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Lorenzo Azzalini, Gennaro Giustino, Soledad Ojeda, Antonio Serra, Alessio La Manna, Hung Q Ly, Barbara Bellini, Susanna Benincasa, Jorge Chavarría, Livia L Gheorghe, Giovanni Longo, Eligio Miccichè, Guido D'Agosta, Fabien Picard, Manuel Pan, Corrado Tamburino, Azeem Latib, Mauro Carlino, Alaide Chieffo, Antonio Colombo
BACKGROUND: There is little evidence regarding the efficacy and safety of bioresorbable scaffolds (BRS) for the percutaneous treatment of chronic total occlusions. METHODS AND RESULTS: We performed a multicenter registry of consecutive chronic total occlusion patients treated with BRS (Absorb; Abbott Vascular) and second-generation drug-eluting stents (DES) at 5 institutions. Long-term target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target-lesion revascularization) was the primary end point...
October 2016: Circulation. Cardiovascular Interventions
James Sapontis, Steven P Marso, David J Cohen, William Lombardi, Dimitri Karmpaliotis, Jeffrey Moses, William J Nicholson, Ashish Pershad, R Michael Wyman, Anthony Spaedy, Stephen Cook, Parag Doshi, Robert Federici, Craig R Thompson, Karen Nugent, Kensey Gosch, John A Spertus, J Aaron Grantham
BACKGROUND: Patients with chronic total occlusions of a coronary artery represent a complex, yet common, clinical conundrum among patients with ischemic heart disease. Chronic total occlusion angioplasty is increasingly being used as a treatment for these complex lesions. There is a compelling need to better quantify the safety, efficacy, benefits, and costs of the procedure. METHODS: To address these gaps in knowledge, we designed the Outcomes, Patient Health Status, and Efficiency IN Chronic Total Occlusion Hybrid Procedures (OPEN CTO) study, an investigator-initiated multicenter, single-arm registry including 12 centers with a planned enrollment of 1000 patients...
October 13, 2016: Coronary Artery Disease
Lei Zhao, Long-Bo Li, Zhi-Hui Wang, Yong-Feng Shi, Jun-Duo Wu, Ji-Chang Zhang, Bin Liu
BACKGROUND: The CrossBoss coronary chronic total occlusion (CTO) crossing catheter has been demonstrated to have greatly improved the success rate of crossing CTO lesions, but there are no published data on its application for in-stent CTO lesions. METHODS: In the current study, we retrospectively reviewed the clinical data of 8 patients with in-stent CTO lesions that were managed with the CrossBoss catheter and herein we report the efficacy and safety of the CrossBoss crossing and re-entry system for this clinically challenging condition...
October 2016: Medicine (Baltimore)
Matteo Ghione, Joanna J Wykrzykowska, Stephan Windecker, Patrick W Serruys, Pawel Buszman, Axel Linke, Hae Young Sohn, Roberto Corti, Diethmar Antoni, William Wijns, Rodrigo Estevez-Loureiro, Marie-Claude Morice, Gerrit-Anne Van Es, Robert Jan van Geuns, Peter Juni, Pedro Eerdmans, Ton De Vries, Stéphanie Konik, Carlo Di Mario
BACKGROUND: Few data are available on long-term follow-up of DES in the treatment of chronic total occlusion (CTO). The LEADERS CTO sub-study compared the long-term results in CTO and non-CTO lesions of a Biolimus A9™-eluting stent (BES) with a sirolimus-eluting stent (SES). METHODS: Among 1,707 patients enrolled in the prospective, multi-center, all-comers LEADERS trial, 81 with CTOs were treated with either a BES (n = 45) or a SES (n = 36). The primary endpoint was the occurrence of major adverse cardiac events (MACE): cardiac death, myocardial infarction (MI) and clinically-indicated target vessel revascularization (TVR)...
September 26, 2016: Cardiology Journal
Judit Karacsonyi, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A Jaffer, Robert W Yeh, Mitul Patel, John Bahadorani, Anthony Doing, Ziad A Ali, Aris Karatasakis, Barbara A Danek, Bavana V Rangan, Aya J Alame, Subhash Banerjee, Emmanouil S Brilakis
BACKGROUND: Balloon uncrossable lesions can be challenging to treat, requiring specialized techniques and equipment. METHODS: We examined the prevalence, clinical and angiographic characteristics, management and procedural outcomes of balloon uncrossable lesions in a multicenter chronic total occlusion (CTO) percutaneous coronary intervention (PCI) registry. RESULTS: Between 2012 and 2016, 718 CTO PCIs (in which the occlusion was successfully crossed with a guidewire) were performed in 701 patients at 11 US centers...
September 21, 2016: Catheterization and Cardiovascular Interventions
Mateusz Tajstra, Łukasz Pyka, Jarosław Gorol, Damian Pres, Marek Gierlotka, Elżbieta Gadula-Gacek, Anna Kurek, Michał Wasiak, Michał Hawranek, Michał Oskar Zembala, Andrzej Lekston, Lech Poloński, Leszek Bryniarski, Mariusz Gąsior
OBJECTIVES: This study sought to assess the impact of chronic total occlusion (CTO) on long-term prognosis in patients with ischemic cardiomyopathy. BACKGROUND: The presence of concomitant CTO in a nonculprit lesion in acute coronary syndromes is associated with worse prognosis. Coronary artery disease is the main cause of heart failure and in many cases at least 1 CTO is observed. METHODS: The study included all patients with systolic heart failure who underwent elective coronary angiography and were registered from January 2009 to December 2014 in the ongoing single-center COMMIT-HF (COnteMporary Modalities In Treatment of Heart Failure) registry (NCT02536443)...
September 12, 2016: JACC. Cardiovascular Interventions
Craig M Walker, Jihad Mustapha, Thomas Zeller, Andrej Schmidt, Miguel Montero-Baker, Aravinda Nanjundappa, Marco Manzi, Luis Mariano Palena, Nelson Bernardo, Yazan Khatib, Robert Beasley, Luis Leon, Fadi A Saab, Adam R Shields, George L Adams
PURPOSE: To report a prospective, multicenter, observational study ( identifier NCT01609621) of the safety and effectiveness of tibiopedal access and retrograde crossing in the treatment of infrainguinal chronic total occlusions (CTOs). METHODS: Twelve sites around the world prospectively enrolled 197 patients (mean age 71±11 years, range 41-93; 129 men) from May 2012 to July 2013 who met the inclusion criterion of at least one CTO for which a retrograde crossing procedure was planned or became necessary...
August 24, 2016: Journal of Endovascular Therapy
Masami Nishino, Naoki Mori, Shin Takiuchi, Daisuke Shishikura, Naofumi Doi, Toru Kataoka, Takayuki Ishihara, Noriyuki Kinoshita
BACKGROUND: Excimer laser coronary atherectomy (ELCA) recently became available in Japan, but ELCA's effectiveness and safety are not clear. METHODS AND RESULTS: We enrolled consecutive patients who underwent ELCA and were registered in the Utility of Laser for Transcatheter Atherectomy-Multicenter Analysis around Naniwa (ULTRAMAN) registry comprising six Japanese medical centers around Naniwa in Japan with patients registered from April 2006 to June 2015. We evaluated the catheter sizes used and compared the success rate, thrombolysis in myocardial infarction (TIMI) flow, blush score, and complications between the rich-thrombus (RT) group [acute coronary syndrome (ACS) and saphenous vein graft (SVG)] and the poor-thrombus (PT) group [in-stent restenosis (ISR), chronic total occlusion (CTO), calcification, and long or bifurcation (L&B) lesions]...
July 2, 2016: Journal of Cardiology
Javier Escaned, Adrian Banning, Vasim Farooq, Mauro Echavarria-Pinto, Yoshinobu Onuma, Nicola Ryan, Rafael Cavalcante, Carlos M Campos, Bojan M Stanetic, Yuki Ishibashi, Pannipa Suwannasom, Arie-Pieter Kappetein, David Taggart, Marie-Angèle Morel, Gerrit-Anne van Es, Patrick W Serruys
AIMS: The applicability of the results of the SYNTAX trial comparing percutaneous coronary intervention (PCI) using first-generation drug-eluting stents (DES) with coronary artery bypass graft (CABG) surgery for the treatment of patients with complex coronary artery disease (CAD) has been challenged by recent major technical and procedural developments in coronary revascularisation. Functional assessment of coronary lesions has contributed to marked improvements in both safety and efficacy of DES implantation...
June 12, 2016: EuroIntervention
Olli A Kajander, Erkki Ilveskoski, Risto Jussila
Chronic total occlusions (CTOs) are frequently detected on diagnostic coronary angiograms. For the selection of patients for CTO percutaneous coronary intervention, factors such as the level of symptoms, level of myocardial viability and extent of ischemia must be taken into account. Remarkable progress has been achieved in the success of complex CTO procedures during the past decade. In addition to antegrade wire escalation strategy, subintimal passage of the guidewire with or without dissection and re-entry techniques and retrograde techniques can be utilized...
2016: Duodecim; Lääketieteellinen Aikakauskirja
Sergio Revuelta Suero, Isaac Martínez López, Manuela Hernández Mateo, Pablo Marqués de Marino, Iñaki Cernuda Artero, Maday Cabrero Fernández, Francisco Javier Serrano Hernando
BACKGROUND: This study compares outcomes of the endovascular treatment (EVT) of iliac artery occlusive disease according to whether the treated lesion is a stenosis or a chronic total occlusion (CTO). METHODS: Patients undergoing EVT from 2003 to 2013 for iliac artery occlusive disease were identified and the lesions treated stratified into stenotic (Group 1, n = 375) or CTO (Group 2, n = 87). Patients were followed clinically and hemodynamically (thigh-brachial index, TBI)...
July 2016: Annals of Vascular Surgery
W M Wilson, S J Walsh, A T Yan, C G Hanratty, A J Bagnall, M Egred, E Smith, K G Oldroyd, M McEntegart, J Irving, J Strange, H Douglas, J C Spratt
OBJECTIVES: Treatment options for coronary chronic total occlusions (CTO) are limited, with low historical success rates from percutaneous coronary intervention (PCI). We report procedural outcomes of CTO PCI from 7 centres with dedicated CTO operators trained in hybrid approaches comprising antegrade/retrograde wire escalation (AWE/RWE) and dissection re-entry (ADR/RDR) techniques. METHODS: Clinical and procedural data were collected from consecutive unselected patients with CTO between 2012 and 2014...
September 15, 2016: Heart: Official Journal of the British Cardiac Society
Edward L Hannan, Ye Zhong, Alice K Jacobs, Nicholas J Stamato, Peter B Berger, Gary Walford, Samin Sharma, Ferdinand J Venditti, Spencer B King
BACKGROUND: Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) has been identified as a beneficial treatment, but there is limited information about its use in everyday practice. METHODS AND RESULTS: Data from New York's PCI registry between July 1, 2009, and June 30, 2012, were used to examine the utilization and variation in use of CTO PCI, the success rates across providers, the multivariable correlates of success, and the mortality of successful CTO PCI...
May 2016: Circulation. Cardiovascular Interventions
Erdem Özel, Ahmet Taştan, Ali Öztürk, Emin Evren Özcan, Baris Kilicaslan, Öner Özdogan
INTRODUCTION: The bioresorbable vascular scaffold system (BVS) is the latest fully absorbable vascular therapy system that is used to treat coronary artery disease. The BVS has been used in different coronary lesion subsets, such as acute thrombotic lesions, bifurcation lesions, ostial lesions and lesions originating from bypass grafts. However, data about the use of BVS in chronic total occlusions (CTO) are limited. We report our BVS experience for the treatment of CTOs in terms of procedural features and one-year clinical follow-up results...
April 12, 2016: Cardiovascular Journal of Africa
Minh N Vo, Georgios Christopoulos, Dimitri Karmpaliotis, William L Lombardi, J Aaron Grantham, Emmanouil S Brilakis
BACKGROUND: After successful guidewire passage, failure to cross the occluded segment with a balloon is the most common cause of procedural failure in coronary chronic total occlusion (CTO) intervention. We evaluated the safety and efficacy of the balloon-assisted microdissection (BAM) technique for treating these complex balloon-uncrossable lesions. METHODS: We identified consecutive cases treated with BAM for balloon-uncrossable CTOs between January 2012 and February 2015 at two experienced CTO percutaneous coronary intervention (PCI) centers and reviewed their clinical and angiographic characteristics and procedural outcomes...
April 2016: Journal of Invasive Cardiology
Sinisa Markovic, Michael Lützner, Wolfgang Rottbauer, Jochen Wöhrle
OBJECTIVES: To evaluate angiographic and clinical results of ZES compared with EES after recanalization of CTOs. BACKGROUND: ZES and EES showed similar clinical results in non-CTO lesions. Whether ZES and EES are also comparable in true CTO lesions (TIMI 0 flow, duration of occlusion of more than 3 months) with a higher risk of restenosis has not been addressed so far. METHODS: 125 patients with successful CTO recanalization via antegrade or retrograde approach were included...
July 2016: Catheterization and Cardiovascular Interventions
Makoto Araki, Tadashi Murai, Yoshihisa Kanaji, Junji Matsuda, Eisuke Usui, Takayuki Niida, Sadamitsu Ichijo, Rikuta Hamaya, Tsunekazu Kakuta
The reverse CART technique provides the potential to modify the retrograde procedure by improving the controlled movement of the retrograde wire and improve the success rates of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Development of interventricular hematoma is a rare complication of CTO PCI. A 63-year-old man with effort angina with a right coronary artery CTO lesion underwent PCI by retrograde approach from the LAD to a septal branch. A contrast "stain" was demonstrated surrounding the septal collateral channel used for the retrograde approach at the end of the procedure without symptom...
2016: Case Reports in Medicine
Beatriz Vaquerizo, Antonio Barros, Sandra Pujadas, Ester Bajo, Marcelo Jiménez, José Gomez-Lara, Francisco Jacobi, Neus Salvatella, Guillem Pons, Juan Cinca, Antonio Serra
The potential of bioresorbable vascular scaffold (BVS) technology has been demonstrated in first-in-man studies with up to 5-year follow-up. This study sought to investigate the 1-year outcomes of the BVS, for the treatment of chronic total occlusions (CTOs), using various imaging techniques. Thirty-five true CTO lesions treated with BVS were included in this prospective study. Scaffolds were deployed after mandatory predilation and intravascular ultrasound analysis. Optical coherence tomography was performed after BVS implantation and at 10 to 12 months...
March 15, 2016: American Journal of Cardiology
Shwan Jalal, Thomas A Lalonde, Hiroshi Yamasaki, Andrew Boshara, Howard S Rosman, Rajendra H Mehta, Thomas P Davis
AIMS: Our aim was to evaluate the effectiveness and safety of CenterCross/MultiCross devices to facilitate the crossing of chronic total occlusions in peripheral arteries. METHODS AND RESULTS: This was a single-centre study in which 53 consecutive patients who were not amenable to initial attempts at crossing using standard guidewires underwent an attempt to recanalise chronically occluded infrainguinal peripheral arteries with MultiCross/CenterCross devices. The primary endpoint of interest was the ability to advance the guidewire beyond the chronic total occlusion (CTO) lesions with the use of these devices...
January 22, 2016: EuroIntervention
Nicolas W Shammas, Gail A Shammas, Jon Robken, Thomas Harris, Ashley Madison, Catherine Dinklenburg, Andrew N Shammas, Christine Harb, Michael Jerin
BACKGROUND: Treatment of chronic total occlusion (CTO) is complex and has a low adoption rate by interventional cardiologists. The introduction of the hybrid approach has provided a systematic step-by-step approach to treat complex CTO lesions with a high success rate. We describe the overall experience with the use of the hybrid approach of a non-CTO operator and analyze differences in the procedural and long term outcomes before and after the initial 30 cases performed. METHODS: A total of 67 unselected, consecutive patients (68 lesions) underwent PCI of a CTO between January 2012 and June 2013 by a non-CTO operator...
January 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
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