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Chronic coronary occlusion

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https://www.readbyqxmd.com/read/28944620/intracoronary-snaring-of-the-retrograde-guidewire-how-to-overcome-extreme-takeoff-angles-in-chronic-total-occlusion-percutaneous-coronary-intervention
#1
Lorenzo Azzalini, Luciano Candilio, Mauro Carlino, Antonio Colombo
Extreme angulation of coronary artery takeoff represents a challenge for wiring and device advancement in percutaneous coronary intervention (PCI). This anatomic feature is particularly adverse in cases of chronic total occlusion (CTO) of the ostial-proximal segment of the target vessel. In this setting, the retrograde approach can help getting access to the occlusion. However, difficulties might arise at the critical step of wire externalization, due to the need to overcome the extreme ostial angle. Here, we describe a case of successful CTO PCI of the proximal circumflex artery, which presented an extreme angle at its takeoff...
September 25, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28943496/clinical-implications-of-periprocedural-myocardial-injury-in-patients-undergoing-percutaneous-coronary-intervention-for-chronic-total-occlusion-role-of-antegrade-and-retrograde-crossing-techniques
#2
Aurel Toma, Barbara Stähli, Cathérine Gebhard, Michael Gick, Jan Minners, Kambis Mashayekhi, Alexandre Avran, Miroslaw Ferenc, Heinz Joachim Buettner, Franz-Josef Neumann
AIMS: Periprocedural myocardial injury (PMI) is frequently observed afterpercutaneous coronary interventions (PCI) for chronic total occlusion (CTO). Weinvestigated the prognostic impact of PMI with the antegrade or the retrogradecrossing technique. METHODS AND RESULTS: A total of 1'909 patients undergoing CTO PCI were stratifiedaccording to the presence/absence of PMI (elevation of cardiac troponin T [cTnT] >5x 99th percentile of normal), and divided according to tertiles of the difference betweenpeak and baseline cTnT within 24 hours (ΔcTnT)...
September 26, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28940388/prognostic-value-of-the-age-creatinine-and-ejection-fraction-score-for-non-infarct-related-chronic-total-occlusion-revascularization-after-primary-percutaneous-intervention-in-acute-st-elevation-myocardial-infarction-patients-a-retrospective-study
#3
Jie Deng, Xiaozeng Wang, Yana Shi, Xin Zhao, Yaling Han
OBJECTIVE: It is not known if ACEF scores could evaluate the prognosis of recanalization of non-infarct-related coronary arteries (non-IRA) with chronic total occlusions (CTO) in patients who successfully underwent primary PCI. The objective of the current study was to assess the prognostic value of ACEF scores in acute ST-segment elevation myocardial infarction (STEMI) patients with non-IRA CTO after successful primary PCI. METHODS: There were 2952 STEMI patients who underwent successful primary PCI from January 2006 to December 2014 in our hospital, among them 377 patients had a non-IRA CTO lesion...
September 20, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28939719/clinical-characteristics-and-management-of-coronary-artery-perforations-a-single-center-11-year-experience-and-practical-overview
#4
Miguel E Lemmert, Rutger J van Bommel, Roberto Diletti, Jeroen M Wilschut, Peter P de Jaegere, F Zijlstra, Joost Daemen, Nicolas M Van Mieghem
BACKGROUND: Coronary artery perforation (CAP) is a potentially lethal complication of percutaneous coronary intervention. We report on the incidence, clinical characteristics, and management of iatrogenic coronary perforations based on an 11-year single-center experience. METHODS AND RESULTS: From February 9, 2005, through November 20, 2016, 150 CAP cases were identified from our percutaneous coronary intervention database of 21 212 procedures (0.71%). Mean age of CAP patients was 66±11 years, and 62...
September 22, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28938238/impact-of-diabetes-mellitus-on-5-year-clinical-outcomes-in-patients-with-chronic-total-occlusion-lesions
#5
Ahmed Mashaly, Seung-Woon Rha, Byoung Geol Choi, Man Jong Baek, Yang Gi Ryu, Se Yeon Choi, Jae Kyeong Byun, Hu Li, Min Suk Shim, Won Young Jang, Woohyeun Kim, Jun Hyuk Kang, Eun Jin Park, Jah Yeon Choi, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh
BACKGROUND: Diabetes mellitus (DM) is a major predictor of cardiovascular morbidity and mortality. However, there are limited data on the impact of DM in patients who have chronic total occlusion (CTO) lesion on long-term outcomes. PATIENTS AND METHODS: A total of 822 CTO patients who underwent coronary angiography, treated by either percutaneous coronary intervention or optimal medical therapy, were enrolled and divided into two groups: (i) diabetic group (n=363) and (ii) nondiabetic group (n=459)...
September 21, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/28932360/very-late-bioresorbable-scaffold-thrombosis-and-reoccurrence-of-dissection-two-years-later-chronic-total-occlusion-recanalization-of-the-left-anterior-descending-artery
#6
Luigi Di Serafino, Plinio Cirillo, Tullio Niglio, Francesco Borgia, Bruno Trimarco, Giovanni Esposito, Eugenio Stabile
We describe the case of a patient presenting with ST-segment elevation myocardial infarction due to very late scaffold thrombosis. The patient was already admitted for an elective percutaneous recanalization of a chronically occluded left anterior descending artery (LAD). The procedure was performed according the sub-intimal tracking and re-entry (STAR) technique with 4 bioresorbable vascular scaffolds implantation. However, even though the coronary flow was preserved at the end of the procedure, the dissected segment was only partially sealed at the distal segment of the LAD...
August 26, 2017: World Journal of Cardiology
https://www.readbyqxmd.com/read/28929594/epicardial-collateral-channel-for-retrograded-recanalization-of-chronic-total-occlusion-percutaneous-coronary-intervention-predictors-of-failure-and-procedural-outcome
#7
Zehan Huang, Dunliang Ma, Bin Zhang, Aba A Folson, Jingye Lin, Kaize Wu, Hongtao Liao, Zhian Zhong
OBJECTIVES: This study set out to identify significant lesion features of chronic total occlusion (CTO) that predict successful retrograde recanalization via epicardial collateral channels (CCs). BACKGROUND: Epicardial CCs remain essential in retrograde percutaneous coronary intervention (PCI) of CTO. However, the unpredictability of success and occurrence of complications limit the application of epicardial CCs for retrograde PCI technique for CTO. METHODS: 103 retro-recanalization cases were analyzed using epicardial CCs with successful recanalization as an end point...
September 19, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28928622/central-perforation-of-atretic-pulmonary-valve-using-coronary-microcatheter
#8
Saurabh Kumar Gupta, Rajnish Juneja, Anita Saxena
Percutaneous perforation of pulmonary valve, using 0.014" guidewires meant for coronary artery chronic total occlusion (CTO), is increasingly being performed for select cases of pulmonary atresia with intact ventricular septum (PA-IVS). Despite growing experience, procedural failures and complications are not uncommon. Even in infants treated successfully, the orifice created in the atretic pulmonary valve is eccentric. In this report, we present usefulness of coronary microcatheter in alignment of perforating coronary guidewire to the center of atretic pulmonary valve resulting in central perforation...
September 2017: Annals of Pediatric Cardiology
https://www.readbyqxmd.com/read/28924163/large-scale-metabolomic-analysis-reveals-potential-biomarkers-for-early-stage-coronary-atherosclerosis
#9
Xueqin Gao, Chaofu Ke, Haixia Liu, Wei Liu, Kang Li, Bo Yu, Meng Sun
Coronary atherosclerosis (CAS) is the pathogenesis of coronary heart disease, which is a prevalent and chronic life-threatening disease. Initially, this disease is not always detected until a patient presents with seriously vascular occlusion. Therefore, new biomarkers for appropriate and timely diagnosis of early CAS is needed for screening to initiate therapy on time. In this study, we used an untargeted metabolomics approach to identify potential biomarkers that could enable highly sensitive and specific CAS detection...
September 18, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28917556/increased-risk-of-ventricular-arrhythmias-in-survivors-of-out-of-hospital-cardiac-arrest-with-chronic-total-coronary-occlusion
#10
Sing-Chien Yap, Rafi Sakhi, Dominic Amj Theuns, Yunus E Yasar, Rohit E Bhagwandien, Roberto Diletti, Felix Zijlstra, Tamas Szili-Torok
BACKGROUND: A chronic total occlusion (CTO) is common in out-of-hospital cardiac arrest (OHCA) survivors with coronary artery disease. It is unclear whether a CTO contributes to ventricular arrhythmias in this population. OBJECTIVE: This study sought to evaluate the impact of unrevascularized CTO's on the occurrence of appropriate implantable cardioverter-defibrillator (ICD) therapy and all-cause mortality in OHCA survivors with coronary artery disease. METHODS: This was a retrospective study that included all consecutive OHCA survivors with coronary artery disease who received an ICD from 1999 until 2015...
September 13, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28916604/coronary-perforation-complicating-percutaneous-coronary-intervention-in-patients-with-a-history-of-coronary-artery-bypass-surgery-an-analysis-of-309-perforation-cases-from-the-british-cardiovascular-intervention-society-database
#11
Tim Kinnaird, Richard Anderson, Nick Ossei-Gerning, James Cockburn, Alex Sirker, Peter Ludman, Mark de Belder, Thomas W Johnson, Samuel Copt, Azfar Zaman, Mamas A Mamas
BACKGROUND: The evidence base for coronary perforation (CP) occurring during percutaneous coronary intervention in patients with a history of coronary artery bypass surgery (PCI-CABG) is limited and the long-term effects unclear. Using a national PCI database, the incidence, predictors, and outcomes of CP during PCI-CABG were defined. METHODS AND RESULTS: Data were analyzed on all PCI-CABG procedures performed in England and Wales between 2005 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes...
September 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28903939/percutaneous-coronary-intervention-versus-optimal-medical-therapy-for-chronic-total-coronary-occlusion-with-well-developed-collaterals
#12
Se Yeon Choi, Byoung Geol Choi, Seung-Woon Rha, Man Jong Baek, Yang Gi Ryu, Yoonjee Park, Jae Kyeong Byun, Minsuk Shim, Hu Li, Ahmed Mashaly, Won Young Jang, Woohyeun Kim, Jah Yeon Choi, Eun Jin Park, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh
BACKGROUND: The impact of percutaneous coronary intervention (PCI) on chronic total occlusion in patients with well-developed collaterals is not clear. METHODS AND RESULTS: A total of 640 chronic total occlusion patients with collateral flow grade ≥2 were divided into 2 groups; chronic total occlusion patients either treated with PCI (the PCI group; n=305) or optimal medical therapy (the optimal medical therapy group; n=335). To adjust for potential confounders, a propensity score matching analysis was performed...
September 13, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28890058/reversal-of-acute-mesenteric-ischemia-by-salvation-of-the-meandering-mesenteric-artery-with-stenting-of-the-left-internal-iliac-artery
#13
Kotsis Thomas, Christoforou P, Nastos C, Chatziioannou A, Theodosopoulos T
The presence of the meandering mesenteric artery, which is a non-constant tortuous arterial component unifying the peripheral intestinal circulation, is evidence of chronic occlusive disease of the main intestinal arteries. This collateral intestinal arterial pathway, when present, must be preserved in any abdominal intervention, as it is often the only remaining arterial supply of the intestine; its ligation can be accompanied by intestinal ischemia. We present herein, the case of a 42-year old man, heavy smoker, who had chronic mesenteric ischemia without particular clinical manifestations till the hospitalization for acute myocardial infarction for which he underwent balloon angioplasty and stenting of the left circumflex coronary artery...
September 7, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28889135/acute-outcome-of-chronic-total-occlusion-cto-recanalizsation-in-the-elderly
#14
J E Guelker, T Rock, R Ott, M Katoh, K Kroeger, R Guelker, H G Klues, D I Shin, A Bufe
OBJECTIVES: Percutaneous coronary intervention (PCI) of total chronic total occlusion (CTO) still remains a major challenge in interventional cardiology. There is only insignificant knowledge reported in the literature about age differences in CTO recanalization. We analyzed in this study the issue of the impact of age on procedural characteristics, complications and short-term outcome. METHODS: Between 2012-2016 we included 440 patients. They underwent PCI for at least one CTO...
August 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28885394/pleiotrophin-levels-are-associated-with-improved-coronary-collateral-circulation
#15
Pinar Türker Duyuler, Serkan Duyuler, Murat Gök, Harun Kundi, Canan Topçuoğlu, Ümit Güray
OBJECTIVES: Elucidation of the underlying mechanisms of angiogenesis and arteriogenesis in coronary collateral formation is necessary for new therapies. Pleiotrophin is a secreted multifunctional cytokine and associated with the formation of functional cardiovascular neovascularization in a series of experimental animal models. We aimed to evaluate the serum levels of pleiotrophin in patients with chronic total coronary artery occlusion and poor or good collateral development. METHODS: We included 88 consecutive patients (mean age of the entire population: 63...
September 6, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/28867125/comparison-of-benefit-of-successful-percutaneous-coronary-intervention-for-chronic-total-occlusion-in-patients-with-versus-without-reduced-%C3%A2-40-left-ventricular-ejection-fraction
#16
Aurel Toma, Barbara E Stähli, Michael Gick, Catherine Gebhard, Beat A Kaufmann, Kambis Mashayekhi, Miroslaw Ferenc, Heinz Joachim Buettner, Franz-Josef Neumann
Successful recanalization of chronic total occlusions (CTO) has been associated with improved survival. Data on outcomes in patients with left ventricular (LV) systolic dysfunction undergoing percutaneous coronary intervention for CTO, however, are scarce. Between January 2005 and December 2013, a total of 2,002 consecutive patients undergoing elective CTO percutaneous coronary intervention at a tertiary care center were divided into patients with (LV ejection fraction ≤ 40%) and without (LV ejection fraction > 40%) LV systolic dysfunction as defined by transthoracic echocardiography...
August 8, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28851720/fully-transradial-versus-transfemoral-approach-for-percutaneous-intervention-of-coronary-chronic-total-occlusions-applying-the-hybrid-algorithm-insights-from-recharge-registry
#17
Erik Jan Bakker, Joren Maeremans, Carlo Zivelonghi, Benjamin Faurie, Alexandre Avran, Simon Walsh, James C Spratt, Paul Knaapen, Colm G Hanratty, Erwan Bressollette, Peter Kayaert, Alan J Bagnall, Mohaned Egred, David Smith, Margaret B McEntegart, William H T Smith, Paul Kelly, John Irving, Elliot J Smith, Julian W Strange, Joseph Dens, Pierfrancesco Agostoni
BACKGROUND: Small observational studies demonstrate the feasibility of transradial approach for chronic total occlusion (CTO) percutaneous coronary intervention. The aim of the current study is to assess technical success, complication rates, and procedural efficiency in fully transradial approach (fTRA) and transfemoral approach (TFA) in a large prospective European registry adopting the hybrid algorithm for CTO percutaneous coronary intervention (Registry of CrossBoss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom, RECHARGE registry)...
September 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28837276/-why-to-treat-a-total-chronic-coronary-occlusion
#18
Patrick Marechal, Olivier Gach, Laurent Davin, Christophe Martinez, Mathieu Lempereur, Marc Magnee, Patrizio Lancellotti
Despite an incidence of about 15% of the patients undergoing coronary angiography, total chronic occlusions (CTO) are rarely revascularized by percutaneous angioplasty (PCI). Nevertheless, current evidence suggest that successful CTO-PCI improve symptoms, quality of live and long-term survival. During the last years, improvement of specific techniques for these complexes procedures and increasing experience of operators allow actually to obtain success and complications rates almost equivalent to non-CTO lesions angioplasty...
August 23, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28836346/the-trap-and-occlude-technique-for-retrograde-wire-externalization-during-chronic-total-occlusion-revascularization
#19
Gabriele L Gasparini, Jacopo A Oreglia, Roberto Garbo
Different strategies of retrograde approach were introduced in recent years to improve the success rate of percutaneous coronary intervention for coronary chronic total occlusions. The aim of this report is to describe a new technique, called "Trap and Occlude Technique," for retrograde wire externalization during CTO percutaneous revascularization. This technique may save time and reduce radiation exposure and procedure-related bleeding.
August 24, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28826896/incidence-treatment-and-outcomes-of-coronary-perforation-during-chronic-total-occlusion-percutaneous-coronary-intervention
#20
Barbara Anna Danek, Aris Karatasakis, Peter Tajti, Yader Sandoval, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc Jaffer, Robert W Yeh, David E Kandzari, Nicholas J Lembo, Mitul P Patel, Ehtisham Mahmud, James W Choi, Anthony H Doing, William L Lombardi, R Michael Wyman, Catalin Toma, Santiago Garcia, Jeffrey W Moses, Ajay J Kirtane, Raja Hatem, Ziad A Ali, Manish Parikh, Judit Karacsonyi, Bavana V Rangan, Houman Khalili, M Nicholas Burke, Subhash Banerjee, Emmanouil S Brilakis
Coronary perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,097 CTO PCIs performed in 2,049 patients from 2012 to 2017. Patient age was 65 ± 10 years, 85% were men, and 36% had prior coronary artery bypass graft surgery. Technical and procedural success were 88% and 87%, respectively. A major periprocedural adverse cardiovascular event occurred in 2.6%. Coronary perforation occurred in 85 patients (4.1%); The frequency of Ellis class 1, 2, and 3 perforations was 21%, 26%, and 52%, respectively...
July 24, 2017: American Journal of Cardiology
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