stingray and stick technique for antegrade dissection and re-entry during chronic total occlusion recanalization: a case report. J Geriatr Cardiol 2019; 16:835-9. [PMID: 31853249 DOI: 10.11909/j.issn.1671-5411.2019.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Iannaccone G, Scarparo P, Wilschut J, Daemen J, Den Dekker W, De Jaegere P, Zijlstra F, Van Mieghem NM, Diletti R. Current approaches for treatment of coronary chronic occlusions. Expert Rev Med Devices 2019; 16:941-954. [PMID: 31594416 DOI: 10.1080/17434440.2019.1676729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Coronary chronic total occlusions (CTO) represent a challenging subset in interventional cardiology.Areas covered: During the last decade, improvements in materials, techniques, and meticulous pre-procedural lesion assessment have increased the success rate in CTO lesions. Several scores have been developed to address overall lesion evaluation and help select the most appropriate treatment strategy. In addition, specific algorithms such as the hybrid algorithm have been introduced to provide a framework for CTO operators and a rapid management of the various challenging aspects of the procedure. The hybrid approach requires operator's ability to switch from one treatment strategy to another when the first one appears to be unsuccessful. Adequate training and operators' experience remain crucial to improve the likelihood of success.Expert opinion: The aim of this review is to provide insights and guidance for operators on current approaches for treatment of CTO and complication management.
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Affiliation(s)
- Giulia Iannaccone
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Paola Scarparo
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wijnand Den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Peter De Jaegere
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
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21
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Hall AB, Tummala PE, Burke MN, Brilakis ES. A Case-Based Illustration of the Use of Microcatheter Pressure Transduction for Confirmation of Distal Wire Position in Complex Percutaneous Coronary Intervention. Cardiovasc Revasc Med 2019; 20:55-59. [PMID: 31495748 DOI: 10.1016/j.carrev.2019.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022]
Abstract
Determining distal wire position during chronic total occlusion percutaneous coronary intervention can be challenging. We describe a novel technique that can help confirm distal true lumen wire position. A microcatheter is advanced distally over the wire and after removing the guidewire, it is connected to a manifold for pressure transduction: an arterial waveform is indicative of intra-luminal position.
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Affiliation(s)
- Allison B Hall
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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22
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Guo L, Zhang S, Wu J, Zhong L, Ding H, Xu J, Zhou X, Huang R. Successful recanalisation of coronary chronic total occlusions is not associated with improved cardiovascular survival compared with initial medical therapy. SCAND CARDIOVASC J 2019; 53:305-311. [PMID: 31315453 DOI: 10.1080/14017431.2019.1645351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective. To compare the clinical outcomes associated with successful percutaneous coronary intervention (PCI) versus initial medical therapy (MT) in patients with coronary chronic total occlusions (CTOs). Methods. Between January 2007 and December 2016, a total of 1702 patients with ≥1 CTO were enrolled. Patients who had a failed CTO-PCI were excluded. After exclusion, 1294 patients with 1520 CTOs were divided into the MT group initially (did not undergo a CTO-PCI attempt) (n = 800) and successful PCI group (n = 494). Propensity-score matching was also performed to adjust for baseline characteristics. The primary outcome was cardiac death. Results. The median overall follow-up duration was 3.6 (IQR, 2.1-5.0) years, there was no significant difference between the two groups with respect to the prevalence of cardiac death (MT vs. successful PCI: 6.6 vs. 3.8%, adjusted hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.41-2.14, p = .867). In the propensity-matched population (286 pairs), there were no significant differences in the prevalence of cardiac death (MT vs. successful PCI: 5.9% vs. 3.1%, HR 0.51, 95% CI 0.23-1.15, p = .104) and major adverse cardiovascular events (MACE) (HR 0.76, 95% CI 0.53-1.09, p = .130) between the two groups. Conclusion. In the treatment of patients with CTOs, successful PCI is not associated with improved long-term cardiovascular survival or reduced the risk of MACE compared with MT alone initially.
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Affiliation(s)
- Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Shanfeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Jian Wu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Lei Zhong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Huaiyu Ding
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Jiaying Xu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Xuchen Zhou
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Rongchong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
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23
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Kokkinidis DG, Katsaros I, Jonnalagadda AK, Papanastasiou CA, Katamreddy A, Schizas D, Bakoyannis C, Armstrong EJ. Use, Safety and Effectiveness of Subintimal Angioplasty and Re-Entry Devices for the Treatment of Iliac Artery Chronic Total Occlusions: A Systematic Review of 30 Studies and 1112 Lesions. Cardiovasc Revasc Med 2019; 21:334-341. [PMID: 31227394 DOI: 10.1016/j.carrev.2019.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/12/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Management of iliac artery occlusive disease has changed dramatically over the past few decades. Secondary to advancement in endovascular technologies and techniques, percutaneous interventions have gradually replaced open surgical approaches even for the most difficult cases. In difficult to cross chronic total occlusions (CTO) of the iliac artery, subintimal angioplasty (SIA) with or without the use of re-entry devices (RED) offers a valuable alternative to intra-luminal crossing. OBJECTIVE To systematically review the literature for studies reporting procedural or short- and long-term clinical outcomes after the use of SIA, with or without RED use for iliac CTOs. METHODS PRISMA guidelines were followed. Literature search (PubMed, Cochrane CENTRAL and EMBASE) and data extraction were performed by two independent researchers. Quantitative synthesis of the reported outcomes was applied when possible. RESULTS Thirty studies met the inclusion criteria and were selected as eligible for this systematic review, with a total of 1002 patients (61.3% males) and 1112 lesions treated with SIA. RED were used in 21.9% of the lesions. Critical limb ischemia was the indication in 51.4%. The overall procedural success rates were 85.8% for SIA and 88.5% for RED. The complication rate ranged from 0 to 10% among different series, but overall it was similar among the two groups (6.9% in the RED group and 6.7% among the SIA group). One year primary patency rates were around 60% in the RED. In the SIA only arm, there was a large heterogeneity, with patency rates ranging from 51.7% to 96.8%. CONCLUSION SIA with or without RED use is a safe and effective treatment for the treatment of iliac artery CTOs. Future studies are needed to delineate whether intraluminal crossing or SIA is more effective for endovascular treatment of iliac CTOs.
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Affiliation(s)
- Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States; Division of Cardiology, Denver VA Medical Center, University of Colorado, Denver, CO, United States.
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | - Adarsh Katamreddy
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Christos Bakoyannis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ehrin J Armstrong
- Division of Cardiology, Denver VA Medical Center, University of Colorado, Denver, CO, United States
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24
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Wang C, Sun Z. Recanalizing left anterior descending artery chronic total occlusion with reverse controlled antegrade and retrograde tracking technology through epicardial collateral. AME Case Rep 2019; 3:15. [PMID: 31231716 PMCID: PMC6556698 DOI: 10.21037/acr.2019.05.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/08/2019] [Indexed: 10/24/2023]
Abstract
During recent years, the reverse controlled antegrade and retrograde tracking (CART) technique has become the dominant retrograde wire crossing technique. When the retrograde guiding wire cannot pass the occlusive lesions or the guiding wire is difficult to kiss, the reverse CART technique can significantly shorten the operation time and greatly improve the success rate of the operation. In this case we succeeded in recanalizing a chronic total occlusion (CTO) lesion with reverse CART for a patient diagnosed with old myocardial infarction (OMI).
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Affiliation(s)
- Chuanhe Wang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110022, China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110022, China
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25
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Akodad M, Spaziano M, Garcia-Alonso CJ, Louvard Y, Sanguineti F, Garot P, Hovasse T, Unterseeh T, Chevalier B, Lefèvre T, Benamer H. Is sex associated with adverse outcomes after percutaneous coronary intervention for CTO? Int J Cardiol 2019; 288:29-33. [PMID: 31047703 DOI: 10.1016/j.ijcard.2019.04.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/25/2019] [Accepted: 04/09/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Conflicting results have been reported regarding sex differences in percutaneous coronary intervention (PCI), but their potential influence on clinical outcomes after chronic total coronary occlusion (CTO) PCI remains unknown. We aimed to identify sex-related differences in long-term clinical outcomes after CTO PCI. METHODS AND RESULTS All consecutive patients undergoing CTO PCI between 2004 and 2012 were included in a prospective registry. Baseline, procedural characteristics and clinical outcomes were compared according to sex. Out of 1343 patients, 194 were female (14.4%). Women were older (68.5 ± 9.9 vs 62.3 ± 10.8 years, p < 0.001), more frequently diabetic (33.5% vs 26.4%, p = 0.026) and hypertensive (70.1% vs 57.4%, p < 0,001), whereas males were more frequently smokers (28.5% vs 15.5%, p < 0.001). J-CTO score was similar between both sexes (1.59 ± 0.91 vs 1.51 ± 0.88). The procedural success rate was also similar in men and women (74.0% vs 77.3%, respectively). At 8 years' follow-up, successful CTO PCI was associated with reduced mortality in women (14.8% vs 36.2%, p = 0.003) and men (18.5% vs 29.1%, p < 0.001). In successful CTO PCI cases, no sex-related differences were observed in terms of major adverse cardiac events. CONCLUSIONS Our study suggests an equal benefit of CTO interventions with a marked reduction in mortality after successful CTO PCI in women and men alike.
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Affiliation(s)
- Mariama Akodad
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France; Hôpital universitaire Arnaud de Villeneuve, Montpellier, France
| | - Marco Spaziano
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France
| | - Carlos J Garcia-Alonso
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France
| | - Bernard Chevalier
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France
| | - Hakim Benamer
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
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Guo L, Wu J, Zhong L, Ding H, Xu J, Zhou X, Huang R. Two-year clinical outcomes of medical therapy vs. revascularization for patients with coronary chronic total occlusion. Hellenic J Cardiol 2019; 61:264-271. [PMID: 30951874 DOI: 10.1016/j.hjc.2019.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/17/2019] [Accepted: 03/27/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES There are little data on the long-term clinical outcomes of medical therapy (MT) compared with revascularization in patients with chronic total occlusions (CTOs). METHODS Between January 2007 and December 2016, a total of 1655 patients with ≥1 CTO were enrolled in our center and were divided into the MT group (n = 800) and revascularization group (n = 855) according to the initial treatment strategy. Propensity score matching was also performed to adjust for baseline characteristics. The primary outcome was cardiac death. RESULTS After 2 years of follow-up, there was no significant difference between the two groups with regard to the prevalence of cardiac death (MT vs. revascularization: 6.6% vs. 4.2%, adjusted hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.60-1.49, p = 0.820). In the propensity-matched population (406 pairs), there were no significant differences in the prevalence of cardiac death (MT vs. revascularization: 5.4% vs. 4.7%, HR 0.88, 95% CI 0.48-1.63, p = 0.694), except for target vessel revascularization (TVR) (0.44, 0.31-0.63, <0.001) and major adverse cardiovascular events (MACE) (0.51, 0.38-0.68, <0.001), between the two groups. There were also no significant differences in the prevalence of cardiac death (MT vs. successful CTO-PCI: 6.6% vs. 4.0%, HR 0.94, 95% CI 0.41-2.15, p = 0.881) between the MT and successful CTO-PCI groups. CONCLUSION As an initial management strategy in patients with CTOs, revascularization did not reduce the risk of cardiac death compared with treatment with medical therapy alone. However, revascularization was associated with reduction in the prevalence of TVR and MACE. Furthermore, successful CTO-PCI was also not associated with improved long-term survival compared with MT alone.
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Affiliation(s)
- Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, China
| | - Jian Wu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, China
| | - Lei Zhong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, China
| | - Huaiyu Ding
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, China
| | - Jiaying Xu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, China
| | - Xuchen Zhou
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, China
| | - Rongchong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, China.
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Miñana G, Consuegra-Sánchez L, Rumiz E, Valero E, García-Blas S, Pernias V, Husser O, Fernández-Cisnal A, Sanchis J, Núñez J. Feasibility of Implanting 50-60 mm-Tapered Drug Eluting Stents in Chronic Total Occlusions. Cardiovasc Revasc Med 2019; 20:1117-1122. [PMID: 30878362 DOI: 10.1016/j.carrev.2019.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/03/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) usually involves multiple overlapping stents implantation to cover long coronary segments. A higher rate of restenosis has been described with stent overlapping. Recently, new long tapered stents emerged as a potential tool for treating long coronary lesions. Feasibility of using these new devices for the CTO PCI has not been described. The aim of this work was to describe our initial experience with 50 and 60 mm-long tapered sirolimus-eluting stents (SES) in CTO PCI. METHODS We included 54 consecutive patients who underwent a CTO PCI and in whom an attempt to implant a 50 or 60 mm-long tapered SES was performed. Baseline clinical, angiographic, and procedural characteristics were recorded. RESULTS The median (IQR) age was 64 (58-73) years, and 45 (83.3%) patients were male. The tapered SES 50 and 60 mm-long was successfully implanted in 51 (94.4%) patients. In three patients, a 60 mm-long stent could not be implanted, and two or three overlapped shorter drug-eluting stents were deployed instead. An average of 1.4 ± 0.6 stents per patient was implanted. A single stent was deployed in 32 (59.3%) patients. During a median follow-up of 330 (149-551) days, repeat PCI in the target vessel was performed in two patients. CONCLUSIONS The use of the new BioMime Morph™ tapered SES for the treatment of CTO appears to be feasible in a high proportion of procedures. Further studies confirming the feasibility of this approach and its potential clinical advantages are needed.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain; CIBER Cardiovascular, Spain
| | | | - Eva Rumiz
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Ernesto Valero
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Sergio García-Blas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Vicente Pernias
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | | | - Agustin Fernández-Cisnal
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain; CIBER Cardiovascular, Spain.
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Abstract
PURPOSE OF REVIEW Chronic total occlusion (CTO) poses one of the greatest technical challenges to interventional cardiologists. Despite recent advancements in techniques and clinical trials showing significant benefits of CTO percutaneous coronary interventions (PCI), the proportion of patients with untreated CTOs remains high. We therefore aim to perform a comprehensive review of the various techniques available, recent advancements, benefits, and complications associated with CTO PCI. RECENT FINDINGS Three randomized clinical trials examining the benefits of CTO PCI have recently been presented. Scoring systems have been developed to facilitate pre-procedural estimation of success and complications of CTO PCI. Technological enhancements in coronary wires and other interventional equipment along with dedicated training for CTO operators have improved the likelihood of successful recanalization of CTOs. CTO PCI has been shown to improve patient symptoms and quality of life. It is therefore important to have an in-depth knowledge of the various CTO techniques, appropriate equipment, and complications when performing these complex procedures. Clinicians should weigh the risks and benefits and choose the appropriate patient population who may benefit from revascularization.
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Affiliation(s)
- Mahesh Anantha-Narayanan
- Division of Cardiovascular Disease, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Santiago Garcia
- Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 E 28th Street, Suite 300, Minneapolis, MN, 55407, USA.
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29
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Heuser RR. Support with a twist: New approaches in CTOs and complex lesions. J Cardiol Cases 2018; 17:12-15. [PMID: 30279844 DOI: 10.1016/j.jccase.2017.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/18/2017] [Accepted: 08/15/2017] [Indexed: 10/18/2022] Open
Abstract
One-third of patients undergoing coronary angiography have coronary chronic total occlusions (CTOs) with the incidence increasing with age. Successful recanalization of a CTO is associated with a reduction in the future need for coronary artery bypass graft surgery (CABG), improvement in left ventricular function, and angina status as well as long-term survival. Success rates for treating CTOs with conventional techniques have remained unchanged over time averaging 65%-70% in experienced hands, well below the success rates for non-occlusive coronary lesions. The antegrade approach is utilized in standard balloon angioplasty. Modification of this technique has been used with an anchoring balloon to more successfully open up CTOs. We describe a new device that in addition to allowing increased support, also centers one in the lumen for both coronary and peripheral intervention. <Learning objective: Coronary total occlusions (CTOs) are the biggest reason patients are sent for coronary bypass when multi-vessel coronary disease is found. In most peripheral artery disease (PAD) patients, at least one peripheral vessel is 100% occluded. Current device designs have improved success rates in treating coronary and peripheral CTOs. The CrossLock™ catheter centers the lumen and gives better support to a chronically occluded vessel. The reader will find this device helpful in treating coronary and peripheral complex disease.>.
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30
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Synetos A, Toutouzas K, Latsios G, Papanikolaou A, Peskesis G, Sianos G, Tousoulis D. Proximal anchoring distal trapping technique in a chronic total occlusion unable to cross. Cardiovasc Revasc Med 2018; 19:887-889. [PMID: 29631951 DOI: 10.1016/j.carrev.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Andreas Synetos
- First Department of Cardiology, Athens Medical School, Athens, Greece.
| | | | - George Latsios
- First Department of Cardiology, Athens Medical School, Athens, Greece
| | | | - George Peskesis
- First Department of Cardiology, Athens Medical School, Athens, Greece
| | - George Sianos
- Cardiology Department, Papageorgiou General Hospital, Thessaloniki, Greece
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31
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Tavallaei MA, Zhou JJ, Roy TL, Wright GA. Performance Assessment of a Radiofrequency Powered Guidewire for Crossing Peripheral Arterial Occlusions Based on Lesion Morphology. Ann Biomed Eng 2018; 46:940-946. [PMID: 29616386 DOI: 10.1007/s10439-018-2021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
Abstract
Endovascular wires and devices for peripheral arterial disease therapy have evolved greatly, yet failure rates of these procedures remain high. Information on lesion composition may inform device selection to improve the success rates of these procedures. This paper, presents an approach for informed guidewire selection. The objective of this study is to quantitatively assess the performance of a radiofrequency powered guidewire in the crossing of various morphology types of peripheral chronic total occlusions. Samples taken from amputated patient limbs are characterized by magnetic resonance imaging. Using a customized catheter test station, the performance of a radiofrequency powered guidewire in puncturing these lesions is compared to a conventional guidewire, and to itself when not powered. The analysis includes quantitative and statistical comparisons of the puncture forces experienced by the different guidewires in "hard" vs. "soft" lesions as well as qualitative assessment of deflections, buckling and puncture success of the wires. Results indicate that the use of radiofrequency ablation significantly reduces the required puncture force, reduced events of buckling and deflection, and resulted in a significantly higher puncture success rate.
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Affiliation(s)
- Mohammad A Tavallaei
- Department of Medical Biophysics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. .,Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room M7 508, Toronto, ON, M4N 3M5, Canada.
| | - James J Zhou
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,University of Waterloo, Waterloo, ON, Canada
| | - Trisha L Roy
- Division of Vascular Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Graham A Wright
- Department of Medical Biophysics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Guo L, Zhong L, Chen K, Wu J, Huang RC. Long-term clinical outcomes of optimal medical therapy vs. successful percutaneous coronary intervention for patients with coronary chronic total occlusions. Hellenic J Cardiol 2018; 59:281-287. [PMID: 29605686 DOI: 10.1016/j.hjc.2018.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/10/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES There are little data on the long-term clinical outcomes of optimal medical therapy (OMT) compared with successful percutaneous coronary intervention (PCI) in patients with chronic total occlusions (CTOs). METHODS A total of 388 patients with ≥1 CTO were enrolled from January 2008 to December 2010. 62 patients were excluded, and 326 patients were divided into an OMT group (n = 125) and PCI group (n = 201) according to the initial treatment strategy. Propensity-score matching was also done to adjust for baseline characteristics. The primary outcome was major adverse cardiac event (MACE), included cardiac death, recurrent myocardial infarction, and repeated revascularization. RESULTS After a mean follow-up of 47.2 ± 20.0 months, there was no significant difference between the two groups with respect to the prevalence of MACE (successful PCI vs. OMT: 29.6% vs. 21.9%, unadjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 0.95-2.28, p=0.085). After multivariate analyses, there were significant differences in the prevalence of MACE (adjusted HR 1.76, 95% CI 1.09-2.28, p=0.02) and repeated revascularization (2.14; 1.18-3.90, 0.01). In the propensity score-matched population (80 pairs), there were no significant differences in the prevalence of MACE (adjusted HR 1.89, 95% CI 0.96-3.71, p=0.06) and cardiac death (1.30, 0.44-3.80, 0.63) between groups. CONCLUSION In the treatment of patients with CTOs, successful PCI did not reduce the long-term risk of MACE compared with OMT.
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Affiliation(s)
- Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Lei Zhong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Kun Chen
- Department of Cardiology, The First People's Hospital of Changde, Hunan province, People's Republic of China
| | - Jian Wu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Rong-Chong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China.
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Abstract
Despite the ongoing development of technical skills, increasing operator experience and improvements in medical devices, percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) are still the most challenging procedures in interventional cardiology for coronary artery disease. Due to the complexity of the procedures, there is an increased complication rate compared with PCIs for the treatment of non-occlusive disease. This may significantly increase procedural morbidity and potentially mortality. CTO-PCI related complications include all the usual complications that are seen in routine PCI in addition to unique issues such as inadvertent occlusion of donor vessels or injury of collateral channels causing haemodynamic instability or ischaemia. To minimise the morbidity associated with these procedures, it is important to be aware of potential complications and recognise them in a timely fashion. Should they arise, operators should be able to deal with them in a safe and efficient manner.
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Affiliation(s)
- Johannes Rigger
- Cardiology Department, Belfast Health & Social Care Trust Belfast, Northern Ireland, UK.,Kantonsspital St Gallen, Switzerland
| | - Colm G Hanratty
- Cardiology Department, Belfast Health & Social Care Trust Belfast, Northern Ireland, UK
| | - Simon J Walsh
- Cardiology Department, Belfast Health & Social Care Trust Belfast, Northern Ireland, UK
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Oreglia JA, Garbo R, Gagnor A, Gasparini GL. Dual lumen microcatheters for complex percutaneous coronary interventions. Cardiovasc Revasc Med 2017; 19:298-305. [PMID: 29146551 DOI: 10.1016/j.carrev.2017.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
In some bifurcation anatomies side branch wiring can be difficult particularly when side branch is highly angulated. Furthermore a combination of bifurcations and chronic total occlusion can be a real challenge for interventional cardiologists. New devices have been produced to facilitate complex PCI and recently introduced dual lumen microcatheters can be really helpful in these scenarios. All these devices have both a rapid-exchange and an over-the-wire lumen. The rationale for dual lumen microcatheters is to preserve the highest number of side-branches. Nevertheless PCI should always aim to the most complete revascularization and to the lowest rate of side-branch loss. The purpose of this review is to describe current available dual lumen microcatheters, interventional scenarios in which their use may be helpful and basics of their proper use.
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Affiliation(s)
- Jacopo A Oreglia
- Department of Invasive Cardiology, Luigi Sacco Hospital, Milan, Italy
| | - Roberto Garbo
- Department of Invasive Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Gabriele L Gasparini
- Department of Invasive Cardiology, Humanitas Research Hospital, Rozzano, (Milan), Italy.
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Sanguineti F, Garcia-Alonso C, Benamer H, Karrillon GJ. [ Chronic total occlusions: Is there a woman specificity?]. Ann Cardiol Angeiol (Paris) 2016; 65:420-424. [PMID: 27817847 DOI: 10.1016/j.ancard.2016.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many differences have been reported regarding gender in angioplasty procedures (PCI), but their potential influence on clinical outcomes after CTO PCI has not been elucidated. Aim of this paper is to analyse these potential differences starting from 2 clinical cases. The basic features found in the two clinical cases presented here, older age and presence of diabetes (that are more frequent in women), are in line with the differences identified in non-CTO studies on angioplasty. Furthermore, CTO in women are generally under-diagnosed and less frequently treated by angioplasty than in men. These features combined to the often atypical clinical presentation could explain why women are generally less frequently enrolled in CTO registries than men. Although data on the impact of gender on this topic are scarce, it appears that, despite a clear outcome difference in patients who have a successful CTO angioplasty and similar success rates, women are still under-referred for a CTO angioplasty. Indeed, CTO angioplasty seems a valid therapeutic option, in women as in men.
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Affiliation(s)
- F Sanguineti
- Centre hospitalier Simone-Veil, 14, rue de Saint-Prix, 95600 Eaubonne, France.
| | - C Garcia-Alonso
- Centre chirurgical Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robbinson, France
| | - H Benamer
- Institut cardiovasculaire Paris Sud, hôpital privé Jacques-Cartier, générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - G J Karrillon
- Centre hospitalier Simone-Veil, 14, rue de Saint-Prix, 95600 Eaubonne, France
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Yuksel IO, Cagirci G, Koklu E, Yilmaz A, Kucukseymen S, Ellidag HY, Cay S, Yilmaz N, Arslan S. Erythropoietin stimulates the coronary collateral development in patients with coronary chronic total occlusion. Neth Heart J 2016; 24:609-16. [PMID: 27561278 PMCID: PMC5039132 DOI: 10.1007/s12471-016-0875-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Erythropoietin (EPO) improves cardiac function and induces neovascularisation in post-myocardial infarction heart failure. The aim of this study was to analyse the association between the serum erythropoietin level and coronary collateral development in patients with coronary artery disease and chronic total occlusion. Methods A total of 168 patients consisting of 117 with coronary artery disease (CAD, (62 with chronic total occlusion (CTO), 55 without CTO)) and 51 with healthy coronary arteries were included in the study. The patients were assigned as coronary artery disease without CTO (group 0), CAD with CTO (group 1: poor collateral development, group 2: good collateral development) and normal coronary arteries (group 3). Results There was a significant positive correlation between serum EPO levels and the Rentrop scores in angiography (r = 0.243, p = 0.001). Similarly, a positive correlation was found between serum EPO levels and the Syntax scores (r = 0.253, p = 0.001). Echocardiography revealed a negative correlation between serum EPO levels and the cardiac ejection fraction (r = −0.210, p = 0.006). Conclusions Serum EPO is a useful biomarker for coronary collateral development in patients with CTO.
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Affiliation(s)
- I O Yuksel
- Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey
| | - G Cagirci
- Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey
| | - E Koklu
- Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey
| | - A Yilmaz
- Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey
| | - S Kucukseymen
- Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.
| | - H Y Ellidag
- Department of Biochemistry, Antalya Education and Research Hospital, Antalya, Turkey
| | - S Cay
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - N Yilmaz
- Department of Biochemistry, Antalya Education and Research Hospital, Antalya, Turkey
| | - S Arslan
- Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey
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Dash D. Complications encountered in coronary chronic total occlusion intervention: Prevention and bailout. Indian Heart J 2016; 68:737-746. [PMID: 27773418 PMCID: PMC5079195 DOI: 10.1016/j.ihj.2016.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/16/2016] [Accepted: 03/07/2016] [Indexed: 11/30/2022] Open
Abstract
Despite the continuing developments of improved medical devices and increasing operator expertize, coronary chronic total occlusion (CTO) remains as one of the most challenging lesion subsets in interventional cardiology. Percutaneous coronary intervention (PCI) of CTO is a complex procedure carrying the risk of complications that are responsible for significant morbidity and mortality. The complications can be classified as coronary (such as coronary occlusion, perforation, device embolization, or entrapment); cardiac non-coronary (such as periprocedural myocardial infarction); extra cardiac (such as vascular access complications, systemic embolization, contrast-induced nephropathy, and radiation-induced injury). Further, certain complications (such as donor vessel dissection or thrombosis) are unique to CTO-PCI. There are also complications related to specialized techniques, such as dissection/reentry and retrograde crossing techniques. A thorough understanding of the potential complications is critical to mitigate risk during these complex procedures.
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Affiliation(s)
- Debabrata Dash
- Interventional Cardiologist, S. L Raheja (A Fortis Associate) Hospital, Nanavati Superspeciality Hospital, Mumbai, India; Guest Professor of Cardiology, Beijing Tiantan Hospital, Beijing, China.
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Abstract
Percutaneous Coronary Intervention (PCI) of Chronic Total Occlusions (CTO) is an accepted revascularization procedure. These complex procedures carry with them certain risks and potential complications. Complications of PCI such as contrast induced renal dysfunction, radiation, etc, assume more relevance given the length and complexity of these procedures. Further, certain complications such as donor vessel injury, foreign body entrapment are unique to CTO PCI. A thorough understanding of the potential complications is important in mitigating risk during these complex procedures.
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Affiliation(s)
- Arun Kalyanasundaram
- Seattle Heart and Vascular Institute 16259 Sylvester Rd SW #401, Burien, WA 98166 USA
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Kapralos I, Kehagias E, Ioannou C, Bouloukaki I, Kostas T, Katsamouris A, Tsetis D. Vibrational angioplasty in recanalization of chronic femoropopliteal arterial occlusions: single center experience. Eur J Radiol 2014; 83:155-62. [PMID: 24518192 DOI: 10.1016/j.ejrad.2013.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/14/2013] [Accepted: 09/20/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE This prospective study aims to present the overall success rate, safety and long-term outcome of vibrational angioplasty technique, in the treatment of chronic total femoropopliteal occlusions in our institute. METHODS Between October 2000 and December 2008, patients with chronic total femoropoliteal arterial occlusions, treated with vibrational angioplasty during the same session after a failed attempt with conventional recanalization technique, were included. Patient's follow up included serial ankle-brachial index measurements and arterial duplex ultrasound examinations at 1, 3, 6, 12, 24, 36 and 48 months. RESULTS Twenty-seven patients (16 males and 11 females) and twenty-eight lesions were included in our study. Twenty-five lesions (89.3%) were successfully recanalized. Pain relief was noticed in twenty-one cases. From ten lesions with tissue loss (ulcer or gangrene) in successfully recanalized occlusions, six healed without major, or minor amputation. One non-healing amputation stump was healed after recanalization, without further complications. Four limbs underwent amputation (one minor and three major) despite successful recanalization, however all had an excellent healing of the amputation stump without further complications. The Kaplan-Meier test demonstrated 90%, 85% and 70% amputation-free survival rate at 12, 24 and 36 months, respectively. No major or minor complications were encountered. CONCLUSIONS Vibrational angioplasty is a safe, effective and durable endovascular technique for the treatment of chronic total occlusions in patients with limb ischemia that would be difficult to recanalize using conventional intraluminal techniques.
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Abstract
The hybrid approach to chronic total occlusion percutaneous coronary intervention requires facility with antegrade and retrograde strategies to achieve high success rates in a time-efficient and safe manner. Antegrade dissection and reentry is an integral component of this approach but historically has been limited by low success rates and an inability to control the site of reentry. The advent of the BridgePoint device, and multiple iterations of technique in conjunction with its use, have markedly improved success rates and procedure efficiency.
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Affiliation(s)
- R Michael Wyman
- Cardiovascular Interventional Research, Torrance Memorial Medical Center, 3445 Pacific Coast Highway, Suite 100, Torrance, CA 90505, USA.
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