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https://www.readbyqxmd.com/read/28325520/percutaneous-revascularization-of-coronary-chronic-total-occlusion-toward-a-reappraisal-of-the-available-evidence
#1
REVIEW
Pasi P Karjalainen, Wail Nammas
Chronic total occlusion (CTO) is a challenging subset of coronary artery disease that is commonly encountered in real-world practice; it is associated with worse long-term prognosis. Observational studies suggest that percutaneous coronary intervention (PCI) for CTO is associated with reduction in myocardial ischemia and improvement in quality of life and left ventricular function. Some observational studies suggested that CTO-PCI is associated with improvement of the 'hard' clinical endpoints; others did not...
March 18, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/28318134/long-term-clinical-outcomes-of-successful-revascularization-with-drug-eluting-stents-for-chronic-total-occlusions-a-systematic-review-and-meta-analysis
#2
Lei Gao, Yabin Wang, Yuqi Liu, Feng Cao, Yundai Chen
OBJECTIVES: To determine whether successful percutaneous coronary intervention (PCI) using drug-eluting stents (DESs) have beneficial effects on long-term outcomes in patients with chronic total occlusions (CTOs) compared with failed PCIs for CTOs. BACKGROUND: Several observational studies have evaluated the long-term clinical outcomes of successful PCIs using DESs for CTOs. However, the results of these studies were inconsistent and inconclusive. METHODS: We searched five online electronic databases to identify all the publications assessing the long-term outcomes of successful and failed PCIs using DESs for CTOs...
March 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28315181/update-on-the-management-of-chronic-total-occlusions-in-coronary-artery-disease
#3
REVIEW
Kathleen Kearney, Ravi S Hira, Robert F Riley, Arun Kalyanasundaram, William L Lombardi
PURPOSE OF THE REVIEW: Chronic total occlusions (CTOs) are found in about a third of patients with coronary artery disease (CAD) and can pose a significant challenge during percutaneous revascularization. However, advances in CTO percutaneous coronary intervention (PCI) strategies, devices, and algorithms have led to significant improvements in successful treatment of CTOs. This review summarizes current management of CTOs in the context of modern PCI techniques and current evidence. RECENT FINDINGS: The hybrid algorithm now provides a standardized, teachable approach to CTO PCI, and success rates are approximately 90% in experienced hands...
April 2017: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/28314674/further-validation-of-the-hybrid-algorithm-for-cto-pci-difficult-lesions-same-success
#4
Mir B Basir, Aris Karatasakis, Mohammad Alqarqaz, Barbara Danek, Bavana V Rangan, Emmanouil S Brilakis, Henry Kim, William W O'Neill, Khaldoon Alaswad
OBJECTIVES: To evaluate the success rates and outcome of the hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) by a single operator in two different clinical settings. METHODS: We compared 279 consecutive CTO PCIs performed by a single, high-volume operator using the hybrid algorithm in two different clinical settings. Data were collected through the PROGRESS CTO Registry. We compared 145 interventions performed in a community program (cohort A) with 134 interventions performed in a referral center (cohort B)...
February 22, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28303648/subadventitial-techniques-for-chronic-total-occlusion-percutaneous-coronary-intervention-the-concept-of-vessel-architecture
#5
Lorenzo Azzalini, Mauro Carlino, Emmanouil S Brilakis, Minh Vo, Stéphane Rinfret, Barry F Uretsky, Dimitri Karmpaliotis, Antonio Colombo
Despite improvements in guidewire technologies, the traditional antegrade wire escalation approach to chronic total occlusion (CTO) recanalization is successful in only 60-80% of selected cases. In particular, long, calcified, and tortuous occlusions are less successfully approached with a true-to-true lumen approach. Frequently, the guidewire tracks into the subadventitial space, with no guarantee of distal re-entry into the true lumen. The ability to manage the subadventitial space has been a key step in the tremendous improvement in success rates of contemporary CTO percutaneous coronary intervention (PCI), whether operating antegradely or retrogradely...
March 17, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28296045/one-year-outcomes-after-successful-chronic-total-occlusion-percutaneous-coronary-intervention
#6
W M Wilson, S J Walsh, A Bagnall, A T Yan, C G Hanratty, M Egred, E Smith, K G Oldroyd, M McEntegart, J Irving, H Douglas, J Strange, J C Spratt
We aimed to determine clinical outcomes 1 year after successful chronic total occlusion (CTO) PCI and, in particular, whether use of dissection and re-entry strategies affects clinical outcomes. Hybrid approaches have increased the procedural success of CTO percutaneous coronary intervention (PCI) but longer-term outcomes are unknown, particularly in relation to dissection and re-entry techniques. Data were collected for consecutive CTO PCIs performed by hybrid-trained operators from 7 United Kingdom (UK) centres between 2012 and 2014...
March 15, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28256296/prediction-of-functional-recovery-after-percutaneous-coronary-revascularization-for-chronic-total-occlusion-using-late-gadolinium-enhanced-magnetic-resonance-imaging
#7
Tatsuya Nakachi, Shingo Kato, Hidekuni Kirigaya, Naoki Iinuma, Kazuki Fukui, Naka Saito, Tae Iwasawa, Masami Kosuge, Kazuo Kimura, Kouichi Tamura
BACKGROUND: Limited data are available regarding the prediction for functional recovery using late gadolinium enhanced magnetic resonance imaging (LGE MRI) after coronary revascularization for chronic total occlusion (CTO PCI). METHODS: We studied 59 patients (mean age, 66±11 years) who underwent successful CTO PCI. Two-dimensional echocardiography and strain measurements were performed before and 8±2 months after CTO PCI. The findings of segmental assessment were compared with the extent of LGE MRI using a 16-segment model...
February 27, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/28255103/percutaneous-coronary-intervention-of-coronary-chronic-total-occlusions-improves-peak-oxygen-uptake-during-cardiopulmonary-exercise-testing
#8
Shuaib M Abdullah, Jeffrey L Hastings, Suwetha Amsavelu, Fransisco Garcia-Morales, Fury Hendrix, Aris Karatasakis, Barbara A Danek, Judit Karacsonyi, Bavana V Rangan, Michele Roesle, Houman Khalili, Subhash Banerjee, Emmanouil S Brilakis
OBJECTIVES: Although coronary chronic total occlusions (CTOs) are treated with percutaneous coronary intervention (PCI) to improve symptoms, studies demonstrating symptom improvement have been mostly limited to questionnaire responses. The current study assessed for changes in peak oxygen uptake during cardiopulmonary exercise testing after CTO-PCI. METHODS: Patients with heart failure or angina symptoms referred for CTO-PCI were prospectively enrolled. The primary outcome of the study was improvement in peak oxygen uptake during cardiopulmonary exercise (CPX) testing 5 months after CTO-PCI...
March 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28244014/gender-based-acute-outcome-in-percutaneous-coronary-intervention%C3%A2-of-chronic-total-coronary-occlusion
#9
J E Guelker, L Bansemir, R Ott, K Kuhr, B Koektuerk, R G Turan, H G Klues, A Bufe
BACKGROUND: Percutaneous coronary intervention (PCI) of total chronic coronary occlusion (CTO) still remains a major challenge. Insignificant data are reported in the literature about gender differences in CTO-PCI in the era of new drug-eluting stents. In this study we analysed the impact of gender on procedural characteristics, complications and acute results. METHODS: Between 2010-2015 we included 780 consecutive patients. They underwent PCI for at least one CTO...
February 27, 2017: Netherlands Heart Journal
https://www.readbyqxmd.com/read/28242588/effects-of-successful-percutaneous-coronary-intervention-of-chronic-total-occlusions-on-myocardial-perfusion-and-left-ventricular-function
#10
Wijnand J Stuijfzand, P Stefan Biesbroek, Pieter G Raijmakers, Roel S Driessen, Stefan P Schumacher, Pepijn van Diemen, Jeffrey van den Berg, Robin Nijveldt, Adriaan A Lammertsma, Simon J Walsh, Colm G Hanratty, James C Spratt, Albert C van Rossum, Alexander Nap, Niels van Royen, Paul Knaapen
AIMS: The aim of the present study was to investigate the effects of successful PCI CTO on absolute myocardial blood flow (MBF) and functional recovery. METHODS AND RESULTS: Patients with a documented CTO were prospectively examined for ischemia and viability with H215O positron emission tomography (PET) and late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR). Sixty-nine consecutive patients, in whom PCI was successful, underwent follow-up PET and CMR after approximately 12 weeks to evaluate potential improvement of MBF as well as systolic function...
February 28, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28242587/impact-of-crossing-strategy-on-mid-term-outcomes-following-percutaneous-revascularisation-of-coronary-chronic-total-occlusions
#11
Lorenzo Azzalini, Rustem Dautov, Emmanouil S Brilakis, Soledad Ojeda, Susanna Benincasa, Barbara Bellini, Aris Karatasakis, Jorge Chavarría, Bavana V Rangan, Manuel Pan, Mauro Carlino, Antonio Colombo, Stéphane Rinfret
AIMS: To compare the impact of crossing strategies on mid-term outcomes following chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS AND RESULTS: We compiled a multicentre registry of consecutive patients undergoing successful CTO PCI. Patients were divided in three groups: true-to-true (TTT) approach, modern dissection/re-entry (DR) techniques (CrossBoss/Stingray, reverse CART), and old DR techniques (LAST, STAR, CART). Cox regression was used to identify independent predictors of major adverse cardiac events (MACE: cardiac death, myocardial infarction and target-vessel revascularisation)...
February 28, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28242583/clinical-implications-of-the-residual-syntax-score-after-percutaneous-coronary-intervention-in-patients-with-chronic-total-occlusion-and-multi-vessel-coronary-artery-disease-a-comparison-with-coronary-artery-bypass-grafting
#12
Woo Jin Jang, Jeong Hoon Yang, Young Bin Song, Joo-Yong Hahn, Jin-Ho Choi, Woo Jung Chun, Ju Hyeon Oh, Yong Hwan Park, Wook Sung Kim, Young Tak Lee, Hyeon-Cheol Gwon, Seung-Hyuk Choi
AIMS: We evaluated clinical impact of residual SYNTAX score (rSS) after percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) and multi-vessel coronary artery disease (CAD). METHODS AND RESULTS: We analyzed data from 1,043 patients with CTO and multi-vessel CAD who were treated with PCI or coronary artery bypass grafting (CABG). Patients were divided into three groups: patients with rSS≤12 after PCI (rSS≤12 group, n=445), patients with rSS>12 after PCI (rSS>12 group, n=150), and patients who underwent CABG (CABG group, n=448)...
February 28, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28236020/impact-of-multi-vessel-versus-single-vessel-disease-on-outcomes-after-percutaneous-coronary-interventions-for-chronic-total-occlusions
#13
Aurel Toma, Barbara E Stähli, Michael Gick, Cathérine Gebhard, Thomas Nührenberg, Kambis Mashayekhi, Miroslaw Ferenc, Franz-Josef Neumann, Heinz Joachim Buettner
BACKGROUND: Successful chronic total occlusion (CTO) revascularization has been associated with prognostic benefits. Whether the extent of coronary artery disease interferes with these benefits has not been investigated yet. AIMS: We sought to compare the survival after percutaneous coronary intervention (PCI) for CTO between patients with multi- (MVD) and single-vessel disease (SVD). METHODS: A total of 2002 consecutive patients undergoing CTO PCI between 01/2005 and 12/2013 were identified and stratified according to the presence/absence of MVD...
February 24, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28218604/everolimus-eluting-bioresorbable-vascular-scaffold-for-treatment-of-complex-chronic-total-occlusions
#14
Jiang Ming Fam, Soledad Ojeda, Roberto Garbo, Azeem Latib, Alessio La Manna, Beatriz Vaquerizo, Marouane Boukhris, Georgios J Vlachojannis, Robert Jan van Geuns, Babu Ezhumalai, Hiroyoshi Kawamoto, Jors van der Sijde, Cordula Felix, Manuel Pan, Roberta Serdoz, Giacomo Giovanni Boccuzzi, Marcella De Paolis, Gennaro Sardella, Corrado Tamburino, Pieter C Smits, Carlo Di Mario, Ashok Seth, Antonio Serra, Antonio Colombo, Patrick Serruys, Alfredo R Galassi, Felix Zijlstra, Nicolas M van Mieghem, Roberto Diletti
AIMS: Bioresorbable vascular scaffolds (BVS) represent a novel therapeutic option for the treatment of coronary artery diseases. The objective of this study is to evaluate the feasibility of BVS implantation in complex chronic total occlusions (CTO). METHODS AND RESULTS: The present report is a multi-centre registry evaluating results after BVS deployment in challenging CTO lesions defined as J-CTO score≥2 (difficult or very difficult). A total of 105 patients were included in the present analysis...
February 21, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28197870/intravascular-ultrasound-guidance-of-percutaneous-coronary-intervention-in-ostial-chronic-total-occlusions-a-description-of-the-technique-and-procedural-results
#15
Nicola Ryan, Nieves Gonzalo, Philip Dingli, Oscar Vedia Cruz, Pilar Jiménez-Quevedo, Luis Nombela-Franco, Ivan Nuñez-Gil, María Del Trigo, Pablo Salinas, Carlos Macaya, Antonio Fernandez-Ortiz, Javier Escaned
Inability to cross the lesion with a guidewire is the most common reason for failure in percutaneous revascularization (PCI) of chronic total occlusions (CTOs). An ostial or stumpless CTO is an acknowledged challenge for CTO recanalization due to difficulty in successful wiring. IVUS imaging provides the opportunity to visualize the occluded vessel and to aid guidewire advancement. We review the value of this technique in a single-centre experience of CTO PCI. This series involves 22 patients who underwent CTO-PCI using IVUS guidance for stumpless CTO wiring at our institution...
February 14, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28185704/everolimus-versus-zotarolimus-eluting-stent-following-percutaneous-coronary-chronic-total-occlusion-intervention
#16
Pil Hyung Lee, Min Soo Cho, Seung-Whan Lee, Jung-Min Ahn, Duk-Woo Park, Soo-Jin Kang, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park
BACKGROUND: Although studies have demonstrated comparable efficacy and safety profiles of everolimus- and zotarolimus-eluting stents (EES and ZES, respectively) for a broad spectrum of coronary artery diseases, there is paucity of data concerning their safety and efficacy for coronary chronic total occlusions (CTOs). This study compared the clinical performance of EES and ZES following successful percutaneous coronary intervention for CTOs. METHODS: The cohort included 539 consecutive CTO patients who underwent successful PCI using EES (n=313) and ZES (n=226) between September 2006 and August 2014...
February 2, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28185396/primary-percutaneous-coronary-intervention-of-native-chronic-total-occlusions-to-treat-st-elevation-myocardial-infarction-secondary-to-acute-vein-graft-occlusion
#17
Pierre Deharo, Julian W Strange, Abdul Mozid
Primary percutaneous coronary intervention (PCI) is the treatment modality of choice in patients presenting with ST elevation myocardial infarction (STEMI). Clinical outcomes have dramatically improved with the wide adoption of primary PCI in patients with STEMI because of acute thrombotic native coronary artery occlusion. However, patients with prior coronary artery bypass graft (CABG) surgery who present with STEMI because of acute saphenous vein graft (SVG) occlusion continue to have worse outcomes because of poor acute and long-term results of SVG stenting...
February 10, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28183464/transradial-coronary-interventions-for-complex-chronic-total-occlusions
#18
Yutaka Tanaka, Noriaki Moriyama, Tomoki Ochiai, Takuma Takada, Kazuki Tobita, Koki Shishido, Kazuya Sugitatsu, Futoshi Yamanaka, Shingo Mizuno, Masato Murakami, Junya Matsumi, Saeko Takahashi, Takeshi Akasaka, Shigeru Saito
OBJECTIVES: The aims of this study were to assess whether the transradial approach can be applied to treat complex chronic total occlusion (CTO) and to determine the predictors of transradial percutaneous coronary intervention (PCI) failure. BACKGROUND: Consistent data on the outcomes of transradial PCI for treating CTO are scarce. METHODS: Consecutive patients who were not receiving hemodialysis and had undergone PCI for CTO were enrolled...
February 13, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28169213/long-term-clinical-outcomes-of-patients-with-coronary-chronic-total-occlusion-treated-with-percutaneous-coronary-intervention-versus-medical-therapy-according-to-presence-of-diabetes-mellitus
#19
Ki Hong Choi, Jeong Hoon Yang, Young Bin Song, Joo-Yong Hahn, Jin-Ho Choi, Hyeon-Cheol Gwon, Sang Hoon Lee, Seung-Hyuk Choi
AIMS: The aim of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) treated with percutaneous coronary intervention (PCI) versus medical therapy (MT) according to the presence of diabetes mellitus. METHODS AND RESULTS: A total of 845 patients without diabetes and 702 patients with diabetes were included from the Samsung Medical Center CTO registry. The inverse probability of treatment weighted (IPTW) method was used to adjust for confounding factors...
February 7, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28169091/predictors-of-excess-patient-radiation-exposure-during-chronic-total-occlusion-coronary-intervention-insights-from-a-contemporary-multicentre-registry
#20
Georgios E Christakopoulos, Georgios Christopoulos, Dimitri Karmpaliotis, Khaldoon Alaswad, Robert W Yeh, Farouc A Jaffer, Michael R Wyman, William L Lombardi, Muhammad Nauman J Tarar, J Aaron Grantham, David E Kandzari, Nicholas Lembo, Jeffrey W Moses, Ajay J Kirtane, Manish Parikh, Philip Green, Matthew Finn, Santiago Garcia, Anthony H Doing, Raja Hatem, Craig A Thompson, Subhash Banerjee, Emmanouil S Brilakis
BACKGROUND: High patient radiation dose during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) might lead to procedural failure and radiation skin injury. METHODS: We examined the association between several clinical and angiographic variables on patient air kerma (AK) radiation dose among 748 consecutive CTO PCIs performed at 9 experienced US centres between May 2012 and May 2015. RESULTS: The mean age was 65 ± 10 years, 87% of patients were men, and 35% had previous coronary artery bypass graft surgery (CABG)...
November 11, 2016: Canadian Journal of Cardiology
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