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Chronic total occlusions

He Huang, Yao-Jun Zhang, Yong-Zhen Fan, Xi Wu, Christos V Bourantas
RATIONALE: Chronic total occlusion continues to be a challenging lesion subset for percutaneous coronary intervention. PATIENT CONCERNS: A 65-year-old male patient was admitted with symptoms of angina pectoris for 9 months. DIAGNOSES: Coronary angiography showed a severe stenosis in the proximal left anterior descending artery and a chronic total occlusion (CTO) in the proximal right coronary artery. The complexity of the CTO was stratified using the J-CTO score and the PROGRESS CTO score...
July 2018: Medicine (Baltimore)
Turan Acar, Volkan Çakır, Nihan Acar, Kemal Atahan, Mehmet Hacıyanlı
Chronic visceral ischemia is described as postprandial abdominal pain caused by intestinal hypoperfusion. Chronic visceral ischemia arising from the stenosis of major mesenteric arteries can cause death. Chronic abdominal pain, weight loss, and sitophobia are the major symptoms. The main cause of chronic visceral ischemia is atherosclerosis; Doppler ultrasonography, tomographic angiography, and magnetic resonance angiography can be used for diagnosis. The gold standard method is mesenteric catheterized angiography...
2018: Turkish Journal of Surgery
Igor Kranjec, Dinko Zavrl Dzananovic, Miha Mrak, Matjaz Bunc
No abstract text is available yet for this article.
January 1, 2018: Angiology
Apurva Patel, Roosha Parikh, WahWah Htun, Robert Bellavics, John T Coppola, Myo Maw, Olivier F Bertrand, Joseph A Puma, Zoltán Ruzsa, Tak W Kwan
BACKGROUND: Improved equipment and techniques have resulted in transition from surgical bypass to endovascular intervention to treat superficial femoral artery (SFA) chronic total occlusions (CTO). A change in access site to radial (TRA) or tibiopedal (TPA) artery for the treatment of these SFA CTO has been reported. The feasibility, efficacy and safety of these two access sites for treatment of SFA CTO have not been reported. METHODS: We performed an as treated analysis of 184 SFA CTO interventions in 161 patients from 01/2014 to 09/2016 using either primary TRA or TPA (operator discretion) at two institutions...
July 18, 2018: Catheterization and Cardiovascular Interventions
Mauro Carlino, Ozan M Demir, Antonio Colombo, Lorenzo Azzalini
OBJECTIVES: To establish if novel microcatheter knuckle technique (MKT) is feasible and efficacious in negotiating the subintimal space in difficult lesions during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: CTOs remain one of the most challenging lesion subsets in PCI. Guidewire manipulation and advancement of equipment within the subintimal space is sometimes challenging and aggressive manipulation in the subintimal space is feared, because of concern of vessel disruption and perforation...
July 18, 2018: Catheterization and Cardiovascular Interventions
Robert F Riley, James M McCabe, Sanjog Kalra, Mohamad Lazkani, Ashish Pershad, Darshan Doshi, Ajay J Kirtane, William Nicholson, Katherine Kearney, Tony Demartini, J Aaron Grantham, Jeffrey Moses, William Lombardi, Dimitri Karmpaliotis
INTRODUCTION: Patients with coronary chronic total occlusions (CTO) often have concurrent higher-risk anatomy and physiology (significant calcium, left ventricular dysfunction, multivessel disease) that increase their procedural risk. We present a retrospective multicenter case series describing use of the Impella percutaneous ventricular assist device (p-VAD) during CTO PCI. METHODS: We performed a retrospective analysis of self-reported data from five large referral centers from 2013 to 2017 and identified patients that underwent elective, hemodynamically supported CTO PCI with the Impella p-VAD device (2...
July 18, 2018: Catheterization and Cardiovascular Interventions
M Weis, S Hoffmann, C Henzler, C Weiss, S O Schoenberg, R Schaffelder, T Schaible, K W Neff
PURPOSE: To evaluate liver-herniation as individual parameter on outcome in children with congenital diaphragmatic hernia. MATERIALS AND METHODS: In a retrospective matched-pair analysis based on observed to expected fetal lung volume (o/e FLV), birth weight, gestational age at time-point of examination, status of tracheal occlusion therapy and side of the defect the individual impact of liver-herniation on survival, need for extracorporeal membrane oxygenation (ECMO) therapy and chronic lung disease (CLD) was investigated...
August 2018: European Journal of Radiology
Yoichiro Sugizaki, Toshiro Shinke, Tomohumi Doi, Nobuaki Igarashi, Hiromasa Otake, Hiroyuki Kawamori, Ken-Ichi Hirata
Ventricular fibrillation (VF) is a catastrophic complication of spontaneous (type 1) acute myocardial infarction (AMI). This study sought to clarify the angiographic coronary characteristics related to out-of-hospital VF in AMI patients. We retrospectively reviewed 464 consecutive cases of suspicious AMI, including type 1 AMI, with or without out-of-hospital VF. In addition to patient demographics, proximal left coronary artery (LCA) disease, multivessel disease (MVD), and chronic total occlusion (CTO) were assessed via coronary angiography and compared between patients with and without out-of-hospital VF...
July 13, 2018: Heart and Vessels
Yingxu Ma, Dongping Li, Jiayi Li, Yixi Li, Fan Bai, Fen Qin, Shenghua Zhou, Qiming Liu
Background: It was under debate whether chronic total occlusion (CTO) patients could benefit from percutaneous coronary intervention (PCI). We sought to compare clinical outcomes of PCI and optimal medical therapy (OMT) in these patients. Methods: PubMed, Embase and Cochrane Library were searched for studies enrolling patients with CTO who accepted PCI or OMT. The meta-analysis was performed by using a random-effect model. In addition, subgroup analyses were performed, including patients after propensity-matching and patients with CTO in infarct-related artery (IRA), respectively...
May 2018: Journal of Thoracic Disease
Jovana Janjic, Frits Mastik, Merel D Leistikow, Johan G Bosch, Geert Springeling, Ton Van Der Steen, Gijs Van Soest
OBJECTIVE: Minimally invasive procedures, such as intravascular and intracardiac interventions, may benefit from guidance with forward-looking (FL) ultrasound. In this work, we investigate FL ultrasound imaging using a single-element transducer integrated in a steerable catheter, together with an optical shape sensing (OSS) system. METHODS: We tested the feasibility of the proposed device by imaging the surface of a tissue-mimicking (TM) phantom and an ex vivo human carotid plaque...
January 18, 2018: IEEE Transactions on Bio-medical Engineering
Leonardo Misuraca, Alberto Massoni, Paolo Calabria, Andrea Picchi, Giuseppe Galzerano, Riccardo Trovato, Ruggiero Landini, Ugo Limbruno
We report the case of a chronic total occlusion in the left circumflex coronary artery due to the struts of a stent previously placed on the left main artery. The procedure was complicated by detachment of the stent advanced into the culprit lesion within the struts of the previously implanted stent in the left main artery. The extraction of the lost stent was performed using the twisting wire technique, but this operation resulted in a further complication, i.e. avulsion of the previously implanted stent on the left main artery...
July 2018: Giornale Italiano di Cardiologia
David C Warltier
Following brief periods (5-15 min) of total coronary artery occlusion and subsequent reperfusion, despite an absence of tissue necrosis, a decrement in contractile function of the postischemic myocardium may nevertheless be present for prolonged periods. This has been termed "stunned" myocardium to differentiate the condition from ischemia or infarction. Because the influence of volatile anesthetics on the recovery of postischemic, reperfused myocardium has yet to be studied, the purpose of this investigation was to compare the effects of halothane and isoflurane on systemic and regional hemodynamics following a brief coronary artery occlusion and reperfusion...
July 5, 2018: Anesthesiology
Daniel A Jones, Krishnaraj S Rathod, Antonis N Pavlidis, Sean M Gallagher, Zoe Astroulakis, Pitt Lim, Alexander Sirker, Charles J Knight, Miles C Dalby, Iqbal S Malik, Anthony Mathur, Roby Rakhit, Simon Redwood, Philip A MacCarthy, Chris Baker, Ranil Desilva, Carlo Di Mario, Roshan Weerackody, Jonathan Hill, Andrew Wragg, Elliot J Smith
BACKGROUND: Chronic total occlusions (CTO) are commonly encountered in patients undergoing coronary angiography; however, percutaneous coronary intervention (PCI) is infrequently performed owing to technical difficulty, the perceived risk of complications and a lack of randomized data. The aim of this study was to analyse the frequency and outcomes of CTO-PCI procedures in a large contemporary cohort of successive patients. PATIENTS AND METHODS: We undertook an observational cohort study of 48 234 patients with stable angina of which 5496 (11...
July 5, 2018: Coronary Artery Disease
Adrián I Löffler, Christopher M Kramer
Left ventricular dysfunction remains one of the best prognostic determinants of survival in patients with coronary artery disease. Revascularization has been shown to improve survival compared with medical therapy alone. Viability testing can help direct patients who will benefit the most from revascularization. Single-photon emission computed tomography, dobutamine stress echo, cardiac MRI, and PET imaging with F18-fluorodeoxyglucose are the most common modalities for assessing myocardial viability. Viability testing can help differentiate which patients benefit most from chronic total occlusion interventions...
July 2018: Interventional Cardiology Clinics
Spencer B King, Bill D Gogas
No abstract text is available yet for this article.
June 28, 2018: European Heart Journal
Jung Woo Chang, Woong Heo, Matthew Seung Suk Choi, Jang Hyun Lee
BACKGROUND: Diabetic foot management is a challenge for reconstructive surgeons because it combines dramatically decreased circulation and chronic infection. The goal of managing this condition is to maximize viable tissue; however, unsatisfactory results, such as extremity amputation, are unavoidable in some cases. For appropriate management, thorough understanding of diabetic foot and the phased approach to its management is needed. The purpose of this study is to introduce an optimal algorithm for diabetic foot management by analyzing cases >12 years...
July 2018: Medicine (Baltimore)
Michael Megaly, Marwan Saad, Peter Tajti, M Nicholas Burke, Ivan Chavez, Mario Gössl, Daniel Lips, Michael Mooney, Anil Poulose, Paul Sorajja, Jay Traverse, Yale Wang, Louis P Kohl, Steven M Bradley, Emmanouil S Brilakis
BACKGROUND: We sought to examine the impact of coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on left ventricular (LV) function. METHODS: We performed a systematic review and meta-analysis of studies published between January 1980 and November 2017 on the impact of successful CTO PCI on LV function. RESULTS: A total of 34 observational studies including 2735 patients were included in the meta-analysis. Over a weighted mean follow-up of 7...
July 4, 2018: Journal of Interventional Cardiology
Min Wang, Wen-Bin Zhang, Jia-le Song, Yi Luan, Chong-Ying Jin
BACKGROUND How to speed the recovery of viable myocardium in chronic total occlusion (CTO) patients after revascularization is still an unsolved problem. Breviscapine is widely used in cardiovascular diseases. However, there has been no study focused on the effect of breviscapine on viable myocardium recovery and left ventricular remodeling after CTO revascularization. MATERIAL AND METHODS We propose to recruit 78 consecutive coronary artery disease (CAD) patients with CTO during a period of 12 months. They will be randomly assigned to receive either breviscapine (40 mg) or placebo in the following 12 months...
July 4, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Ignacio J Amat-Santos, Victoria Martin-Yuste, José Antonio Fernández-Díaz, Javier Martin-Moreiras, Juan Caballero-Borrego, Pablo Salinas, Soledad Ojeda, Fernando Rivero, Julio Núñez Villota, Mohsen Mohandes, Daniela Dubois, Francisco Bosa Ojeda, Eva Rumiz, José M de la Torre Hernández, Jesús Jiménez-Mazuecos, Javier Lacunza, Paula Tejedor, Itziar Gómez, Luis R Goncalves-Ramirez, Paol Rojas, Manel Sabaté, Javier Goicolea, Alejandro Diego Nieto, Miriam Jiménez-Fernández, Javier Escaned, Nieves Gonzalo, Laura Pardo, Javier Cuesta, Gema Miñana, Juan Sanchis, Sergio Rojas, Raúl Millán, Beatriz Vaquerizo, Sara Rodríguez, Dae-Hyun Lee, Francisco J Morales, Alejandro Gutiérrez, María López, Jaume Maristany, Juan Rondán, Guillermo Galeote, Zuheir Kabbanni, Sergio Rodríguez, Luis Teruel, Mario Sadaba, Alfonso Jurado, Vicente Mainar, Juan Sánchez-Rubio, Hugo Vinhas, Renato Fernandes
INTRODUCTION AND OBJECTIVES: There is current controversy regarding the benefits of percutaneous recanalization (PCI) of chronic total coronary occlusions (CTO). Our aim was to determine acute and follow-up outcomes in our setting. METHODS: Two-year prospective registry of consecutive patients undergoing PCI of CTO in 24 centers. RESULTS: A total of 1000 PCIs of CTO were performed in 952 patients. Most were symptomatic (81.5%), with chronic ischemic heart disease (59...
June 25, 2018: Revista Española de Cardiología
Taehwan Yoo, Rishav Aggarwal, Tzu-Fei Wang, Bhagwan Satiani, Mounir J Haurani
OBJECTIVE: The role of follow-up venous duplex ultrasound (DUS) after acute lower extremity deep vein thrombosis (DVT) remains unclear, yet it is commonly performed. We aimed to clarify the role of follow-up DUS. Our primary objective was to determine the association between the presence of residual venous obstruction (RVO) on DUS and DVT recurrence or propagation (rDVT). Secondary objectives included finding risk factors associated with RVO and rDVT. METHODS: We conducted a retrospective study of patients diagnosed with DVT on DUS from January 1, 2011, to December 31, 2013, that received a follow-up DUS...
June 23, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
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