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Chronic coronary occlusion

Maciej Lesiak, Sylwia Zawada-Iwańczyk, Magdalena Łanocha, Aneta Klotzka, Michał Lesiak
Bioresorbable scaffolds (BRS) have been introduced to clinical practice to avoid some limitations associated with the presence of permanent metal prostheses in coronary arteries. Due to elimination of the natural vasomotion of the vessel and flow disturbance, stents impair endothelial function, increasing the risk of adverse events such as late and very late thrombosis or accelerated neoatherosclerosis. Additionally, the presence of metallic stents hinders non-invasive imaging of coronaries and may exclude the possibility of bypass graft anastomosis within the stented segment...
March 15, 2018: Minerva Cardioangiologica
Mehmet Akif Cakar, Ersun Tatli, Alptug Tokatli, Harun Kilic, Huseyin Gunduz, Ramazan Akdemir
INTRODUCTION: Percutaneous endovascular therapy is an accepted and preferred procedure for symptomatic subclavian artery disease. However, the technical feasibility and effectiveness of treating chronic total occlusion of the subclavian artery with this approach is uncertain. We aimed to evaluate the initial and mid-term results of endovascular therapy for patients with symptomatic chronic total occlusion of the left subclavian artery. METHODS: Consecutive patients who underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery between January 2010 and February 2014 were included...
March 16, 2018: Singapore Medical Journal
Andrea Di Marco, Teresa Oloriz Sanjuan, Gabriele Paglino, Francesca Baratto, Pasquale Vergara, Caterina Bisceglia, Nicola Trevisi, Simone Sala, Alessandra Marzi, Simone Gulletta, Manuela Cireddu, Ignasi Anguera, Paolo Della Bella
INTRODUCTION: Late potentials (LP) abolition is recognized as an effective strategy for substrate ablation of ventricular tachycardia (VT). The presence of a chronic total occlusion in a coronary artery responsible for a previous myocardial infarction (infarct related artery CTO, IRA-CTO) is emerging as a predictor of ventricular arrhythmias and VT recurrence after ablation. We sought to analyze the effects of LP abolition, focusing on the high-risk sub-group of patients with IRA-CTO...
March 15, 2018: Journal of Cardiovascular Electrophysiology
Amir Pourmorteza, Noemie Keller, Richard Chen, Albert Lardo, Henry Halperin, Marcus Y Chen, Elliot McVeigh
Resting regional wall motion abnormality (RWMA) has significant prognostic value beyond the findings of computed tomography (CT) coronary angiography. Stretch quantification of endocardial engraved zones (SQUEEZ) has been proposed as a measure of regional cardiac function. The purpose of the work reported here was to determine the effect of lowering the radiation dose on the precision of automatic SQUEEZ assessments of RWMA. Chronic myocardial infarction was created by a 2-h occlusion of the left anterior descending coronary artery in 10 swine (heart rates 80-100, ejection fraction 25-57%)...
March 13, 2018: International Journal of Cardiovascular Imaging
Asaad A Khan, George D Dangas
Several chronic total occlusions (CTOs) may be undilatable despite successful wire passage; several techniques can be used for lesion preparation, such as high-pressure balloon inflations, rotational atherectomy laser, cutting balloon, and scoring balloons. Presence of moderate to severe calcification and lesion length over 40 mm in association with comorbidities, such as diabetes mellitus and reduced ejection fraction, may contribute to making a CTO lesion undilatable. Still, appropriate therapy selection for a patient with CTO should be individualized and procedure safety attended to...
March 1, 2018: Catheterization and Cardiovascular Interventions
Mohammad A Hossain, Amy Quinlan, Jennifer Heck-Kanellidis, Dawn Calderon, Tejas Patel, Bhavika Gandhi, Shrinil Patel, Mahida Hetavi, Eric J Costanzo, James Cosentino, Chirag Patel, Asa Dewan, Yen-Hong Kuo, Loay Salman, Tushar J Vachharajani
BACKGROUND: While transradial approach to conduct percutaneous coronary interventions offers multiple advantages, the procedure can cause radial artery damage and occlusion. Because radial artery is the preferred site for the creation of an arteriovenous fistula to provide dialysis, patients with chronic kidney disease are particularly dependent on radial artery for their long-term survival. METHODS: In this retrospective study, we investigated the prevalence of chronic kidney disease in patients undergoing coronary interventions via radial artery...
March 1, 2018: Journal of Vascular Access
Qian Wu, Mengmeng Yu, Yuehua Li, Wenbin Li, Zhigang Lu, Meng Wei, Jing Yan, Jiayin Zhang
Objective: To investigate the morphological changes of coronary chronic total occlusion (CTO) as determined by coronary computed tomography angiography (CCTA) follow-up using semi-automated quantitative analysis. Materials and Methods: Thirty patients with 31 CTO lesions confirmed by invasive coronary angiography and baseline/follow-up CCTA were retrospectively included. CTOs were quantitatively analyzed by a semi-automated coronary plaque analysis software (Coronary Plaque Analysis, version 2...
March 2018: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Tim Kinnaird, Richard Anderson, Sean Gallagher, James Cockburn, Alex Sirker, Peter Ludman, Mark de Belder, Samuel Copt, James Nolan, Azfar Zaman, Mamas Mamas
OBJECTIVES: Using the British Cardiovascular Intervention Society percutaneous coronary intervention (PCI) database, access site choice and outcomes of patients undergoing PCI with previous coronary artery bypass grafting (CABG) were studied. BACKGROUND: Given the influence of access site on outcomes, use of radial access in PCI-CABG warrants further investigation. METHODS: Data were analyzed from 58,870 PCI-CABG procedures performed between 2005 and 2014...
March 12, 2018: JACC. Cardiovascular Interventions
Li Wang, Min-Jie Lu, Lei Feng, Juan Wang, Wei Fang, Zuo-Xiang He, Ke-Fei Dou, Shi-Hua Zhao, Min-Fu Yang
BACKGROUND: The relationship between myocardial viability and angiographic collateral flow is not fully elucidated in ischemic cardiomyopathy (ICM) with coronary artery chronic total occlusion (CTO). We aimed to clarify the relationship between myocardial hibernation, myocardial scar, and angiographic collateral flow in these patients. METHODS AND RESULTS: Seventy-one consecutive ICM patients with 122 CTOs and 652 dysfunctional segments within CTO territories were retrospectively analyzed...
March 7, 2018: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
Damiano Regazzoli, Daisuke Hachinohe, Ozan M Demir, Mauro Carlino, Julien Lemoine, Satoru Mitomo, Enrico Poletti, Max Amor, Antonio Colombo, Lorenzo Azzalini
Candidates for percutaneous coronary revascularization are becoming progressively older and more complex. A combination of factors related to the patient, lesion, and/or hemodynamic conditions may increase the risk of adverse events. Therefore, when a high-risk procedure is identified, it is crucial to provide the patient with adequate support in order to safely perform percutaneous coronary intervention (PCI). We report the case of a 77-year-old man with moderate left ventricular dysfunction and stage IV chronic kidney disease who underwent successful recanalization of a chronically occluded left anterior descending artery...
February 7, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Andrzej Grzybowski, Waldemar Elikowski, Magdalena Gaca-Wysocka
RATIONALE: To analyze cardiovascular risk factors and comorbidity of acute unilateral visual loss due to combined central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CLRAO). PATIENT CONCERNS: Among patients with retinal vein or artery occlusion hospitalized at the Department of Ophthalmology between January 2011 and August 2017, subjects with combined CRVO/CLRAO were selected. All of them underwent ophthalmologic and cardiologic examination, including fluorescein angiography, optical coherence tomography, 12-lead electrocardiogram, transthoracic and transesophageal echocardiography, carotid Doppler sonography, cerebral magnetic resonance imaging, and a panel of laboratory tests...
January 2018: Medicine (Baltimore)
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
Sinisa Stojkovic, Dejan Milasinovic
No abstract text is available yet for this article.
March 1, 2018: Heart: Official Journal of the British Cardiac Society
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
Yohei Kawatani, Yoshitsugu Nakamura, Takaki Hori
Ischemic heart disease presents with various symptoms, and chest pain is a chief complaint. Occlusion of the left main trunk often results in serious symptoms such as cardiogenic shock. However, while extremely rare, left main trunk occlusion can present with only slight chronic symptoms. In the present case, a 62-year-old woman with few risk factors for ischemic heart disease visited our hospital complaining of exertional chest pain, which had gradually intensified over the past several years. Coronary artery computed tomography revealed total occlusion of the left main trunk, which was examined closely using coronary angiography...
February 2018: Journal of Surgical Case Reports
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
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