1
|
Ochiumi Y, Tsuchikane E, Kishi K, Okada H, Ito Y, Oikawa Y, Yoshikawa R, Okamura A, Tanaka H, Katoh O. The Characteristics of Primary Retrograde Approach Selection for Native Coronary Chronic Occlusion With Short Occlusion Length from the Japanese CTO-PCI Expert Registry. Am J Cardiol 2024; 218:113-120. [PMID: 38432339 DOI: 10.1016/j.amjcard.2024.02.040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/30/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Although the coronary chronic total occlusion (CTO) crossing algorithm has been published, the characteristics associated with the first strategy selection for short-length lesions <20 mm is still debatable. This study aimed to determine the characteristics associated with primary retrograde approach (PRA) for native CTO with short occlusion length in percutaneous coronary intervention (PCI). Between January 2014 and December 2021, we examined data on 4,088 lesions in the Japanese CTO-PCI Expert Registry with occlusion lengths <20 mm. Then, the characteristics for short-length CTO, which was performed by way of the PRA, were assessed. PRA was performed in 785 patients (19.2%). The guidewire success rate was 93.6%, and the technical success rate was 91.3%. Previous coronary artery bypass grafting, chronic kidney disease, and 6 lesion/anatomic characteristics (i.e., blunt stump, distal runoff <1 mm, CTO lesion tortuosity, reattempt procedures, ostial location, and the presence of collateral channel grade 2) were associated with PRA (p <0.05). Moreover, hemodialysis was an independent factor of unsuccessful anterograde guidewire crossing, along with distal runoff <1 mm, the existence of calcification, and CTO lesion tortuosity (all p <0.05). In clinical settings, these independent factors for PRA in short-length CTO can help in selecting the CTO-PCI strategy.
Collapse
Affiliation(s)
- Yusuke Ochiumi
- Department of Cardiology, Hiroshima Heart Center, Hiroshima, Japan
| | | | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshiaki Ito
- Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Kanagawa, Japan
| | - Yuji Oikawa
- Departmentof Cardiovascular Medicine, the Cardiovascular Institute, Tokyo, Japan
| | | | - Atsunori Okamura
- Division of Cardiology, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
| | | |
Collapse
|
2
|
van Veelen A, Verstraelen TE, Somsen YBO, Elias J, van Dongen IM, Delnoy PPHM, Scholten MF, Boersma LVA, Maass AH, Strikwerda S, Firouzi M, Allaart CP, Vernooy K, Grauss RW, Tukkie R, Knaapen P, Zwinderman AH, Dijkgraaf MGW, Claessen BEPM, van Barreveld M, Wilde AAM, Henriques JPS. Impact of a Chronic Total Coronary Occlusion on the Incidence of Appropriate Implantable Cardioverter-Defibrillator Shocks and Mortality: A Substudy of the Dutch Outcome in ICD Therapy (DO-IT)) Registry. J Am Heart Assoc 2024; 13:e032033. [PMID: 38591264 DOI: 10.1161/jaha.123.032033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Chronic total coronary occlusions (CTO) substantially increase the risk for sudden cardiac death. Among patients with chronic ischemic heart disease at risk for sudden cardiac death, an implantable cardioverter defibrillator (ICD) is the favored therapy for primary prevention of sudden cardiac death. This study sought to investigate the impact of CTOs on the risk for appropriate ICD shocks and mortality within a nationwide prospective cohort. METHODS AND RESULTS This is a subanalysis of the nationwide Dutch-Outcome in ICD Therapy (DO-IT) registry of primary prevention ICD recipients in The Netherlands between September 2014 and June 2016 (n=1442). We identified patients with chronic ischemic heart disease (n=663) and assessed available coronary angiograms for CTO presence (n=415). Patients with revascularized CTOs were excluded (n=79). The primary end point was the composite of all-cause mortality and appropriate ICD shocks. Clinical follow-up was conducted for at least 2 years. A total of 336 patients were included, with an average age of 67±9 years, and 20.5% was female (n=69). An unrevascularized CTO was identified in 110 patients (32.7%). During a median follow-up period of 27 months (interquartile range, 24-32), the primary end point occurred in 21.1% of patients with CTO (n=23) compared with 11.9% in patients without CTO (n=27; P=0.034). Corrected for baseline characteristics including left ventricular ejection fraction, and the presence of a CTO was an independent predictor for the primary end point (hazard ratio, 1.82 [95% CI, 1.03-3.22]; P=0.038). CONCLUSIONS Within this nationwide prospective registry of primary prevention ICD recipients, the presence of an unrevascularized CTO was an independent predictor for the composite outcome of all-cause mortality and appropriate ICD shocks.
Collapse
Affiliation(s)
- Anna van Veelen
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Tom E Verstraelen
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Yvemarie B O Somsen
- Department of Cardiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Joëlle Elias
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Ivo M van Dongen
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | | | - Marcoen F Scholten
- Department of Cardiology Thorax Center Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - Lucas V A Boersma
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
- Department of Cardiology St. Antonius Hospital Nieuwegein The Netherlands
| | - Alexander H Maass
- Department of Cardiology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | | | - Mehran Firouzi
- Department of Cardiology Maasstad Hospital Rotterdam The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Kevin Vernooy
- Department of Cardiology Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+) Maastricht The Netherlands
| | - Robert W Grauss
- Department of Cardiology Haaglanden Medical Center The Hague The Netherlands
| | - Raymond Tukkie
- Department of Cardiology Spaarne Gasthuis Haarlem The Netherlands
| | - Paul Knaapen
- Department of Cardiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Aeilko H Zwinderman
- Department of Epidemiology and Data Science Amsterdam UMC, Location AMC, University of Amsterdam Amsterdam The Netherlands
- Methodology Amsterdam Public Health Amsterdam The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science Amsterdam UMC, Location AMC, University of Amsterdam Amsterdam The Netherlands
- Methodology Amsterdam Public Health Amsterdam The Netherlands
| | - Bimmer E P M Claessen
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Marit van Barreveld
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
- Department of Epidemiology and Data Science Amsterdam UMC, Location AMC, University of Amsterdam Amsterdam The Netherlands
- Methodology Amsterdam Public Health Amsterdam The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - José P S Henriques
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| |
Collapse
|
3
|
Vural MG, Temel HY, Turunc E, Akdemir R, Tatli E, Agac MT. Transcoronary Gradients of Mechanosensitive MicroRNAs as Predictors of Collateral Development in Chronic Total Occlusion. Medicina (Kaunas) 2024; 60:590. [PMID: 38674237 DOI: 10.3390/medicina60040590] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/30/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: In this present study, we investigated the impact of mechanosensitive microRNAs (mechano-miRs) on the collateral development in 126 chronic total occlusion (CTO) patients, selected from 810 undergoing angiography. Materials and Methods: We quantified the collateral blood supply using the collateral flow index (CFI) and assessed the transcoronary mechano-miR gradients. Results: The patients with favorable collaterals had higher CFI values (0.45 ± 0.02) than those with poor collaterals (0.38 ± 0.03, p < 0.001). Significant differences in transcoronary gradients were found for miR-10a, miR-19a, miR-21, miR-23b, miR-26a, miR-92a, miR-126, miR-130a, miR-663, and let7d (p < 0.05). miR-26a and miR-21 showed strong positive correlations with the CFI (r = 0.715 and r = 0.663, respectively), while let7d and miR-663 were negatively correlated (r = -0.684 and r = -0.604, respectively). The correlations between cytokine gradients and mechano-miR gradients were also significant, including Transforming Growth Factor Beta with miR-126 (r = 0.673, p < 0.001) and Vascular Endothelial Growth Factor with miR-10a (r = 0.602, p = 0.002). A regression analysis highlighted the hemoglobin level, smoking, beta-blocker use, miR-26a, and miR-663 as significant CFI determinants, indicating their roles in modulating the collateral vessel development. Conclusions: These findings suggest mechanosensitive microRNAs as predictive biomarkers for collateral circulation, offering new therapeutic perspectives for CTO patients.
Collapse
Affiliation(s)
- Mustafa Gökhan Vural
- Department of Cardiology, University of Health Sciences, Ankara Training and Research Hospital, Ankara 06230, Turkey
| | - Hulya Yilmaz Temel
- Department of Bioengineering, Faculty of Engineering, Ege University, Bornova 35040, Turkey
| | - Ezgi Turunc
- Department of Biochemistry, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir 35620, Turkey
| | - Ramazan Akdemir
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya 54050, Turkey
| | - Ersan Tatli
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya 54050, Turkey
| | - Mustafa Tarik Agac
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya 54050, Turkey
| |
Collapse
|
4
|
Al-Ogaili A, Alexandrou M, Rempakos A, Mutlu D, Choi JW, Poommipanit P, Khatri JJ, Alaswad K, Basir MB, Chandwaney RH, Gorgulu S, ElGuindy AM, Elbarouni B, Jaber W, Rinfret S, Nicholson W, Jaffer FA, Aygul N, Azzalini L, Kearney KE, Frizzell J, Davies R, Goktekin O, Rangan BV, Mastrodemos OC, Sandoval Y, Nicholas Burke M, Brilakis ES. Retrograde chronic total occlusion percutaneous coronary intervention via ipsilateral collaterals. Catheter Cardiovasc Interv 2024. [PMID: 38563074 DOI: 10.1002/ccd.31019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/22/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND There is limited data on retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) via ipsilateral epicardial collaterals (IEC). AIMS To compare the clinical and angiographic characteristics, and outcomes of retrograde CTO PCI via IEC versus other collaterals in a large multicenter registry. METHODS Observational cohort study from the Prospective Global registry for the study of Chronic Total Occlusion Intervention (PROGRESS-CTO). RESULTS Of 4466 retrograde cases performed between 2012 and 2023, crossing through IEC was attempted in 191 (4.3%) cases with 50% wiring success. The most common target vessel in the IEC group was the left circumflex (50%), in comparison to other retrograde cases, where the right coronary artery was most common (70%). The Japanese CTO score was similar between the two groups (3.13 ± 1.23 vs. 3.06 ± 1.06, p = 0.456); however, the IEC group had a higher Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) score (1.95 ± 1.02 vs. 1.27 ± 0.92, p < 0.0001). The most used IEC guidewire was the SUOH 03 (39%), and the most frequently used microcatheter was the Caravel (43%). Dual injection was less common in IEC cases (66% vs. 89%, p < 0.0001). Technical (76% vs. 79%, p = 0.317) and procedural success rates (74% vs. 79%, p = 0.281) were not different between the two groups. However, IEC cases had a higher procedural complications rate (25.8% vs. 16.4%, p = 0.0008), including perforations (17.3% vs. 9.0%, p = 0.0001), pericardiocentesis (3.1% vs. 1.2%, p = 0.018), and dissection/thrombus of the donor vessel (3.7% vs. 1.2%, p = 0.002). CONCLUSION The use of IEC for retrograde CTO PCI was associated with similar technical and procedural success rates when compared with other retrograde cases, but higher incidence of periprocedural complications.
Collapse
Affiliation(s)
- Ahmed Al-Ogaili
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Deniz Mutlu
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, USA
| | | | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mir B Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | | | | | | | | | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | | | | | - Bavana V Rangan
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| |
Collapse
|
5
|
Yan Y, Yuan F, Liu X, Luo T, Feng X, Yao J, Zhang M, Gu F, Song G, Lyu S. Percutaneous Coronary Intervention Offers Clinical Benefits to Diabetic Patients With Stable Chronic Total Occlusion. Angiology 2024; 75:375-385. [PMID: 36809177 DOI: 10.1177/00033197231153246] [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: 02/23/2023]
Abstract
Whether percutaneous coronary intervention for chronic total occlusion (CTO-PCI) in diabetic patients offers more benefits compared with initial medical therapy (CTO-MT) is unclear. In this study, diabetic patients with one CTO (clinical manifestations: stable angina or silent ischemia) were enrolled. Consecutively, enrolled patients (n = 1605) were assigned to different groups: CTO-PCI (1044 [65.0%]) and initial CTO-MT (561 [35%]). After a median follow-up of 44 months, CTO-PCI tended to be superior to initial CTO-MT in major adverse cardiovascular events (adjusted hazard-ratio [aHR]: .81, 95% conference-interval: .65-1.02) and significantly superior in cardiac death (aHR: .58 [.39-.87]) and all-cause death (aHR: .678[.473-.970]). Such superiority mainly attributed to a successful CTO-PCI. CTO-PCI tended to be performed in patients with younger age, good collaterals, left anterior descending branch CTO, and right coronary artery CTO. While, those with left circumflex CTO and severe clinical/angiographic situations were more likely to be assigned to initial CTO-MT. However, none of these variables influenced the benefits of CTO-PCI. Thus, we concluded that for diabetic patients with stable CTO, CTO-PCI (mainly successful CTO-PCI) offered patients survival benefits over initial CTO-MT. These benefits were consistent regardless of clinical/angiographic characteristics.
Collapse
Affiliation(s)
- Yunfeng Yan
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Fei Yuan
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Xinmin Liu
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Taiyang Luo
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Xu Feng
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Jing Yao
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Mingduo Zhang
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Feifei Gu
- Department of Cardiology, Emergency General Hospital, Beijing, China
| | - Guangyuan Song
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Shuzheng Lyu
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| |
Collapse
|
6
|
Alexandrou M, Rempakos A, Mutlu D, Al Ogaili A, Choi JW, Poommipanit P, Alaswad K, Basir MB, Davies R, Jaffer FA, Chandwaney RH, Azzalini L, Aygul N, Dattilo P, Jefferson BK, Gorgulu S, Khatri JJ, Krestyaninov O, Frizzell J, Elbarouni B, Rangan BV, Mastrodemos O, Burke MN, Sandoval Y, Brilakis ES. Equipment entrapment/loss during chronic total occlusion percutaneous coronary intervention. J Invasive Cardiol 2024; 36. [PMID: 38412445 DOI: 10.25270/jic/23.00266] [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] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND There is limited data on equipment loss or entrapment during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We analyzed the baseline clinical and angiographic characteristics and outcomes of equipment loss/entrapment at 43 US and non-US centers between 2017 and 2023. RESULTS Equipment loss/entrapment was reported in 40 (0.4%) of 10 719 cases during the study period. These included guidewire entrapment/fracture (n = 21), microcatheter entrapment/fracture (n = 11), stent loss (n = 8) and balloon entrapment/fracture/rupture (n = 5). The equipment loss/entrapment cases were more likely to have moderate to severe calcification, longer lesion length, higher J-CTO and PROGRESS-CTO complications scores, and use of the retrograde approach compared with the remaining cases. Retrieval was attempted in 71.4% of the guidewire, 90.9% of the microcatheter, 100% of the stent loss, and 100% of the balloon cases, and was successful in 26.7%, 30.0%, 50%, and 40% of the cases, respectively. Procedures complicated by equipment loss/entrapment had higher procedure and fluoroscopy time, contrast volume and patient air kerma radiation dose, lower procedural (60.0% vs 85.6%, P less than .001) and technical (75.0% vs 86.8%, P = .05) success, and higher incidence of major adverse cardiac events (MACE) (17.5% vs 1.8%, P less than .001), acute MI (7.5% vs 0.4%, P less than .001), emergency coronary artery bypass graft (CABG) (2.5% vs 0.1%, P = .03), perforation (20.0% vs 4.9%, P less than .001), and death (7.5% vs 0.4%, P less than .001). CONCLUSIONS Equipment loss is a rare complication of CTO PCI; it is more common in complex CTOs and is associated with lower technical success and higher MACE.
Collapse
Affiliation(s)
- Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Deniz Mutlu
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ahmed Al Ogaili
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | | | | | | | | | | | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Phil Dattilo
- Medical Center of the Rockies, Loveland, CO, USA
| | | | | | | | | | | | | | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital,Minneapolis, MN, USA
| | - Olga Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital,Minneapolis, MN, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital,Minneapolis, MN, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital,Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital,Minneapolis, MN, USA.
| |
Collapse
|
7
|
Nobre Menezes M, Mamas MA. PCI in Cancer Patients: Adding Another Piece to a Complex and Still Very Incomplete Puzzle. Circ Cardiovasc Interv 2024; 17:e014076. [PMID: 38626081 DOI: 10.1161/circinterventions.124.014076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Affiliation(s)
- Miguel Nobre Menezes
- Structural and Coronary Heart Disease Unit, Cardio-Oncology Unit CHULN Hospital de Santa Maria, Cardiovascular Center of the University of Lisbon (CCUL@RISE), Universidade de Lisboa, Lisbon, Portugal (M.N.M.)
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, United Kingdom (M.A.M.)
| |
Collapse
|
8
|
Mutlu D, Rempakos A, Alexandrou M, Al-Ogaili A, Rangan BV, Mastrodemos OC, Sandoval Y, Burke MN, Brilakis ES. Radiation dose during contemporary percutaneous coronary interventions for chronic total occlusion: insights from the PROGRESS-CTO registry. J Invasive Cardiol 2024; 36. [PMID: 38412437 DOI: 10.25270/jic/23.00281] [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] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with high radiation doses. In this manuscript, we examined the contemporary trends and determinants of radiation dose in the PROGRESS CTO (Prospective Global Registry for the Study of CTO Intervention; Clinicaltrials.gov identifier: NCT02061436) registry. Radiation dose during CTO PCI did not change significantly since 2020, highlighting the need for innovation and operator education to further maintain radiation safety.
Collapse
Affiliation(s)
- Deniz Mutlu
- From the Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ahmed Al-Ogaili
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
| |
Collapse
|
9
|
Giordano A, Biondi-Zoccai G. Which is the best approach for percutaneous coronary intervention of chronic total occlusions? The one you feel most confident with! Catheter Cardiovasc Interv 2024; 103:821-822. [PMID: 38506100 DOI: 10.1002/ccd.31011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
Key points
Percutaneous coronary intervention of chronic total occlusion remains a challenging niche, where minimization of technical failure and complication rates must be dearly pursued.
The minimalist hybrid approach is a novel recanalization strategy which provides an individualized technical framework minimizing simultaneous dual injection and large‐bore catheters unless clearly needed.
This study reports an observational comparison between a standard revascularization strategy for chronic total occlusion and the minimalist hybrid approach, suggesting the latter may be associated with some benefits, including more parsimonious use of costly devices.
Collapse
Affiliation(s)
- Arturo Giordano
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
- Interventional Cardiology Unit, Casa di Salute S. Lucia, S. Giuseppe Vesuviano, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| |
Collapse
|
10
|
Prins KW, Durbin J, Archer SL. Complete Revascularization of the Pulmonary Circulation in Chronic Thromboembolic Pulmonary Hypertension: Value of Addressing Chronic Total Occlusions. Can J Cardiol 2024; 40:634-636. [PMID: 38030122 PMCID: PMC11009058 DOI: 10.1016/j.cjca.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Kurt W Prins
- Cardiovascular Division, Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Josh Durbin
- Department of Medicine (Cardiology), Queen's University, Kingston, Ontario, Canada
| | - Stephen L Archer
- Department of Medicine (Cardiology), Queen's University, Kingston, Ontario, Canada; Translational Institute of Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| |
Collapse
|
11
|
Zhang S, Hu G, Zhang B, Li Y, Li B, Liu Z, Ma P, Qiu Y, Xu Q. Successful true cavity pathfinding with balloon assisted CTO with bifurcation lesions: Two case reports. Medicine (Baltimore) 2024; 103:e37404. [PMID: 38552077 PMCID: PMC10977579 DOI: 10.1097/md.0000000000037404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/07/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Coronary artery disease is a prevalent global cardiovascular ailment, with percutaneous coronary intervention (PCI) standing out as a crucial method for relieving symptoms and enhancing the quality of life in patients with coronary heart disease. However, the presence of concurrent chronic total occlusion (CTO) and bifurcation lesions within coronary arteries elevates the complexity and treatment risks, especially when the entry point of the CTO is ambiguous. OBJECTIVE This study aims to present an innovative approach for treating CTO complicated with bifurcation lesions, focusing on true cavity pathfinding assisted by a balloon. METHODS Two cases of CTO patients with concomitant bifurcation lesions are described. One case involves CTO of the left anterior descending artery) combined with anterior non-angle trigeminal lesions, while the other entails CTO of the posterior left artery combined with posterior angle trigeminal lesions. True lumen identification using a balloon and subsequent opening of the CTO blood vessel were performed in both cases. RESULTS In both cases, the true lumen was successfully located with the assistance of a balloon, leading to the successful opening of the CTO blood vessel. This approach not only simplified the procedure but also reduced procedural difficulty and associated risks of complications compared to traditional guide wire operations. CONCLUSION The application of true cavity pathfinding assisted by a balloon offers a novel and effective strategy for managing CTO complicated with bifurcation lesions. The method simplifies the procedure, decreases procedural difficulty, and lowers the risk of complications associated with guide wire operations. However, further studies and long-term follow-up data are warranted to validate the reliability and long-term efficacy of this innovative approach.
Collapse
Affiliation(s)
- Shichang Zhang
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Guangxin Hu
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Botao Zhang
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yinping Li
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ben Li
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhijun Liu
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ping Ma
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yumin Qiu
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Qingbin Xu
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| |
Collapse
|
12
|
Alexandrou M, Rempakos A, Mutlu D, Ogaili AA, Choi JW, Poommipanit P, Alaswad K, Basir MB, Davies R, Benton S, Jaffer FA, Chandwaney RH, Kearney KE, ElGuindy AM, Rafeh NA, Goktekin O, Gorgulu S, Khatri JJ, Krestyaninov O, Khelimskii D, Rangan BV, Mastrodemos OC, Burke MN, Sandoval Y, Lombardi WL, Brilakis ES, Azzalini L. Comparative Analysis of Polymer Versus Non-Polymer Jacketed Wires in Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol 2024; 215:10-18. [PMID: 38224729 DOI: 10.1016/j.amjcard.2024.01.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
There is significant variation in wire utilization patterns for chronic total occlusion (CTO) percutaneous coronary intervention. This study aimed to compare the outcomes of polymer-jacketed wires (PJWs) versus non-PJWs in anterograde procedures. We analyzed clinical and angiographic characteristics, and procedural outcomes of 7,575 anterograde CTO percutaneous coronary interventions that were performed at 47 centers between 2012 and 2023. Cases in which PJWs were exclusively used were classified in the PJW group, whereas cases where at least one non-PJW was employed were classified in the non-PJW group. Study end points were as follows: technical success, coronary perforation, major adverse cardiac event. PJWs were exclusively used in 3,481 cases (46.0%). These cases had lower prevalence of proximal cap ambiguity, blunt stump, and moderate/severe calcification. They also had lower Japanese CTO (J-CTO), Prospective Global Registry for the Study of Chronic Total Occlusion (PROGRESS-CTO), and PROGRESS-CTO complications scores, higher technical success (94.3% vs 85.7%, p <0.001), and lower perforation rates (2.2% vs 3.2%, p = 0.013). Major adverse cardiac event rates did not differ between groups (1.3% vs 1.5%, p = 0.53). Exclusive use of PJWs was independently associated with higher technical success in both the multivariable (odds ratio [OR] 2.66, 95% confidence interval [CI] 2.13 to 3.36, p <0.001) and inverse probability of treatment weight analysis (OR 2.43, 95% CI 2.04 to 2.89, p <0.001). Exclusive use of PJWs was associated with lower risk of perforation in the multivariable analysis (OR 0.69, 95% CI 0.49 to 0.95, p = 0.02), and showed a similar trend in the inverse probability of treatment weight analysis (OR 0.77, 95% CI 0.57 to 1.04, p = 0.09). Exclusive use of PJWs is associated with higher technical success and lower perforation risk in this non-randomized series of patients.
Collapse
Affiliation(s)
- Michaella Alexandrou
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Athanasios Rempakos
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Deniz Mutlu
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ahmed Al Ogaili
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Paul Poommipanit
- Section of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Mir Babar Basir
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Rhian Davies
- Department of Cardiology, WellSpan York Hospital, York, Pennsylvania
| | - Stewart Benton
- Department of Cardiology, WellSpan York Hospital, York, Pennsylvania
| | - Farouc A Jaffer
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Raj H Chandwaney
- Department of Invasive Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | - Nidal Abi Rafeh
- Department of Cardiology, North Oaks Health System, Hammond, Louisiana
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | | | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Dmitrii Khelimskii
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Bavana V Rangan
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Olga C Mastrodemos
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - M Nicholas Burke
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - William L Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Emmanouil S Brilakis
- Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
| |
Collapse
|
13
|
Mutlu D, Rempakos A, Alexandrou M, Al-Ogaili A, Jaffer FA, Alaswad K, Khatri JJ, Young L, Basir MB, Krestyaninov O, Khelimskii D, Gorguluu S, Goktekin O, Choi JW, Chandwaney RH, Potluri S, Poommipanit P, Uretsky B, Kandzari DE, Aygul N, Azzalini L, Rangan BV, Mastrodemos OC, Sandoval Y, Burke MN, Brilakis ES. Use of plaque modification microcatheters during percutaneous coronary interventions for chronic total occlusion: insights from the PROGRESS-CTO Registry. J Invasive Cardiol 2024. [PMID: 38471154 DOI: 10.25270/jic/24.00014] [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] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Plaque modification microcatheters (PM) (Tornus [Asahi] and Turnpike Gold [Teleflex]) are devices that are mainly used to modify the cap or lesion and maintain good support in chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI). We evaluated the frequency of use and outcomes of plaque modification microcatheters in an international multicenter registry. Plaque modification microcatheters were utilized in 242 cases (1.6%: Tornus in 51% and Turnpike Gold in 49%) with decreasing frequency over time (P-for-trend: 0.007 and 0.035, respectively). Technical and procedural success and the incidence of major cardiac adverse events were similar with Tornus and Turnpike Gold use. PM are infrequently utilized in CTO-PCI and are associated with high success and acceptable complication rates.
Collapse
Affiliation(s)
- Deniz Mutlu
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ahmed Al-Ogaili
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | | | | | - Mir B Basir
- Henry Ford Cardiovascular Division, Detroit, Michigan, USA
| | - Oleg Krestyaninov
- Meshalkin National Research Institute, Novosibirsk, Russian Federation
| | | | | | | | - James W Choi
- Texas Health Presbyterian Dallas Hospital and Baylor Scott and White Heart and Vascular Hospital , Dallas, Texas, USA
| | - Raj H Chandwaney
- Oklahoma Heart Institute, Tulsa, Oklahoma, USA; 10The Heart Hospital Baylor Plano, Plano, Texas, USA
| | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Barry Uretsky
- Central Arkansas Veterans Health System; University of Arkansas for Medical Sciences, Little Rock, Arkansas, USACentral Arkansas Veterans Health System, and University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Nazif Aygul
- Goztepe Medical Park Hospital, Istanbul, Turkey
| | | | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
| |
Collapse
|
14
|
Murasato Y, Meno K, Mori T. Coronary intervention in chronic total occlusion in left main coronary artery. J Invasive Cardiol 2024. [PMID: 38471151 DOI: 10.25270/jic/24.00027] [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] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
An 83-year-old man who had undergone coronary aorta bypass graft surgery 25 years ago required treatment for new-onset worsening angina.
Collapse
Affiliation(s)
- Yoshinobu Murasato
- Department of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
| | - Kyohei Meno
- Department of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takahiro Mori
- Department of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| |
Collapse
|
15
|
Castaldi G, Kovacic M, Poletti E, Benedetti A, Moroni A, Scott B, Wilgenhof A, Bezzeccheri A, Vescovo G, Budassi S, El Jattari H, Convens C, Verheye S, Vermeersch P, Zivelonghi C, Tumscitz C, Agostoni P. Minimalistic Hybrid Approach for the Percutaneous Treatment of Coronary Chronic Total Occlusions: Midterm Follow-Up of an International Multicenter Cohort. Am J Cardiol 2024; 214:77-84. [PMID: 38160923 DOI: 10.1016/j.amjcard.2023.12.036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/26/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
The minimalistic hybrid approach (MHA) is a recently proposed algorithm to perform chronic total occlusion (CTO) percutaneous coronary intervention (PCI), reducing the overall invasiveness of the procedure without impacting the acute results. However, data on midterm results are lacking. This study aimed to evaluate the midterm clinical outcomes of a multicenter international cohort of CTO PCI treated according to the MHA. Data from a consecutive series of patients with a CTO who underwent PCI according to the MHA between February 2019 and March 2022 were prospectively collected in 3 European centers and retrospectively analyzed. The main outcome was the first occurrence of a major adverse cardiac event (MACE), defined as a composite outcome of all-cause death, any myocardial infarction, and target vessel revascularization, at the last follow-up available. A total of 212 patients were included. The majority of the patients were symptomatic for angina (Canadian Cardiovascular Society class 2 or 3: 63.7%) at the time of the index procedure. The mean Japanese-CTO and CASTLE scores were 2.1 ± 1.2 and 2.0 ± 1.3, respectively. Technical success (CTO open with optimal flow) was achieved in 198 patients (93.9%) and procedural success (technical success without in-hospital MACEs) in 195 (91.9%). At the last follow-up available (median 677 days), the cumulative incidence rate of MACEs was 11.5%; in particular, all-cause death was 7.4%, any myocardial infarction was 4.3%, and unplanned target vessel revascularization was 6.5%. In conclusion, the midterm results of the MHA seem to be in line with contemporary results of other CTO PCI algorithms, thus potentially validating the MHA as a valuable alternative, provided that interventionalists are already expert CTO operators and accustomed to the definitions and peculiarities of MHA.
Collapse
Affiliation(s)
- Gianluca Castaldi
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Universitair Ziekenhuis Leuven, Leuven, Belgium
| | | | - Enrico Poletti
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Alice Benedetti
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Alice Moroni
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Adriaan Wilgenhof
- Cardiovascular Center Aalst, Onze Lieve Vrouw Clinic, Aalst, Belgium
| | - Andrea Bezzeccheri
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Giovanni Vescovo
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science, Ospedale dell'Angelo, Venice, Italy
| | - Simone Budassi
- Cardiovascular Sciences Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Hicham El Jattari
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carl Convens
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Tumscitz
- Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | | |
Collapse
|
16
|
Filho EM, Araujo GN, Machado GP, Padilla L, de Paula JET, Botelho AC, Campos CM, Quesada FLH, Alcantara M, Santiago R, de Los Santos FD, Oliveira MD, Ribeiro MH, Perez L, Pinto ME, Côrtes LA, Piccaro P, Brilakis ES, Quadros AS. Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions. Catheter Cardiovasc Interv 2024; 103:539-547. [PMID: 38431912 DOI: 10.1002/ccd.30987] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 11/25/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications. AIM Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use. RESULTS From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in the GCE group were older and had more comorbidities. The median J-CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78-2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41-2.41, p = 0.986), in-hospital death (OR: 1.39, 95% CI: 0.54-3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52-2.19, p = 0.850) were similar in both groups. CONCLUSION In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.
Collapse
Affiliation(s)
| | - Gustavo N Araujo
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Instituto de Cardiologia de Santa Catarina, São José, Brazil
| | | | - Lucio Padilla
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Félix D de Los Santos
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Centro Medico ABC, Mexico City, Mexico
| | - Marcos D Oliveira
- Hospital São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Marcelo H Ribeiro
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Hospital SOS Cardio, Florianópolis, Brazil
| | - Luiz Perez
- Hospital Clinico Regional Dr Guillermo Grant Benavente, Concepcion, Chile
| | | | | | - Pedro Piccaro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | |
Collapse
|
17
|
Poletti E, Zivelonghi C, Dens J, Bennett J, Ungureanu C, Coussement P, Cottens D, Lesizza P, Jossart A, De Cock E, Scott B, Agostoni P. Performance of the minimalistic hybrid approach algorithm versus other conventional algorithms in the percutaneous treatment of chronic total occlusions. Catheter Cardiovasc Interv 2024; 103:548-559. [PMID: 38329188 DOI: 10.1002/ccd.30963] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/24/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The "Minimalistic Hybrid Approach" (MHA) has been proposed to reduce the invasiveness of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). AIMS This study aims to assess whether MHA may also reduce the utilization of PCI resources (devices, radiations, and contrast) by comparing it with other conventional algorithms. METHODS We aimed to assess the impact of MHA on device, radiation, and contrast usage during CTO-PCI analyzing data from the Belgian Working Group on CTO (BWG-CTO) registry. Patients were divided, depending on the algorithm used, into two groups: Conventional versus Minimalistic. Primary objectives were procedure performance measures such as device usage (microcatheters and guidewires), radiological parameters, and contrast use. At 1-year follow-up, patients were evaluated for target vessel failure (TVF), defined as a composite of cardiac death, new myocardial infarction, and target vessel revascularization. RESULTS Overall, we analyzed 821 CTO-PCIs (Conventional n = 650, Minimalistic n = 171). The Minimalistic group demonstrated higher complexity of CTO lesions. After adjusting for propensity score, the Minimalistic group had a significantly lower number of microcatheters used (1.49 ± 0.85 vs. 1.24 ± 0.64, p = 0.026), while the number of guidewires was comparable (4.80 ± 3.29 vs. 4.35 ± 2.94, p = 0.30). Both groups had similar rates of success and procedural complications, as well as comparable procedural and fluoroscopic times and contrast volume used. At the 1-year follow-up, both groups showed comparable rates of TVF (hazard ratio: 0.57; 95% confidence interval: 0.24-1.34, p = 0.195). CONCLUSION The MHA may slightly reduce the number of dedicated devices used during CTO-PCI, without adversely affecting the procedural success or long-term outcome.
Collapse
Affiliation(s)
- Enrico Poletti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Joseph Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
| | | | | | - Daan Cottens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Adrien Jossart
- Department of Cardiology, Hôpital de Jolimont, La Louvière, Belgium
| | | | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | | |
Collapse
|
18
|
Madanchi M, Bossard M, Majcen I, Cioffi GM, Ferraro F, Gnan E, Gjergjizi V, Zhi Y, Bade V, Wolfrum M, Moccetti F, Toggweiler S, Attinger-Toller A, Cuculi F. Outcomes following coronary chronic total occlusion revascularization with drug-coated balloons. J Invasive Cardiol 2024; 36. [PMID: 38441987 DOI: 10.25270/jic/22.00260] [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] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVES Despite the introduction of improved drug eluting stents (DES), the rate of repeat revascularization procedures following percutaneous coronary interventions (PCI) in coronary chronic total occlusions (CTO) remains high. By leaving vessels uncaged and limiting length of stented segments, drug-coated balloons (DCB) represent an appealing alternative to DES for CTO-PCI. Since data supporting the use of DCBs in CTO-PCI is scarce, we compared the outcomes of patients undergoing CTO-PCI involving DCBs vs DES only. METHODS From 2 prospective registries, outcomes of patients undergoing CTO-PCI involving DCBs and those undergoing PCI with DES only were compared. Outcomes included major adverse cardiac and cerebrovascular events (MACCE) and cardiovascular death (CV-death). RESULTS Overall, 157 patients were studied; 112 (71%) underwent CTO-PCI involving DCBs and 45 (29%) were treated with DES only. Mean J-CTO score was 1.84 ± 0.7. Most CTO-lesions involved the right coronary artery, 88 (56%), and 26 (17%) cases were in-stent occlusions. In the DCB group, 46 (41%) lesions were treated with DCBs alone. Mean lengths of the stented segments in the DCB vs DES cohorts were 59 ± 28 mm vs 87 ± 37 mm (P less than .001), respectively. After 12 months, the MACCE rate was higher in the DES only vs DCB group (26% vs 11%, P=.03). Length of the stented segment was an independent predictor for MACCE (HR 1.15 [95% CI, 1.05-1.26] per 10-mm stent length). CONCLUSIONS Revascularization of CTO lesions involving DCBs appears safe and potentially lowers MACCE rates compared to treatment with DES alone. Importantly, using DCBs for CTO treatment may reduce total stent length, which determines PCI outcomes.
Collapse
Affiliation(s)
- Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Irena Majcen
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Giacomo M Cioffi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences, Hamilton, Canada
| | - Francesco Ferraro
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Eleonora Gnan
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - Varis Gjergjizi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Yuan Zhi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Vanessa Bade
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; 2Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| |
Collapse
|
19
|
Wong SF, Chow HC, Chung TS. Use of chronic total occlusion wiring techniques for extremely angulated side branch access. J Invasive Cardiol 2024; 36. [PMID: 38441992 DOI: 10.25270/jic/23.00207] [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] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
A 75-year-old man was admitted for non-ST-segment elevation myocardial infarction (NSTEMI).
Collapse
Affiliation(s)
- Siu-Fung Wong
- Division of Cardiology, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, China.
| | - Hiu-Cheong Chow
- Division of Cardiology, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, China
| | - Tak-Shun Chung
- Division of Cardiology, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, China
| |
Collapse
|
20
|
Gold DA, Sandesara PB, Jain V, Gold ME, Vatsa N, Desai SR, Hassan ME, Yuan C, Ko YA, Ejaz K, Alvi Z, Jaber WA, Nicholson WJ, Quyyumi AA. Long-Term Outcomes in Patients With Chronic Total Occlusion. Am J Cardiol 2024; 214:59-65. [PMID: 38195045 PMCID: PMC10947430 DOI: 10.1016/j.amjcard.2023.12.052] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/24/2023] [Indexed: 01/11/2024]
Abstract
Although a chronic total occlusion (CTO) in the setting of an acute coronary syndrome is associated with greater risk, the prognosis of patients with a CTO and stable coronary artery disease (CAD) remains unknown. This study aimed to investigate adverse event rates in patients with stable CAD with and without a CTO. In 3,597 patients with stable CAD (>50% coronary luminal stenosis) who underwent cardiac catheterization, all-cause mortality, cardiovascular mortality, and the composite major adverse cardiac event (MACE) rates for cardiovascular death, myocardial infarction, and heart failure hospitalization were evaluated. Cox proportional hazards and Fine and Gray subdistribution hazard models were used to compare event-free survival in patient subsets after adjustment for covariates. Event rates were higher in patients with CTOs than in those without CTOs after adjusting for demographic and clinical characteristics (cardiovascular death hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.05 to 1.57, p = 0.012). Patients with CTO revascularization had lower event rates than those of patients without CTO revascularization (cardiovascular death HR 0.43, CI 0.26 to 0.70, p = 0.001). Those with nonrevascularized CTOs were at particularly great risk when compared with those without CTO (cardiovascular death HR 1.52, CI 1.25 to 1.84, p <0.001). Moreover, those with revascularized CTOs had similar event rates to those of patients with CAD without CTOs. Patients with CTO have higher rates of adverse cardiovascular events than those of patients with significant CAD without CTO. This risk is greatest in patients with nonrevascularized CTO.
Collapse
Affiliation(s)
- Daniel A Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Vardhmaan Jain
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew E Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nishant Vatsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shivang R Desai
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Malika Elhage Hassan
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Chenyang Yuan
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kiran Ejaz
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Zain Alvi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wissam A Jaber
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - William J Nicholson
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
| |
Collapse
|
21
|
Madanchi M, Bossard M, Majcen I, Cioffi GM, Ferraro F, Gnan E, Gjergjizi V, Zhi Y, Bade V, Wolfrum M, Moccetti F, Toggweiler S, Attinger-Toller A, Cuculi F. Outcomes following coronary chronic total occlusion revascularization with drug-coated balloons. J Invasive Cardiol 2024; 36. [PMID: 38441987 DOI: 10.25270/jic/23.00260] [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] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVES Despite the introduction of improved drug eluting stents (DES), the rate of repeat revascularization procedures following percutaneous coronary interventions (PCI) in coronary chronic total occlusions (CTO) remains high. By leaving vessels uncaged and limiting length of stented segments, drug-coated balloons (DCB) represent an appealing alternative to DES for CTO-PCI. Since data supporting the use of DCBs in CTO-PCI is scarce, we compared the outcomes of patients undergoing CTO-PCI involving DCBs vs DES only. METHODS From 2 prospective registries, outcomes of patients undergoing CTO-PCI involving DCBs and those undergoing PCI with DES only were compared. Outcomes included major adverse cardiac and cerebrovascular events (MACCE) and cardiovascular death (CV-death). RESULTS Overall, 157 patients were studied; 112 (71%) underwent CTO-PCI involving DCBs and 45 (29%) were treated with DES only. Mean J-CTO score was 1.84 ± 0.7. Most CTO-lesions involved the right coronary artery, 88 (56%), and 26 (17%) cases were in-stent occlusions. In the DCB group, 46 (41%) lesions were treated with DCBs alone. Mean lengths of the stented segments in the DCB vs DES cohorts were 59 ± 28 mm vs 87 ± 37 mm (P less than .001), respectively. After 12 months, the MACCE rate was higher in the DES only vs DCB group (26% vs 11%, P=.03). Length of the stented segment was an independent predictor for MACCE (HR 1.15 [95% CI, 1.05-1.26] per 10-mm stent length). CONCLUSIONS Revascularization of CTO lesions involving DCBs appears safe and potentially lowers MACCE rates compared to treatment with DES alone. Importantly, using DCBs for CTO treatment may reduce total stent length, which determines PCI outcomes.
Collapse
Affiliation(s)
- Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Irena Majcen
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Giacomo M Cioffi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences, Hamilton, Canada
| | - Francesco Ferraro
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Eleonora Gnan
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - Varis Gjergjizi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Yuan Zhi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Vanessa Bade
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; 2Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| |
Collapse
|
22
|
Mutlu D, Rempakos A, Alexandrou M, Al-Ogaili A, Yamane M, Alaswad K, Basir M, Davies R, Choi J, Gagnor A, Garbo R, Goktekin O, Gorgulu S, Khatri JJ, Nicholson W, Rinfret S, Jaber W, Egred M, Milkas A, Di Mario C, Mashayekhi K, Sandoval Y, Burke MN, Brilakis ES. Update on chronic total occlusion percutaneous coronary intervention. J Invasive Cardiol 2024; 36. [PMID: 38441986 DOI: 10.25270/jic/23.00239] [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] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) continues to evolve. This review summarizes recent publications categorized by outcomes, techniques, complications, and ongoing studies in this rapidly growing area.
Collapse
Affiliation(s)
- Deniz Mutlu
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ahmed Al-Ogaili
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | - Mir Basir
- Henry Ford Cardiovascular Division, Detroit, Michigan, USA
| | | | - James Choi
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | | | | | | | | | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | | | | | | | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
| |
Collapse
|
23
|
Rempakos A, Alexandrou M, Mutlu D, Choi JW, Poommipanit P, Khatri JJ, Young L, Dattilo P, Sadek Y, Davies R, Gorgulu S, Jaffer FA, Chandwaney R, Jefferson B, Elbarouni B, Azzalini L, Kearney KE, Alaswad K, Basir MB, Krestyaninov O, Khelimskii D, Aygul N, Abi-Rafeh N, Elguindy A, Goktekin O, Rangan BV, Mastrodemos OC, Al-Ogaili A, Sandoval Y, Burke MN, Brilakis ES, Kalyanasundaram A. Predictors of successful primary antegrade wiring in chronic total occlusion percutaneous coronary intervention. J Invasive Cardiol 2024. [PMID: 38446022 DOI: 10.25270/jic/23.00305] [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] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Antegrade wiring is the most commonly used chronic total occlusion (CTO) crossing technique. METHODS Using data from the PROGRESS CTO registry (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; Clinicaltrials.gov identifier: NCT02061436), we examined the clinical and angiographic characteristics and procedural outcomes of CTO percutaneous coronary interventions (PCIs) performed using a primary antegrade wiring strategy. RESULTS Of the 13 563 CTO PCIs performed at 46 centers between 2012 and 2023, a primary antegrade wiring strategy was used in 11 332 (83.6%). Upon multivariable logistic regression analysis, proximal cap ambiguity (odds ratio [OR]: 0.52; 95% CI, 0.46-0.59), side branch at the proximal cap (OR: 0.85; 95% CI, 0.77-0.95), blunt/no stump (OR: 0.52; 95% CI: 0.47-0.59), increasing lesion length (OR [per 10 mm increase]: 0.79; 95% CI, 0.76-0.81), moderate to severe calcification (OR: 0.73; 95% CI, 0.66-0.81), moderate to severe proximal tortuosity (OR: 0.67; 95% CI, 0.59-0.75), bifurcation at the distal cap (OR: 0.66; 95% CI, 0.59-0.73), left anterior descending artery CTO (OR [vs right coronary artery]: 1.44; 95% CI, 1.28-1.62) and left circumflex CTO (OR [vs right coronary artery]: 1.22; 95% CI, 1.07-1.40), non-in-stent restenosis lesion (OR: 0.56; 95% CI, 0.49-0.65), and good distal landing zone (OR: 1.18; 95% CI, 1.06-1.32) were independently associated with primary antegrade wiring crossing success. CONCLUSIONS The use of antegrade wiring as the initial strategy was high (83.6%) in our registry. We identified several parameters associated with primary antegrade wiring success.
Collapse
Affiliation(s)
- Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Deniz Mutlu
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | | | | - Brian Jefferson
- Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | | | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Mir B Basir
- Henry Ford Cardiovascular Division, Detroit, Michigan, USA
| | | | | | | | | | - Ahmed Elguindy
- Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | | | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ahmed Al-Ogaili
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | |
Collapse
|
24
|
Azzalini L, Boukhris M. Percutaneous Coronary Intervention of Left Anterior Descending Chronic Total Occlusion: Watch Out for Myocardial Bridging! JACC Cardiovasc Interv 2024; 17:502-504. [PMID: 38340100 DOI: 10.1016/j.jcin.2023.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/31/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.
| | | |
Collapse
|
25
|
Mutlu D, Rempakos A, Alexandrou M, Al-Ogaili A, Khatri JJ, Alaswad K, Gorgulu S, Sandoval Y, Burke MN, Brilakis ES. Validation of the J-Channel Score for retrograde channel crossing in the PROGRESS-CTO registry. J Invasive Cardiol 2024. [PMID: 38422527 DOI: 10.25270/jic/24.00006] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Successful collateral channel (CC) crossing is essential for the success of retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Based on the Japanese CTO PCI expert registry, the J-Channel score was developed to predict CC crossing. We examined the performance of the J-Channel score in patients who underwent retrograde CTO-PCI at 31 centers between 2013-2023 as part of the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO). We observed an association between successful CC crossing and the J-Channel score, its predictive efficacy was modest for both wire and microcatheter crossing.
Collapse
Affiliation(s)
- Deniz Mutlu
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ahmed Al-Ogaili
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | | | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
| |
Collapse
|
26
|
Yamamoto K, Sugizaki Y, Karmpaliotis D, Sato T, Matsumura M, Narui S, Yamamoto MH, Fall KN, James EI, Glinski JB, Rabban ML, Prasad M, Ng VG, Sethi SS, Nazif TM, Parikh SA, Vahl TP, Ali ZA, Rabbani LE, Collins MB, Leon MB, McEntegart M, Moses JW, Kirtane AJ, Ochiai M, Mintz GS, Maehara A. Presence and Relevance of Myocardial Bridge in LAD-PCI of CTO and Non-CTO Lesions. JACC Cardiovasc Interv 2024; 17:491-501. [PMID: 38340105 DOI: 10.1016/j.jcin.2023.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/27/2023] [Accepted: 12/12/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) studies show that one-quarter of left anterior descending (LAD) arteries have a myocardial bridge. An MB may be associated with stent failure when the stent extends into the MB. OBJECTIVES The aim of this study was to investigate: 1) the association between an MB and chronic total occlusion (CTO) in any LAD lesions; and 2) the association between an MB and subsequent clinical outcomes after percutaneous coronary intervention in LAD CTOs. METHODS A total of 3,342 LAD lesions with IVUS-guided percutaneous coronary intervention (280 CTO and 3,062 non-CTO lesions) were included. The primary outcome was target lesion failure (cardiac death, target vessel myocardial infarction, definite stent thrombosis, and ischemic-driven target lesion revascularization). RESULTS An MB by IVUS was significantly more prevalent in LAD CTOs than LAD non-CTOs (40.4% [113/280] vs 25.8% [789/3,062]; P < 0.0001). The discrepancy in CTO length between angiography and IVUS was greater in 113 LAD CTOs with an MB than 167 LAD CTOs without an MB (6.0 [Q1, Q3: 0.1, 12.2] mm vs 0.2 [Q1, Q3: -1.4, 8.4] mm; P < 0.0001). Overall, 48.7% (55/113) of LAD CTOs had a stent that extended into an MB after which target lesion failure was significantly higher compared to a stent that did not extend into an MB (26.3% vs 0%; P = 0.0004) or compared to an LAD CTO without an MB (26.3% vs 9.6%; P = 0.02). CONCLUSIONS An MB was more common in LAD CTO than non-CTO LAD lesions. If present, approximately one-half of LAD CTOs had a stent extending into an MB that, in turn, was associated with worse outcomes.
Collapse
Affiliation(s)
- Kei Yamamoto
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Yoichiro Sugizaki
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Dimitri Karmpaliotis
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Takao Sato
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Shuro Narui
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Myong Hwa Yamamoto
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Khady N Fall
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Elizabeth I James
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - John B Glinski
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Maya L Rabban
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Megha Prasad
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Vivian G Ng
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Sanjum S Sethi
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Tamim M Nazif
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Torsten P Vahl
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital, Roslyn, New York, New York, USA
| | - LeRoy E Rabbani
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Michael B Collins
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Martin B Leon
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Margaret McEntegart
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Jeffrey W Moses
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital, Roslyn, New York, New York, USA
| | - Ajay J Kirtane
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Masahiko Ochiai
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Akiko Maehara
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.
| |
Collapse
|
27
|
Račytė A, Pikturnaitė G, Baltrūnas T, Kalvaitis E, Vaitėnas G, Skrebūnas A, Baltrūnienė V, Ručinskas K. Oxygen Saturation Increase in Ischemic Wound Tissues after Direct and Indirect Revascularization. Biomedicines 2024; 12:367. [PMID: 38397969 PMCID: PMC10887106 DOI: 10.3390/biomedicines12020367] [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: 01/05/2024] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The primary approach for treating ischemic wounds is restoring oxygen supply to the ischemic region. While direct angiosomal revascularization is often associated with better post-operative wound healing and limb salvage, its superiority over non-angiosomal revascularization remains controversial. This study aimed to compare intraoperative tissue oxygen saturation changes in ischemic zones following either direct or indirect revascularization in below-the-knee arteries. METHODS This prospective observational study included patients undergoing direct and indirect below-the-knee endovascular revascularizations. Assignment to the groups was not randomized. Near-infrared spectroscopy was used to monitor rSO2 changes near the ischemic wounds intraoperatively. The changes were compared between the groups. RESULTS 15 patients (50%) underwent direct angiosomal revascularization, while an equal number of patients underwent indirect revascularization. Overall, a statistically significant increase in regional oxygen saturation was observed after revascularization (p = 0.001). No statistically significant difference was found between the direct and indirect revascularization groups (p = 0.619). CONCLUSIONS This study revealed a minor difference in the oxygen saturation increase between the angiosomal and non-angiosomal revascularization groups. Such a finding indicates that the clinical significance of angiosomal revascularization is negligible and might be concealed by confounding factors, such as the vessel diameter and outflow impact on the restenosis rate.
Collapse
Affiliation(s)
- Austėja Račytė
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.P.); (T.B.); (G.V.); (A.S.); (V.B.); (K.R.)
| | - Gabija Pikturnaitė
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.P.); (T.B.); (G.V.); (A.S.); (V.B.); (K.R.)
| | - Tomas Baltrūnas
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.P.); (T.B.); (G.V.); (A.S.); (V.B.); (K.R.)
| | - Evaldas Kalvaitis
- Health Telematics Science Institute, Kaunas University of Technology, 44249 Kaunas, Lithuania;
| | - Gediminas Vaitėnas
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.P.); (T.B.); (G.V.); (A.S.); (V.B.); (K.R.)
| | - Arminas Skrebūnas
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.P.); (T.B.); (G.V.); (A.S.); (V.B.); (K.R.)
| | - Vaida Baltrūnienė
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.P.); (T.B.); (G.V.); (A.S.); (V.B.); (K.R.)
| | - Kęstutis Ručinskas
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.P.); (T.B.); (G.V.); (A.S.); (V.B.); (K.R.)
| |
Collapse
|
28
|
Donahue JK, Chrispin J, Ajijola OA. Mechanism of Ventricular Tachycardia Occurring in Chronic Myocardial Infarction Scar. Circ Res 2024; 134:328-342. [PMID: 38300981 PMCID: PMC10836816 DOI: 10.1161/circresaha.123.321553] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Cardiac arrest is the leading cause of death in the more economically developed countries. Ventricular tachycardia associated with myocardial infarct is a prominent cause of cardiac arrest. Ventricular arrhythmias occur in 3 phases of infarction: during the ischemic event, during the healing phase, and after the scar matures. Mechanisms of arrhythmias in these phases are distinct. This review focuses on arrhythmia mechanisms for ventricular tachycardia in mature myocardial scar. Available data have shown that postinfarct ventricular tachycardia is a reentrant arrhythmia occurring in circuits found in the surviving myocardial strands that traverse the scar. Electrical conduction follows a zigzag course through that area. Conduction velocity is impaired by decreased gap junction density and impaired myocyte excitability. Enhanced sympathetic tone decreases action potential duration and increases sarcoplasmic reticular calcium leak and triggered activity. These elements of the ventricular tachycardia mechanism are found diffusely throughout scar. A distinct myocyte repolarization pattern is unique to the ventricular tachycardia circuit, setting up conditions for classical reentry. Our understanding of ventricular tachycardia mechanisms continues to evolve as new data become available. The ultimate use of this information would be the development of novel diagnostics and therapeutics to reliably identify at-risk patients and prevent their ventricular arrhythmias.
Collapse
Affiliation(s)
| | - Jonathan Chrispin
- The Johns Hopkins University School of Medicine, Baltimore, MD (J.C.)
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA (O.A.A.)
| |
Collapse
|
29
|
Kanabar K, Vyas P, Natarajan K, Shah N, Dake R. Use of export thrombus aspiration catheter as a dual lumen catheter for antegrade LAD CTO wiring with side branch. J Invasive Cardiol 2024; 36. [PMID: 38335512 DOI: 10.25270/jic/23.00134] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
A 50-year-old female patient presented with class III angina for 6 months, positive stress test, and a prior CT angiogram suggestive of 3-vessel disease.
Collapse
Affiliation(s)
- Kewel Kanabar
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India.
| | - Pooja Vyas
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India
| | - Karthik Natarajan
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India
| | - Nirmal Shah
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India
| | - Radhakishan Dake
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India
| |
Collapse
|
30
|
Chi KW, Wu EB. Extraplaque blood withdrawal stenting: A miraculous cure for subintimal hematoma. J Invasive Cardiol 2024; 36. [PMID: 38335511 DOI: 10.25270/jic/23.00175] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
We report the Extraplaque Blood Withdrawal stenting technique to treat chronic total occlusion percutaneous coronary intervention (CTO PCI)-induced extraplaque hematoma.
Collapse
Affiliation(s)
- Ken Wk Chi
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong
| | - Eugene B Wu
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong.
| |
Collapse
|
31
|
Del Giudice C, Gandini R. Subintimal Crossing of Chronic Total Occlusions in Peripheral Arteries With a Dual Guidewire Balloon Catheter: The PRAESTO Study. J Endovasc Ther 2024; 31:45-54. [PMID: 35786089 DOI: 10.1177/15266028221106308] [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: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and efficacy of antegrade fenestration re-entry (AFR) using a dual guidewire angioplasty balloon for chronic total occlusion (CTO) in patients with peripheral artery disease (PAD). MATERIAL AND METHODS This is a retrospective score matching analysis study comparing a study cohort composed of PAD patients with CTO treated with AFR subintimal recanalization using a dual guidewire angioplasty balloon and a matched control group, selected on baseline cardiovascular risk factor and lesions characteristics, treated with a conventional subintimal recanalization. Procedure outcomes include procedural success, successful subintimal re-entry, need for distal puncture, procedural time, fluoroscopy time, and dose area product. Clinical variables, including primary patency, freedom from amputation, freedom from re-interventions, and freedom from death, were used to compare the study groups. RESULTS Thirty patients in the study group were compared with 60 patients in the matched control group (mean age, male). A significant higher subintimal re-entry success (100% vs 76.7% in control group, p=0.004) and lower need of distal tibial punction (0 vs 14 [23.3%] patients in control group, p=0.004) were observed in the study group. A surgical conversion to bypass was needed in 5 patients in the control group. Shorter procedural and fluoroscopy time were observed in the study group (41.1±10.8 minutes vs 146.6±62. and 16.7±3.5 minutes vs 34.3±14.2 minutes in control group respectively, p<0.001 and p<0.001). Lower DAP were observed in the study group (914.1±309.9 µGym² vs 2026.5±845.7 µGym² in control group p<0.001). No significant difference were observed in terms of primary patency, mortality, amputation, and freedom from re-intervention. CONCLUSION AFR using the Presto dual guidewire balloon is a step forward for crossing CTO which allows a simplified and quick treatment of BTK and ATK lesions compared with conventional approaches without increase of procedural risk and maintaining good clinical outcomes.
Collapse
Affiliation(s)
- Costantino Del Giudice
- Department of Radiology, Interventional Radiology, Institut Mutualiste Montsouris, Paris, France
| | - Roberto Gandini
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| |
Collapse
|
32
|
Moscardelli S, Condos G, Lombardi WL, Azzalini L. Intracoronary snaring of the retrograde guidewire: A novel method to solve compartment mismatch in complex retrograde CTO PCI. Catheter Cardiovasc Interv 2024; 103:435-442. [PMID: 38282340 DOI: 10.1002/ccd.30962] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/27/2023] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Abstract
The retrograde approach has allowed a remarkable improvement in the success rate of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). After collateral channel crossing, the most crucial aspect of retrograde CTO PCI is creating the connection between the antegrade and retrograde system. Currently, the most common technique to achieve this is reverse controlled antegrade and retrograde subintimal tracking. However, this maneuver sometimes fails due to compartment mismatch (intraplaque situation of one wire and extraplaque situation of the other). New approaches are therefore needed to overcome challenges in this important step of the procedure. Here we present an innovative solution to this problem, which involved capturing the retrograde guidewire (advanced into a side branch at the distal cap) with a microsnare that had been advanced antegradely: this severed the dissection flap separating the antegrade and retrograde system, thus allowing us to successfully recanalize the CTO.
Collapse
Affiliation(s)
- Silvia Moscardelli
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Gregory Condos
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - William L Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
33
|
Apostolos A, Chlorogiannis DD, Chrysostomidis G, Bozika M, Timpilis F, Kramvis A, Karamasis GV, Leventopoulos G, Davlouros P, Tsigkas G. Efficacy and Safety of Thirty-Day Dual-Antiplatelet Therapy Following Complex Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2024; 11:43. [PMID: 38392257 PMCID: PMC10889500 DOI: 10.3390/jcdd11020043] [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: 12/10/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
The optimal duration of DAPT after complex PCI remains under investigation. The purpose of this systematic review and meta-analysis was to explore the safety and efficacy of a one-month therapy period versus a longer duration of DAPT after complex PCI. We systematically screened three major databases, searching for randomized controlled trials or sub-analyses of them, which compared shortened DAPT (S-DAPT), namely, one month, and longer DAPT (L-DAPT), namely, more than three months. The primary endpoint was any Net Adverse Clinical Event (NACE), and the secondary was any MACE (Major Adverse Cardiac Event), its components (mortality, myocardial infarction, stroke, and stent thrombosis), and major bleeding events. Three studies were included in the analysis, with a total of 6275 patients. Shortening DAPT to 30 days after complex PCI did not increase the risk of NACEs (OR: 0.77, 95% CI: 0.52-1.14), MACEs, mortality, myocardial infractions, stroke, or stent thrombosis. Pooled major bleeding incidence was reduced, but this finding was not statistically significant. This systematic review and meta-analysis showed that one-month DAPT did not differ compared to a longer duration of DAPT after complex PCI in terms of safety and efficacy endpoints. Further studies are still required to confirm these findings.
Collapse
Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, Hippocration General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | | | | | - Maria Bozika
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Filippos Timpilis
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Angelos Kramvis
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Grigoris V Karamasis
- Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Rimini 1, Chaidari, 124 62 Athens, Greece
| | | | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| |
Collapse
|
34
|
Gao W, Li C, Yuan J, Zhang Y, Liu G, Zhang J, Shi H, Liu H, Ge J. Circ-MBOAT2 Regulates Angiogenesis via the miR-495/NOTCH1 Axis and Associates with Myocardial Perfusion in Patients with Coronary Chronic Total Occlusion. Int J Mol Sci 2024; 25:793. [PMID: 38255868 PMCID: PMC10815571 DOI: 10.3390/ijms25020793] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/24/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Revascularization of coronary chronic total occlusion (CTO) still remains controversial. The factors that impact collateral circulation and myocardial perfusion are of interest. Circular RNA (circRNA) has been shown to regulate the process of angiogenesis. However, the effects of circ-membrane-bound O-acyltransferase domain containing 2 (circ-MBOAT2) on angiogenesis in patients with CTO were unclear. In this study, we evaluated circulating circRNAs and miRNAs in patients with CTO and stable coronary artery disease using high-throughput sequencing. Another cohort of patients were selected to verify the expressions of circ-MBOAT2 and miR-495. The role and mechanism of circ-MBOAT2 in the process of angiogenesis were explored through in vitro and vivo studies. Finally, we came back to a clinical perspective and investigated whether circ-MBOAT2 and miR-495 were associated with the improvement of myocardial perfusion evaluated by single-photon emission computed tomography (SPECT). We found that the expression of circ-MBOAT2 was significantly up-regulated while miR-495 was significantly down-regulated in patients with CTO. The expression of circ-MBOAT2 was negatively correlated with miR-495 in patients with CTO. In an in vitro study, we found that circ-MBOAT2 promoted tube formation and cell migration via the miR-495/NOTCH1 axis in endothelial cells. In an in vivo study, we showed that the inhibition of miR-495 caused the increase in collateral formation in mice after hindlimb ischemia. In a human study, we showed the expressions of circ-MBOAT2 and miR-495 were associated with myocardial perfusion improvement after revascularization of CTO. In conclusion, circ-MBOAT2 regulates angiogenesis via the miR-495/NOTCH1 axis and associates with myocardial perfusion in patients with CTO. Our findings suggest that circ-MBOAT2 and miR-495 may be potential therapeutic targets and prognostic factors for patients with CTO.
Collapse
Affiliation(s)
- Wei Gao
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China; (W.G.); (C.L.)
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Chenguang Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China; (W.G.); (C.L.)
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Jie Yuan
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China; (W.G.); (C.L.)
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Youming Zhang
- Department of Cardiology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai 201700, China
| | - Guobing Liu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jianhui Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China; (W.G.); (C.L.)
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Haibo Liu
- Department of Cardiology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai 201700, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China; (W.G.); (C.L.)
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| |
Collapse
|
35
|
Agostoni P, Moroni A, Scott B, Poletti E, Benedetti A, Zivelonghi C. An Adaptable, Cheap and Easy-to-Use Interventional Tool to Obtain Vascular Sealing: The Condom Technique. JACC Cardiovasc Interv 2024; 17:94-96. [PMID: 38069989 DOI: 10.1016/j.jcin.2023.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 01/12/2024]
Affiliation(s)
| | - Alice Moroni
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Enrico Poletti
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Alice Benedetti
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| |
Collapse
|
36
|
Alexandrou M, Rempakos A, Mutlu D, Al Ogaili A, Choi JW, Poommipanit P, Khatri JJ, Ybarra LF, Jaber W, Rinfret S, Nicholson W, Azzalini L, Kearney KE, Gorgulu S, ElGuindy AM, Abi Rafeh N, Krestyaninov O, Khelimskii D, Goktekin O, Rangan BV, Mastrodemos OC, Sandoval Y, Burke MN, Brilakis ES. Everolimus-Versus Zotarolimus-Eluting Stents in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from the PROGRESS-CTO Registry. Am J Cardiol 2024; 210:256-258. [PMID: 37884112 DOI: 10.1016/j.amjcard.2023.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Michaella Alexandrou
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Athanasios Rempakos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Deniz Mutlu
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ahmed Al Ogaili
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Paul Poommipanit
- Section of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | | | - Luiz F Ybarra
- Department of Cardiology, London Health Sciences Center, Western University, London, Ontario, Canada
| | - Wissam Jaber
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Stephane Rinfret
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - William Nicholson
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | | | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Dmitrii Khelimskii
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Bavana V Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Olga C Mastrodemos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - M Nicholas Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
| |
Collapse
|
37
|
Moroni A, Poletti E, Scott B, Castaldi G, El Jattari H, Benedetti A, Convens C, Verheye S, Vermeersch P, Zivelonghi C, Agostoni P. Prevalence of Collateral Typology in Coronary Chronic Total Occlusion and Its Impact on Percutaneous Intervention Performance. Am J Cardiol 2024; 210:153-162. [PMID: 37898156 DOI: 10.1016/j.amjcard.2023.09.113] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 10/30/2023]
Abstract
The presence of collateral channels providing distal blood supply is a distinctive characteristic of chronic total occlusion (CTO) lesions. However, data about the distinct baseline and procedural characteristics of each collateral subset are scarce. Accordingly, we sought to explore the procedural aspects specific for each collateral typology (ipsilateral collaterals [ICs], contralateral collaterals [CCs] or mixed) in CTO-percutaneous coronary intervention (PCI). A retrospective analysis of our CTO-PCI registry was performed to investigate the prevalence, procedural characteristics, and outcomes specific for each CTO-PCI subset, defined according to the inter-arterial connection anatomy. A total of 209 cases were included. Of the included cases, 45 (22%) and 92 (44%) patients displayed solely IC or CC, respectively, whereas in 72 (34%) both IC and CC were present (mixed). The procedural success rate was high (91.1%) and comparable among the different groups, despite greater lesion complexity in the CC group. The most frequent target vessel was the left circumflex in the IC group (51% of cases) and the right coronary artery in the CC (63%) and mixed (57%) groups. Among the IC cases, 42% showed a poor collateral connection function (2% and 10% for the CC and mixed group, respectively), and 46% showed a suboptimal collateral recipient artery filling (21% and 20% for the CC and mixed group, respectively). Most of the IC cases were performed using a single access (96%). In conclusion, the success and complication rates were comparable among the collateral typology groups, irrespective of the differences in the baseline and procedural characteristics. Phenotyping CTO as hereby proposed might be helpful for targeted procedural considerations.
Collapse
Affiliation(s)
- Alice Moroni
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Enrico Poletti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium; Clinical and Interventional Cardiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Italy
| | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Gianluca Castaldi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium; Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Hicham El Jattari
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Alice Benedetti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | | |
Collapse
|
38
|
Shekiladze N, Sandesara PB, Tai Z, Maisuradze N, Jaber W, Nicholson W. Technical aspects of entrapped coronary guidewire retrieval using rotational atherectomy device: A case series. Catheter Cardiovasc Interv 2024; 103:89-96. [PMID: 38071427 DOI: 10.1002/ccd.30923] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/31/2023] [Accepted: 11/21/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND This article highlights four unique cases where rotational atherectomy (RA Rotapro, Boston Scientific) was used to cut and retrieve an entrapped coronary guidewire with parts extending into the aorta We discuss the technique and step by step approach to the retrieval procedure. CASE SUMMARY Three of four cases described a guide wire entrapment in the right coronary artery (RCA), and one in the left anterior descending artery via retrograde route. In all cases the guide wire was intact within the intracoronary segment. In Case 1, the guide wire (Runthrough; Terumo) was entrapped in an acute marginal branch during chronic total occlusion (CTO) percutaneous coronary intervention. In Case 2, a whisper wire (Abbott) was entrapped during re-wiring of the right posterolateral branch through stent struts, the traction on the wire caused severe malformation of distal and proximal stents requiring second staged procedure to complete revascularization of the RCA CTO. In Case 3, a Runthrough wire was entrapped between two layers of stents and fractured at the proximal point with filaments extending into descending aorta. And in Case 4, a Pilot 200 (Abbott) wire was entrapped retrograde in the subintimal space via saphenous vein graft connection by tying a knot at the distal tip of the wire. In all four cases RA was used to successfully cut and remove the entrapped guide wires. DISCUSSION Rotablation technique appears to be a safe and effective strategy for the management of entrapped coronary guidewire when conventional strategies fail.
Collapse
Affiliation(s)
- Nikoloz Shekiladze
- Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pratik B Sandesara
- Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zaheed Tai
- Division of Cardiology, Winter Haven Hospital, Winter Haven, Florida, USA
| | - Nodar Maisuradze
- Division of Cardiology, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Wissam Jaber
- Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William Nicholson
- Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
39
|
Tajstra M, Bryniarski L, Bujak K, Wilczek K, Gil R, Dobrzycki S, Wojakowski W, Legutko J, Gierlotka M, Gąsior M. Impact of chronic total occlusion on prognosis in cardiogenic shock due to unprotected left main coronary artery culprit lesion. Insights from the Polish Registry of Acute Coronary Syndromes. Kardiol Pol 2024; 82:166-174. [PMID: 38493472 DOI: 10.33963/v.phj.98889] [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: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Notwithstanding readily available revascularization, significant advancements in mechanical circulatory support, and pharmacological progress, cardiogenic shock (CS) secondary to unprotected left main culprit lesion-related acute myocardial infarction (ULMCL-related AMI) is associated with very high mortality. In this population, chronic total occlusion (CTO) is relatively frequent. AIMS This study sought to assess the association between the presence of CTO and 12-month mortality in patients with CS due to ULMCL-related AMI. RESULTS The study included consecutive patients admitted for AMI-related CS with ULMCL who underwent percutaneous coronary intervention (PCI) and were enrolled in the prospective Polish Registry of Acute Coronary Syndromes (PL-ACS) between January 2017 and December 2021. The patients were stratified into two groups based on the presence of at least one CTO. The primary endpoint was all-cause death at 12 months. Of the 250 included patients, 60 (24%) patients had one or more CTOs of a major coronary artery (+CTO), and in 190 (76%) patients, the presence of CTO was not observed (-CTO). The 12-month mortality rates for the +CTO and -CTO patients were 85% and 69.8%, respectively (P log-rank = 0.03). After multivariable adjustment for differences in the baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (hazard ratio, 1.423; 95% CI, 1.027-1.973; P = 0.034). CONCLUSIONS Our analysis showed that in patients with CS due to ULMCL-related AMI treated with PCI, the presence of CTO is associated with worse 12-month prognosis.
Collapse
Affiliation(s)
- Mateusz Tajstra
- 3rd Department of Cardiology, Silesian Centre for Heart Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland.
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Kamil Bujak
- 3rd Department of Cardiology, Silesian Centre for Heart Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Krzysztof Wilczek
- 3rd Department of Cardiology, Silesian Centre for Heart Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Robert Gil
- State Medical Institute of the Ministry of Interior and Administration, Warszawa, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Silesian Centre for Heart Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| |
Collapse
|
40
|
Chang HY, Huang CC, Hung CS, Meng SW, Lin MS, Chen YH, Yeh CF, Kao HL. Accurate Prediction of Retrograde Collateral Channel Crossing in Coronary Artery Chronic Total Occlusion Intervention. Am J Cardiol 2024; 210:93-99. [PMID: 37844720 DOI: 10.1016/j.amjcard.2023.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
Successful collateral channel (CC) crossing is an essential step in retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCIs). We previously developed a dedicated CC score based on CC size and tortuosity to facilitate target CC selection. Validation and comparison to other scoring systems were lacking. Thus, the aims of this study were to (1) validate the CC score in a larger independent cohort, and (2) compare its accuracy and clinical usefulness with the J-channel score. All coronary CTO PCIs attempted by experienced high-volume operators from January 2017 to December 2021 were enrolled. The CC and J-channel scores were calculated for all attempted CCs with bi-plane high-resolution cine angiography images. CC crossing success was defined as guidewire reaching the distal true lumen retrogradely. In total, 502 patients who received CTO PCI were included. The retrograde approach was utilized in 244 target CTOs, and a total of 329 CCs were attempted. The overall CC crossing rate was 67.8% (223 of 329) and final technical success rate 92.2% (225 of 244). The average CC score was 2.0 and average J-channel score was 0.71. The sensitivity and specificity of successful CC crossing with the CC score ≥2 were 81.2%, and 84.0%, respectively. Comparison between the CC score (area under the curve 0.87; 95% confidence interval 0.83 to 0.90) and the J-channel score (area under the curve 0.61, 95% confidence interval 0.55 to 0.67) demonstrated superior predictive performance of the CC score (p <0.001). The CC score was an easy-to-use and accurate tool for the prediction of successful CC crossing in retrograde CTO PCI. The CC score can help operators select the ideal target CC, thereby facilitating final procedural success.
Collapse
Affiliation(s)
- Hao-Yun Chang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Chang Huang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Sheng Hung
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Wei Meng
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Hsien Chen
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Fan Yeh
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
41
|
Moroni A, El Jattari H, Vermeersch P, Zivelonghi C, Agostoni P. Unintentional Extraction of a 7-Year-Old Stent With the Twisting Wire Technique. JACC Cardiovasc Interv 2023; 16:3045-3046. [PMID: 37902152 DOI: 10.1016/j.jcin.2023.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Affiliation(s)
- Alice Moroni
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Hicham El Jattari
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | | |
Collapse
|
42
|
Gurgoglione FL, Pitocco D, Montone RA, Rinaldi R, Bonadonna RC, Magnani G, Calvieri C, Solinas E, Rizzi A, Tartaglione L, Flex A, Viti L, Trani C, Ardissino D, Crea F, Niccoli G. Microvascular Complications Are Associated With Coronary Collateralization in Type 2 Diabetes and Chronic Occlusion. J Clin Endocrinol Metab 2023; 109:237-244. [PMID: 37417706 DOI: 10.1210/clinem/dgad396] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 06/15/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
CONTEXT Coronary collateral (CC) vessel development appears to be protective with regard to adverse cardiovascular events and survival in patients with coronary chronic total occlusion (CTO). The influence of type 2 diabetes mellitus (T2DM) on CC growth has been controversial. In particular, the role of diabetic microvascular complications (DMC) in determining coronary collateralization has not been elucidated. OBJECTIVE To investigate whether patients with DMC presented differences in CC vessel presence and grading as compared with patients without DMC. METHODS We conducted a single-center observational study, including consecutive T2DM patients, without previous cardiovascular history, undergoing a clinically indicated coronary angiography for chronic coronary syndrome (CCS) and angiographic evidence of at least one CTO. Patients were subdivided into 2 study groups according to the presence/absence of at least one DMC (neuropathy, nephropathy, or retinopathy). The presence and grading of angiographically visible CC development from the patent vessels to the occluded artery were assessed using the Rentrop classification. RESULTS We enrolled 157 patients (mean age 68.6 ± 9.8 years; 120 [76.4%] men). Patients with DMC (75 [47.8%]) had a higher prevalence of CC (69 [92.0%] vs 62 [75.6%], P = .006) and high-grade CC (55 [73.3%] vs 39 [47.6%], P = .001) compared with those without, and we found a positive association between the number of DMC in each patient and the prevalence of high-grade CC. CONCLUSION Among T2DM patients with coronary CTO, the presence of DMC was associated with a high CC development.
Collapse
Affiliation(s)
- Filippo Luca Gurgoglione
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Dario Pitocco
- Diabetology Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Rinaldi
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo C Bonadonna
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Division of Endocrinology and Metabolic Diseases, University of Parma, 43126 Parma, Italy
| | - Giulia Magnani
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Camilla Calvieri
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University, 00185 Rome, Italy
| | - Emilia Solinas
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Alessandro Rizzi
- Diabetology Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Linda Tartaglione
- Diabetology Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Andrea Flex
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Viti
- Diabetology Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Diego Ardissino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| |
Collapse
|
43
|
Fujimura N, Takahara M, Obara H, Ichihashi S, George RK, Igari K, Banno H, Hozawa K, Yamaoka T, Kian CJ, Tan JWH, Park K, Skyi PYC, Kato T, Kawarada O. Comparison of Aortobifemoral Bypass and Endovascular Treatment for Chronic Infrarenal Abdominal Aortic Occlusion From the CHAOS ( CHronic Abdominal Aortic Occlusion, A Sian Multicenter) Registry. J Endovasc Ther 2023; 30:828-837. [PMID: 35674459 DOI: 10.1177/15266028221098710] [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: 12/24/2022]
Abstract
PURPOSE To directly compare the clinical outcomes of aortobifemoral bypass surgery (ABF) and endovascular treatment (EVT) for chronic total occlusion (CTO) of the infrarenal abdominal aorta (IAA). MATERIALS AND METHODS In this retrospective, multicenter study, we used an international database of 436 patients who underwent revascularization for CTO of the IAA between 2007 and 2017 at 30 Asian cardiovascular centers. After excluding 52 patients who underwent axillobifemoral bypass surgery, 384 patients (139 ABFs and 245 EVTs) were included in the analysis. Propensity score-matched analysis was performed to compare clinical results in the periprocedural period and the long-term. RESULTS Propensity score matching extracted 88 pairs. Procedure time (ABF; 288 [240-345] minutes vs EVT; 159 [100-205] minutes, p<0.001) and length of hospital stay (17 [12-23] days vs 5 [4-13] days, p<0.001) were significantly shorter in the EVT group than in the ABF group, while the proportions of procedural success (98.9% versus 96.6%, p=0.620), complications (9.1% versus 12.3%, p=0.550), and mortality (2.3% versus 3.8%, p=1.000) were not different between the groups. At 1 months, ABI significantly increased more in the ABF group for both in a limb with the lower (0.56 versus 0.50, p=0.018) and the higher (0.49 versus 0.34, p=0.001) baseline ABI, while the change of the Rutherford category was not significantly different between the groups (p=0.590). At 5 years, compared with the EVT group, the ABF group had significantly better primary patency (89.4±4.3% versus 74.8±4.3%, p=0.035) and survival rates (86.9±4.5% versus 66.2±7.5%, p=0.007). However, there was no significant difference between the groups for secondary patency (100.0%±0.0% versus 93.5%±3.9%, p=0.160) and freedom from target lesion revascularization (TLR) (89.3±4.3% vs 77.3±7.3%, p=0.096). CONCLUSION Even with recent advancements in EVT, primary patency was still significantly better for ABF in CTO of the IAA. However, there was no difference between the groups in terms of secondary patency and freedom from TLR at 5 years. Furthermore, there was no difference in procedural success, complications, mortality, and improvement in the Rutherford classification during the periprocedural period, with significantly shorter procedure time and hospital stay in the EVT group.
Collapse
Affiliation(s)
- Naoki Fujimura
- Department of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | | | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Robbie K George
- Department of Vascular Surgery and Endovascular Surgery, Narayana Hrudayalaya Hospital and Mazumdar Shaw Multispeciality Hospital, Bengaluru, India
| | - Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Banno
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Hozawa
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Ch'ng J Kian
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Jimmy W H Tan
- Department of Cardiovascular Surgery, An Nan Hospital, China Medical University, Tainan
| | - Kihyuk Park
- Division of Vascular Surgery, Department of Surgery, Daegu Catholic University School of Medicine, Daegu, South Korea
| | - Pang Y C Skyi
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Taku Kato
- Department of Cardiology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Osami Kawarada
- Department of Cardiovascular Medicine, Hanwa Memorial Hospital, Osaka, Japan
| |
Collapse
|
44
|
Simonte G, Fino G, Casali F, Parlani G, Lenti M, Isernia G. Effectiveness of the Rotarex Excisional Atherectomy System in Both Subacute and Chronic Aortoiliac Endograft Thrombosis: An Innovative Option for the Modern Endovascular Surgeon Toolkit. J Endovasc Ther 2023; 30:957-963. [PMID: 35735194 DOI: 10.1177/15266028221105177] [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
PURPOSE To report a successful revascularization case using the Rotarex™S atherothrombectomy system in a recent iliac limb thrombosis, and chronic hypogastric stent obstruction after previous aortoiliac aneurysm endovascular repair (EVAR). CASE REPORT A 72-year-old patient was treated for recent right iliac limb thrombosis and left iliac branch chronic hypogastric stent occlusion, 5 years after EVAR. A total endovascular approach, using both upper extremity and femoral vascular access, was settled with 2 Rotarex™S (6Fr and 10Fr) devices. The Rotarex™S catheters removed most of the intraluminal material, allowing additional endografts and bare metal stents to be deployed to support a new healthy lumen surface. CONCLUSION The total endovascular approach provided by the Rotarex™S device appears to be safe and effective in treating aortoiliac endografts occlusions, both in subacute and chronic phases. Larger studies could highlight differences and eventual advantages compared with more traditional solutions.
Collapse
Affiliation(s)
- Gioele Simonte
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
- Unit of Vascular Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Gianluigi Fino
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Francesco Casali
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Gianbattista Parlani
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Massimo Lenti
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Giacomo Isernia
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| |
Collapse
|
45
|
Qin Q, Chen L, Ge L, Qian J, Ma J, Ge J. Long-term clinical outcomes of drug-coated balloon for the management of chronic total occlusions. Coron Artery Dis 2023; 34:555-561. [PMID: 37721311 PMCID: PMC10602222 DOI: 10.1097/mca.0000000000001288] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/12/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES This study aims to compare the clinical outcomes of patients with de novo chronic total occlusion (CTO) lesions treated by hybrid strategy and drug-coated balloons (DCB)-only strategy. BACKGROUNDS DCBs have been used as an alternative to or in combination with drug-eluting stents in CTO lesions. However, the clinical impact of DCB treatment on CTO lesion remains uncertain. METHODS We retrospectively enrolled 154 patients with de novo CTO lesions treated by DCB, including 57 cases in hybrid group and 97 cases in DCB-only group. RESULTS The lesions in hybrid group were more complicated than those in DCB-only group as shown by higher J-CTO score, and therefore higher percentage of retrograde approach, more IVUS guidance, more CTO guidewires, and longer procedural time were demonstrated. Although the percentage of non-flow-limiting dissection and residual stenosis of more than 30% were lower in hybrid group, TIMI flow grade, satisfactory and acceptable recanalization rate were not significantly different between two groups. During a median follow-up was 470 days, the incidence of target lesion revascularization (TLR), myocardial infarction and cardiac death was 11.0%, 1.3% and 1.9%, respectively. The long-term TLR-free survival was comparable between hybrid and DCB-only groups. By multivariate analysis, DCB length and age were predictors of TLR. CONCLUSION DCB treatment appears effective and safe in selected de novo CTO lesions during long-term follow up. The recanalization results and long-term outcomes are comparable between hybrid and DCB-only group despite more complicated lesions in hybrid group.
Collapse
Affiliation(s)
- Qing Qin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lu Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lei Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| |
Collapse
|
46
|
Uyanik M, Yildirim U, Avci B, Soylu K. Assessment of silent brain injury in patients undergoing elective percutaneous coronary intervention due to chronic total occlusion. Scand Cardiovasc J Suppl 2023; 57:25-30. [PMID: 36443919 DOI: 10.1080/14017431.2022.2150786] [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: 11/30/2022]
Abstract
Objective: Silent brain infarcts (SBI) are thromboembolic complications associated with cardiac surgery, diagnostic angiography, and percutaneous interventions. Serum neuron-specific enolase (NSE) is the proven biomarker for measuring neuronal damage. This study aimed to evaluate the incidence of SBI, defined as elevated NSE after coronary chronic total occlusion (CTO) intervention and elective coronary stenting. Design: The study population consisted of two patient groups: the CTO group included consecutive patients with coronary CTO intervention, and the control group consisted of patients who underwent elective coronary intervention. NSE blood levels were measured before and 12-18 h after the procedure. NSE blood levels of >20 ng/mL were considered SBI. Results: A total of 108 patients were included in the study. Of these, 55 (50.9%) had SBI after the procedure. The SBI rate was 59.7% in the CTO group and 39.1% in the control group. Patients with SBI were more likely to have diabetes mellitus, hyperlipidemia, higher HbA1c, higher total stent length, and longer procedural time. Multivariate logistic regression analysis showed that CTO procedure (odds ratio [OR]: 3.129; 95% confidence interval [CI]: 1.246-7.858; p < 0.015) and diabetes mellitus (OR: 2.93; 95% CI: 1.185-7.291; p < 0.020) are independent predictors of SBI. Conclusion: Our data suggest that SBI occurs more frequently after CTO intervention than after non-CTO intervention. Intervention complexity and patient clinical characteristics may explain the increased incidence.
Collapse
Affiliation(s)
- Muhammet Uyanik
- Faculty of Medicine, Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey
| | - Ufuk Yildirim
- Faculty of Medicine, Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey
| | - Bahattin Avci
- Faculty of Medicine, Department of Biochemistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Korhan Soylu
- Faculty of Medicine, Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey
| |
Collapse
|
47
|
Megaly M, Davis J, Alaswad K, Brilakis ES. Retrograde stent target technique for left main chronic total Occlusion revascularization. J Invasive Cardiol 2023; 35. [PMID: 38108872 DOI: 10.25270/jic/23.00028] [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] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
A 72-year-old woman presented with progressive angina and anterior ischemia on a nuclear stress test.
Collapse
Affiliation(s)
- Michael Megaly
- Willis Knighton Heart Institute, Shreveport, Louisiana, USA.
| | - Jonathan Davis
- Willis Knighton Heart Institute, Shreveport, Louisiana, USA
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | | |
Collapse
|
48
|
Alexandrescu VA, Van Overmeire L, Makrygiannis G, Azdad K, Popitiu M, Paquet S, Poppe L, Nodit M. Clinical Implications of Diabetic Peripheral Neuropathy in Primary Infrapopliteal Angioplasty Approach for Neuro-Ischemic Foot Wounds. J Endovasc Ther 2023; 30:920-930. [PMID: 35786131 DOI: 10.1177/15266028221106312] [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
BACKGROUND To assess the clinical effects of diabetic peripheral neuropathy (DPN) in patients with chronic limb-threatening ischemia (CLTI) treated by primary infrapopliteal angioplasty for neuro-ischemic Rutherford 5, foot wounds. MATERIALS AND METHODS Over a 10-year period (2009-2019), a series of 304 diabetic ischemic limbs adding or not evincible neuropathic affectation were treated by primary infrapopliteal angioplasty and their files were retrospectively reviewed. Mean length of treated arterial lesions was 6.1 cm (range 1-22 cm). Inferior limb vibration perception threshold diagnostic was performed for comparing and scoring detectable DPN in all studied diabetic patients (classed from 0 to 10 points). There were 19% limbs with normal (0-1 points) perception (group 1), 55% others with "mild" and "moderate" (2-6 points) neuropathic impairment (group 2), and 26% limbs showing "severe" (7-10 points) DPN (group 3). RESULTS Primary infrapopliteal angioplasty succeeded in 89% cases in group 1, in 82% in group 2, and in 68% of limbs in group 3. This latest group assembled the heaviest neuropathic affectation and arterial calcifications and proved the lowest clinical benefit at 36 months: 35% (95% confidence interval [CI]=22% to 48%) of primary patency, 36% (95% CI=22% to 50%) wound healing, and 54% (95% CI=39% to 69%) limb preservation rates. A comparison between groups 1 vs 3 and 2 vs 3 of primary patency (p=0.014 and p=0.043), tissue healing (p=0.049 and p=0.01), and limb salvage (p=0.006 and p=0.023) proved significant, yet without statistical weight for group 1 vs 2 (p>0.05). Overall survival was not significantly affected between groups (p=0.34). CONCLUSION The presence of severe DPN may jeopardize the results of infrapopliteal angioplasty in terms of patency, tissue cicatrization, and limb preservation, yet without significance on survival of these patients. When present, DPN requires appropriate stratification as specific indicator in CLTI treatment.
Collapse
Affiliation(s)
- Vlad Adrian Alexandrescu
- Department of Thoracic and Vascular Surgery, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium
| | - Lionel Van Overmeire
- Department of Nephrology and Internal Medicine, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium
| | - Georgios Makrygiannis
- Department of Thoracic and Vascular Surgery, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium
| | - Khalid Azdad
- Department of Radiology, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium
| | - Mircea Popitiu
- Department of Vascular Surgery and Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Séverine Paquet
- Department of Thoracic and Vascular Surgery, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium
| | - Laura Poppe
- Department of Thoracic and Vascular Surgery, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium
| | - Mihaela Nodit
- Department of Geriatric Care and Internal Medicine, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium
| |
Collapse
|
49
|
Allana SS, Kostantinis S, Simsek B, Karacsonyi J, Rempakos A, Alaswad K, Krestyaninov O, Khelimskii D, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Patel MP, Mahmud E, Koutouzis M, Tsiafoutis I, Gorgulu S, Elbarouni B, Nicholson W, Jaber W, Rinfret S, Abi Rafeh N, Goktekin O, ElGuindy AM, Sandoval Y, Burke MN, Rangan BV, Brilakis ES. Lesion complexity and procedural outcomes associated with ostial chronic total occlusions: Insights from the PROGRESS-CTO Registry. J Invasive Cardiol 2023; 35. [PMID: 38108870 DOI: 10.25270/jic/23.00034] [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] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Ostial CTOs can be challenging to revascularize. We aim to describe the outcomes of ostial chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We examined the clinical and angiographic characteristics and procedural outcomes of 8788 CTO PCIs performed at 35 US and non-US centers between 2012 and 2022. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target-vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. RESULTS Ostial CTOs constituted 12% of all CTOs. Patients with ostial CTOs had higher J-CTO score (2.9 ± 1.2 vs 2.3 ± 1.3; P less than .01). Ostial CTO PCI had lower technical (82% vs. 86%; P less than .01) and procedural (81% vs. 85%; P less than .01) success rates compared with non-ostial CTO PCI. Ostial location was not independently associated with technical success (OR 1.03, CI 95% 0.83-1.29 P =.73). Ostial CTO PCI had a trend towards higher incidence of MACE (2.6% vs. 1.8%; P =.06), driven by higher incidence of in-hospital death (0.9% vs 0.3% P less than.01) and stroke (0.5% vs 0.1% P less than .01). Ostial lesions required more often use of the retrograde approach (30% vs 9%; P less than .01). Ostial CTO PCI required longer procedure time (149 [103,204] vs 110 [72,160] min; P less than .01) and higher air kerma radiation dose (2.3 [1.3, 3.6] vs 2.0 [1.1, 3.5] Gray; P less than .01). CONCLUSIONS Ostial CTOs are associated with higher lesion complexity and lower technical and procedural success rates. CTO PCI of ostial lesions is associated with frequent need for retrograde crossing, higher incidence of death and stroke, longer procedure time and higher radiation dose.
Collapse
Affiliation(s)
- Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | | | | | | | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | | | | | | | | | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
| |
Collapse
|
50
|
Simsek B, Rempakos A, Kostantinis S, Alexandrou M, Gorgulu S, Alaswad K, Frizzell JD, Yildirim U, Poommipanit P, Aygul N, Abi Rafeh N, Bagur R, Davies R, Goktekin O, Choi JW, Reddy N, Dattilo P, Kerrigan J, Haddad EV, Mastrodemos OC, Rangan BV, Karacsonyi J, Allana SS, Kearney KE, Sandoval Y, Burke MN, Brilakis ES, Azzalini L. Activated clotting time and outcomes of chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-CTO Registry. J Invasive Cardiol 2023; 35. [PMID: 38108868 DOI: 10.25270/jic/23.00170] [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] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND The optimal range of activated clotting time (ACT) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. METHODS We examined the association between ACT and in-hospital ischemic and bleeding outcomes in patients who underwent CTO PCI in the Prospective Global Registry for the Study of CTO Intervention. RESULTS ACT values were available for 4377 patients who underwent CTO PCI between 2012 and 2023 at 29 centers. The mean ACT distribution was less than 250 seconds (19%), 250 to 349 seconds (50%), and greater than or equal to 350 seconds (31%). The incidence of ischemic events, bleeding events, and net adverse cardiovascular events (NACE) was 0.8%, 3.0%, and 3.8%, respectively. In multiple logistic regression analysis, increasing nadir ACT was associated with decreasing ischemic events (adjusted odds ratio [aOR] per 50-second increments: 0.69 [95% confidence interval (CI), 0.50-0.94; P=.017]; and increasing peak ACT was associated with increasing bleeding events (aOR per 50-second increments: 1.17 [95% CI ,1.01-1.36; P=.032]). A U-shaped association was seen between mean ACT and NACE, where restricted cubic spline analysis demonstrated that patients with a low ( less than 200 seconds) or high ( greater than 400 seconds) ACT had increasing NACE risk compared with an ACT of 200 to 400 seconds (aOR 2.06, 95% CI 1.18-3.62; P=.012). CONCLUSIONS Among patients who underwent CTO PCI, mean ACT had a U-shaped relationship with NACE, where patients with a low ( less than 200 seconds) ACT (driven by ischemic events) or high ( greater than 400 seconds) ACT (driven by bleeding) had higher NACE compared with an ACT of 200 to 400 seconds.
Collapse
Affiliation(s)
- Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University, Istanbul, Turkey
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jarrod D Frizzell
- Department of Cardiology, The Christ Hospital, Cincinnati, Ohio, USA
| | - Ufuk Yildirim
- Department of Cardiology, Ondokuz Mayis University, Samsun, Turkey
| | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nazif Aygul
- Department of Cardiology, Selcuk University, Konya, Turkey
| | | | - Rodrigo Bagur
- Department of Cardiology, London Health Sciences Center, Western University, London, Ontario, Canada
| | - Rhian Davies
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | | | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Niranjan Reddy
- Department of Cardiology, Kettering Health Medical Group, Dayton, Ohio, USA
| | - Philip Dattilo
- UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | - Jimmy Kerrigan
- Ascension Saint Thomas Heart Hospital, Nashville, Tennessee, USA
| | - Elias V Haddad
- Ascension Saint Thomas Heart Hospital, Nashville, Tennessee, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA 98195, USA.
| |
Collapse
|