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Chenguang Li, Yi Shen, Rende Xu, Yuxiang Dai, Shufu Chang, Hao Lu, Lei Ge, Jianying Ma, Juying Qian, Junbo Ge
The safety and efficacy of bivalirudin during percutaneous coronary intervention (PCI) in high bleeding risk patients with chronic total occlusion lesions (CTO) has not been studied till date. The use of bivalirudin may increase the thrombotic events during CTO-PCI.Between May 2013 and April 2014, a total of 117 high bleeding risk patients with CTOs underwent PCI. Bivalirudin was used in 89 cases with different strategies, including standard usage, combination of heparin, and additional bolus of bivalirudin on the basis of standard usage...
March 20, 2018: International Heart Journal
Lorenzo Azzalini, Luciano Candilio, Soledad Ojeda, Joseph Dens, Alessio La Manna, Susanna Benincasa, Barbara Bellini, Francisco Hidalgo, Jorge Chavarría, Joren Maeremans, Giacomo Gravina, Eligio Miccichè, Guido D'Agosta, Giuseppe Venuti, Corrado Tamburino, Manuel Pan, Mauro Carlino, Antonio Colombo
We aimed to evaluate the impact of incomplete revascularization (ICR) on long-term outcomes of patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Consecutive patients undergoing CTO PCI at 4 centers were included. Baseline SYNTAX score (bSS: low [≤ 22], intermediate [>22 and <33], high [≥33]), residual SYNTAX score (rSS: 0, >0 and ≤8, >8), and SYNTAX revascularization index (SRI: 100 × (bSS-rSS)/bSS: 100%, 50% to 99%, <50%) were calculated. The primary end point was major adverse cardiac events (MACEs; cardiac death, any myocardial infarction, any revascularization) on follow-up...
February 23, 2018: American Journal of Cardiology
Peter Tajti, M Nicholas Burke, Dimitri Karmpaliotis, Khaldoon Alaswad, Gerald S Werner, Lorenzo Azzalini, Mauro Carlino, Mitul Patel, Kambis Mashayekhi, Mohaned Egred, Oleg Krestyaninov, Dmitrii Khelimskii, William J Nicholson, Imre Ungi, Alfredo R Galassi, Subhash Banerjee, Emmanouil S Brilakis
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been rapidly evolving during recent years. With improvement in equipment and techniques, high success rates can be achieved at experienced centers, although overall success rates remain low. Prospective, randomized-controlled data regarding optimal use and indications for CTO PCI remain limited. CTO PCI should be performed when the anticipated benefit exceeds the potential risk. New high-quality studies of the clinical outcomes and techniques of CTO PCI are needed, as is the expansion of expert centers and operators that can achieve excellent clinical outcomes in this challenging patient and lesion subgroup...
March 12, 2018: JACC. Cardiovascular Interventions
Jiangtao Tong, Qian Yu, Chenggang Li, Xiaojuan Shao, Yong Xia
BACKGROUND: Randomized trials and meta-analyses demonstrated that chronic total occlusion (CTO) in noninfarct related artery (n-IRA) was associated with increased all-cause mortality. Recently, several observational studies suggested that the successful revascularization of n-IRA with CTO decreased all-cause mortality. METHODS: A systematic search was performed in Cochrane Controlled Trials Registry, PubMed, MEDLINE, and EMBASE databases for relevant studies. Article assessing the prognostic role of revascularization of n-IRA with CTO was enrolled in this meta-analysis...
January 2018: Medicine (Baltimore)
Grigoris V Karamasis, Andreas S Kalogeropoulos, Shah H Mohdnazri, Firas Al-Janabi, Rohan Jagathesan, Gerald J Clesham, Kare H Tang, Paul A Kelly, John R Davies, Thomas R Keeble
BACKGROUND: The aim of this study was to assess the impact of right atrial pressure (Pra) on non-CTO vessels FFR measurements in patients with a chronic total occlusion. METHODS: Consecutive patients who underwent PCI for a CTO of the right coronary artery (RCA) were included. Prior to RCA recanalization, FFR and FFRmyo were measured in non-CTO vessels. FFR was calculated using the Pd/Pa equation during maximum hyperaemia and also accounting for right atrial pressure (Pd-Pra/Pa-Pra)...
February 7, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Hsin-I Teng, Shih-Hsien Sung, Shao-Sung Huang, Ju-Pin Pan, Shing-Jong Lin, Wan-Leong Chan, Wen-Lieng Lee, Tse-Min Lu, Cheng-Hsueh Wu
OBJECTIVES: The purpose of this study was to assess the long-term clinical impact of revascularization of coronary concomitant coronary chronic total occlusion (CTO) in patients with Non-ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND: CTO is associated with poorer prognosis in patients with NSTEMI. The evidence of revascularization of CTO in patients with NSTEMI is still conflicting. METHODS: Consecutive patients with NSTEMI and CTO who underwent percutaneous coronary intervention (PCI) within 72 h of admission from 2006 to 2015 were retrospectively recruited and analyzed...
March 1, 2018: Journal of Interventional Cardiology
Barbara A Danek, Mir B Basir, William W O'Neill, Mohammad Alqarqaz, Aris Karatasakis, Dimitri Karmpaliotis, Farouc A Jaffer, Robert W Yeh, Michael Wyman, William L Lombardi, David Kandzari, Nicholas Lembo, Anthony Doing, Mitul Patel, Ehtisham Mahmud, James W Choi, Catalin Toma, Jeffrey W Moses, Ajay Kirtane, Manish Parikh, Ziad A Ali, Santiago Garcia, Judit Karacsonyi, Bavana V Rangan, Craig A Thompson, Subhash Banerjee, Emmanouil S Brilakis, Khaldoon Alaswad
OBJECTIVE: To study outcomes with use of percutaneous mechanical circulatory support (MCS) devices in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: We examined characteristics and outcomes of 1598 CTO-PCIs performed from 2012-2017 at 12 high-volume centers. RESULTS: Patient age was 66 ± 10 years; 86% were men. An MCS device was used electively in 69 procedures (4%) and urgently in 22 procedures (1%). The most commonly used elective MCS device was Impella 2...
March 2018: Journal of Invasive Cardiology
Rustem Dautov, Luiz Fernando Ybarra, Can Manh Nguyen, Claire Gibrat, Dominique Joyal, Stéphane Rinfret
OBJECTIVES: We examined the incidence of periprocedural cardiac enzyme rise (PCER) [troponin T (TnT) or high-sensivity (hs)TnT >5× the upper limit of normal (ULN)] and periprocedural myocardial infarction (PMI), predictors of PCER and impact of PCER on the longer-term major adverse cardiac events (MACE) following hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: PCER and PMI after CTO PCI, risk factors for PCER and its impact on longer-term MACE are not fully understood...
February 26, 2018: Catheterization and Cardiovascular Interventions
Brian J Potter, Alexis Matteau, Nicolas Noiseux, Samer Mansour
No abstract text is available yet for this article.
March 2018: Canadian Journal of Cardiology
Joëlle Elias, Ivo M van Dongen, Truls Råmunddal, Peep Laanmets, Erlend Eriksen, Martijn Meuwissen, H Rolf Michels, Matthijs Bax, Dan Ioanes, Maarten Jan Suttorp, Bradley H Strauss, Emanuele Barbato, Koen M Marques, Bimmer E P M Claessen, Alexander Hirsch, René J van der Schaaf, Jan G P Tijssen, José P S Henriques, Loes P Hoebers
BACKGROUND: During primary percutaneous coronary intervention (PCI), a concurrent chronic total occlusion (CTO) is found in 10% of patients with ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI have been suggested; however, randomised data are lacking. Our aim was to determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No PCI in patients with STEMI with a concurrent CTO. METHODS: The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) was a multicentre randomised trial that included 302 patients with STEMI after successful primary PCI with a concurrent CTO...
February 20, 2018: Heart: Official Journal of the British Cardiac Society
Gopakumar Ks, Mathew Iype, Sunitha Viswanathan, A George Koshy, Prabha Nini Gupta, K Sivaprasad, V V Radhakrishnan
Chronic Total Occlusion (CTO) intervention is a challenging area in interventional cardiology. Presently about 70% of CTO interventions are successful. MATERIALS AND METHODS: This was a single center prospective study of a cohort of all patients undergoing percutaneous coronary intervention (PCI) as elective or adhoc procedure for CTO from August 2014 to June 2015. Only antegrade CTO interventions were included. In all patients the following data were recorded. RESULTS: A total of 210 (8...
January 2018: Indian Heart Journal
Francesco Gallo, Matteo Tebaldi, Carlo Tumscitz
Percutaneous treatment of chronic total occlusions (CTO) is one of the major challenges in contemporary interventional cardiology. These lesions are identified in 15% to 30% of all patients referred for coronary angiography. Percutaneous coronary intervention (PCI) of CTOs is technically challenging and requires familiarity with advanced interventional techniques as well as specialty equipment. The choice of strategy and materials is based on clinical features and coronary anatomy; the correct choice is essential to improve the success probability...
January 2018: Giornale Italiano di Cardiologia
Lorenzo Azzalini, Ozan M Demir, Gabriele L Gasparini, Luca Grancini, Alessio La Manna, Soledad Ojeda, Susanna Benincasa, Barbara Bellini, Enrico Poletti, Davide Maccagni, Margherita Soldi, Loredana Iannetta, Daniela Trabattoni, Giacomo Gravina, Francisco Hidalgo, Francesco Giannini, Manuel Pan, Corrado Tamburino, Antonio L Bartorelli, Bernhard Reimers, Cosmo Godino, Mauro Carlino, Antonio Colombo
BACKGROUND: We aimed to evaluate the mid-term outcomes of a novel thin-strut bioresorbable-polymer sirolimus-eluting stent (BP-SES) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), as compared with durable-polymer everolimus-eluting stents (EES). METHODS: We compiled a multicenter registry of patients undergoing CTO recanalization followed by BP-SES or EES implantation. The primary endpoint was the incidence of target-lesion failure (TLF, a composite of cardiac death, target-vessel myocardial infarction, and target-lesion revascularization) at one year...
January 31, 2018: International Journal of Cardiology
Andrew H McNeice, Matthew Brooks, Colm G Hanratty, Michael Stevenson, James C Spratt, Simon J Walsh
OBJECTIVES: A retrospective study was performed to investigate if the generation of X-ray system used was an independent factor for radiation dose in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: PCI procedures for CTOs are known to be associated with higher doses of radiation. The authors suspected progressive reductions in radiation doses for CTO PCI as newer X-ray systems were introduced into clinical practice. METHODS: Procedures performed over a five-year period by three interventional cardiologists were retrospectively reviewed...
February 7, 2018: Catheterization and Cardiovascular Interventions
Hui-Ping Zhang, Hu Ai, Ying Zhao, Hui Li, Guo-Dong Tang, Nai-Xin Zheng, Fu-Cheng Sun, Jing-Hua Liu
BACKGROUND: There are little published data reporting the effect of coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on the prognosis of elderly patients with identified CTOs. We sought to evaluate the clinical effect of CTO PCI on the prognosis of elderly patients with CTOs. METHODS: A total of 445 consecutive patients diagnosed with a CTO by angiography from January 2011 to December 2013 were enrolled. We compared long-term clinical outcomes between the elderly group (≥75 years; n = 120, 27...
February 2018: American Journal of the Medical Sciences
Lorenzo Azzalini, Soledad Ojeda, Aris Karatasakis, Joren Maeremans, Masaki Tanabe, Alessio La Manna, Rustem Dautov, Luiz F Ybarra, Susanna Benincasa, Barbara Bellini, Luciano Candilio, Ozan M Demir, Francisco Hidalgo, Judit Karacsonyi, Giacomo Gravina, Eligio Miccichè, Guido D'Agosta, Giuseppe Venuti, Corrado Tamburino, Manuel Pan, Mauro Carlino, Joseph Dens, Emmanouil S Brilakis, Antonio Colombo, Stéphane Rinfret
BACKGROUND: We aimed to investigate the procedural and long-term outcomes of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in patients who had undergone previous coronary artery bypass grafting (CABG) vs those who had not, and to evaluate the role of the Registry of CrossBoss and Hybrid procedures in France, the Netherlands, Belgium, and United Kingdom (RECHARGE) score in predicting acute and long-term outcomes. METHODS: We compiled a multicentre registry of consecutive patients undergoing CTO PCI at 7 centres between January 2009 and April 2017...
December 26, 2017: Canadian Journal of Cardiology
Shunsuke Matsuno, Etsuo Tsuchikane, Scott A Harding, Eugene B Wu, Hsien-Li Kao, Emmanouil S Brilakis, Kambis Mashayekhi, Gerald S Werner
During recent years, equipment and techniques for percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) have significantly improved. The retrograde approach remains critical to the improved success of CTO PCI. Currently, the reverse controlled antegrade and retrograde tracking (CART) technique has become the dominant retrograde wire crossing technique. In this article, we propose a standardized terminology and classification of this technique into 3 subtypes: a) conventional reverse CART, that usually involves use of large balloons on the antegrade wire to achieve reentry within the CTO segment; b) "directed" reverse CART which is characterized by small antegrade balloon size and more active, intentional vessel tracking and penetration with a controllable retrograde wire, still within the CTO segment; and c) "extended" reverse CART in which the intimal/ subintimal dissection is extended proximal or distal to the CTO segment, achieving reentry outside the CTO segment...
January 23, 2018: EuroIntervention
Keisuke Hirai, Kenichi Sakakura, Yusuke Watanabe, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
BACKGROUND: Percutaneous coronary interventions (PCI), especially medical devices, consume large amounts of medical resources. It is important to know which type of lesions requires high device costs among current PCI. The purpose of this study was to investigate the association between lesion characteristics and medical device costs in current PCI. METHODS: We identified 593 coronary artery lesions in our PCI database between January 1, 2015 and December 31, 2015...
December 23, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Aurel Toma, Barbara E Stähli, Michael Gick, Miroslaw Ferenc, Kambis Mashayekhi, Heinz Joachim Buettner, Franz-Josef Neumann, Catherine Gebhard
OBJECTIVE: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has undergone impressive progress during the last decade, both in strategies and equipment. It is unknown whether technical refinement has translated into improved outcomes in women undergoing CTO-PCI. METHOD AND RESULTS: A total of 2002 consecutive patients (17% females, mean age 65.2 ± 10.7 years) undergoing PCI of at least one CTO lesion at our center between 01/2005 and 12/2013 were evaluated...
January 22, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Jérémie Dabin, Joren Maeremans, Danielle Berus, Werner Schoonjans, Giulia Tamborino, Jo Dens, Peter Kayaert
Percutaneous coronary interventions (PCI) of coronary chronic total occlusions (CTO) increase the risk of high radiation exposure for both the patient and the cardiologist. This study evaluated the maximum dose to the patients' skin (MSD) and the exposure of the cardiologists during CTO-PCI. Moreover, the efficiency of radioprotective drapes to reduce cardiologist exposure was assessed. Patient dose was measured during 31 procedures; dose to the cardiologist's extremities were measured during 65 procedures, among which 31 were performed with radioprotective drapes...
January 17, 2018: Radiation Protection Dosimetry
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