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chronic total coronary occlusion

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https://www.readbyqxmd.com/read/29628223/the-distal-left-radial-artery-access-for-coronary-angiography-and-intervention-a-new-era
#1
Karim M Al-Azizi, Amir S Lotfi
BACKGROUND: Patients' intra and post procedural comfort, quick recovery, as well as procedure success, are key elements for choosing the right arterial access site. Radial artery access has been of increasing interest since it was first described. Advanced treatments of coronary lesions, from primary percutaneous interventions during ST elevation myocardial infarction cases to chronic total occlusion cases, have been increasingly done through the radial access. Distal left trans radial artery (dlTRA) is a new technique first described by Kiemineij...
March 26, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/29627112/impact-of-chronic-kidney-disease-on-outcomes-after-percutaneous-coronary-intervention-for-chronic-total-occlusions-from-the-japanese-multicenter-registry
#2
Toru Naganuma, Kenichi Tsujita, Satoru Mitomo, Hisaaki Ishiguro, Sandeep Basavarajaiah, Katsumasa Sato, Tsuyoshi Kobayashi, Junei Obata, Suguru Nagamatsu, Kenshi Yamanaga, Naohiro Komura, Kenji Sakamoto, Eiichiro Yamamoto, Yasuhiro Izumiya, Sunao Kojima, Koichi Kaikita, Hisao Ogawa, Sunao Nakamura
The impact of chronic kidney disease (CKD) and potential pharmacologic intervention on clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) remains unknown. A total of 1,463 patients underwent successful CTO-PCI between August 2004 and December 2014. Major adverse cardiovascular events (MACE) defined as the composite of all-cause death, myocardial infarction and target lesion revascularization, cardiac death, and stent thrombosis were compared between patients with and without CKD (555 and 908 patients, respectively)...
March 13, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29625510/interventional-management-of-balloon-uncrossable-coronary-chronic-total-occlusion-is-there-any-way-out
#3
REVIEW
Debabrata Dash
It has been estimated that coronary chronic total occlusion (CTO) is encountered in 15 to 20% patients referred for coronary angiography (CAG). The success of percutaneous coronary intervention (PCI) of CTO can be attributed to the vast array of hardware that has now become available and also to the vastly enhanced operator expertise. It is however realistic to state that despite the tremendous increase in the rate of success, there then comes a subset of CTO where PCI attempts fail. The reason for such failures given that other variables remain constant is the inability to cross the CTO lesion...
April 2018: Korean Circulation Journal
https://www.readbyqxmd.com/read/29623172/chronic-total-occlusion-coronary-intervention-in-search-of-a-definitive-benefit
#4
REVIEW
Alpesh Shah
Percutaneous coronary intervention (PCI) of chronic coronary total occlusion is the latest frontier in percutaneous intervention. There are vast improvements in the initial success and safety of the procedure as well as a better understanding of appropriateness and benefits. Advances in technology and skill allow for increased utilization of PCI in cases of chronic coronary total occlusion, with benefits regarding symptoms and quality of life. Percutaneous coronary intervention for chronic coronary total occlusion can correct ischemia and achieve complete revascularization while avoiding traditional coronary bypass grafting, although survival benefits remain unclear...
January 2018: Methodist DeBakey Cardiovascular Journal
https://www.readbyqxmd.com/read/29622966/influence-of-collaterals-on-the-left-ventricular-end-diastolic-pressure-and-serum-nt-probnp-levels-in-patients-with-coronary-chronic-total-occlusion
#5
Fuad Samadov, Osman Yesildag, Ibrahim Sari, Halil Atas, Aysel Akhundova, Yelda Basaran
Objective: Although numerous studies have shown the protective effects of the well-developed coronary collaterals on left ventricular functions, the relationship between collateral grade and left ventricular end diastolic pressure has not been studied in chronic total occlusion patients. Also, there are conflicting data on the effect of collaterals on NT-proBNP levels. The aim of our study was to evaluate the relationship between coronary collateral circulation and left ventricular end diastolic pressure and NT-proBNP levels in chronic total occlusion patients...
June 2017: The Egyptian heart journal: (EHJ): official bulletin of the Egyptian Society of Cardiology
https://www.readbyqxmd.com/read/29605686/long-term-clinical-outcomes-of-optimal-medical-therapy-vs-successful-percutaneous-coronary-intervention-for-patients-with-coronary-chronic-total-occlusions
#6
Lei Guo, Lei Zhong, Kun Chen, Jian Wu, Rong-Chong Huang
OBJECTIVES: There are little data on the long-term clinical outcomes of optimal medical therapy (OMT) compared with successful percutaneous coronary intervention (PCI) in patients with chronic total occlusions (CTOs). METHODS: A total of 388 patients with ≥1 CTO were enrolled from January 2008 to December 2010. 62 patients were excluded, and 326 patients were divided into an OMT group (n = 125) and PCI group (n = 201) according to the initial treatment strategy...
March 29, 2018: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
https://www.readbyqxmd.com/read/29602581/macrophage-migration-inhibitory-factor-mif-is-associated-with-degree-of-collateralization-in-patients-with-totally-occluded-coronary-arteries
#7
Luigi Di Serafino, Jozef Bartunek, Guy Heyndrickx, Karen Dierickx, Gabriella Scognamiglio, Tullio Tesorio, Bernard De Bruyne, Bruno Trimarco, William Wijns, Emanuele Barbato
BACKGROUND: Collaterals in patients with coronary artery disease (CAD) limit myocardial infarction and improve survival. Macrophage migration inhibitory factor (MIF) might play a role in collateral development. We aimed this study to evaluate the association of Macrophage migration Inhibitory Factor (MIF) with the extent of collateralization in patients with coronary occlusion. METHODS AND RESULTS: We consecutively enrolled: a) 40 patients undergoing PCI of a chronic coronary total occlusion (CTO); b) 26 patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI (pPCI) of the infarct-related artery (IRA); c) 12 control patients undergoing angiography without significant coronary artery disease (CTRL)...
March 21, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29602259/an-algorithmic-approach-for-the-management-of-ostial-right-coronary-artery-chronic-total-occlusions
#8
Alexandre Avran, Marouane Boukhris, Laurent Drogoul, Emanouil S Brilakis
Treatment of ostial chronic total occlusions (CTOs) of the right coronary artery (RCA) can be challenging. We present an algorithmic approach to the management of such lesions that incorporates all contemporary equipment and techniques. If the RCA ostium can be engaged with a guide catheter then antegrade crossing attempts should be performed. If the antegrade guidewire enters the subintimal space, re-entry into the distal true lumen is performed provided that the antegrade guide catheter provides enough support...
March 30, 2018: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29589974/coronary-chronic-total-occlusion-intervention-utility-or-futility
#9
Patrick Marechal, Laurent Davin, Olivier Gach, Christophe Martinez, Mathieu Lempereur, Nicolas Lhoest, Patrizio Lancellotti
Despite an incidence of about 18-52% of the patients undergoing coronary angiography, chronic total occlusions (CTO) are rarely revascularised by percutaneous angioplasty (PCI). Nevertheless, current evidence suggests that successful CTO angioplasty improves symptoms, quality of life and long-term survival. During the last decade, the improvement of specific tools and techniques for these complex procedures, and the increasing experience of operators, have led to the achievement of success and complication rates almost equivalent to non-CTO angioplasty...
March 28, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29572584/noise-reduction-technology-reduces-radiation-dose-in-chronic-total-occlusions-percutaneous-coronary-intervention-a-propensity-score-matched-analysis
#10
Davide Maccagni, Susanna Benincasa, Barbara Bellini, Luciano Candilio, Enrico Poletti, Mauro Carlino, Antonio Colombo, Lorenzo Azzalini
Chronic total occlusions (CTO) percutaneous coronary intervention (PCI) is associated with high radiation dose. Our study aim was to evaluate the impact of the implementation of a noise reduction technology (NRT) on patient radiation dose during CTO PCI. A total of 187 CTO PCIs performed between February 2016 and May 2017 were analyzed according to the angiographic systems utilized: Standard (n = 60) versus NRT (n = 127). Propensity score matching (PSM) was performed to control for differences in baseline characteristics...
March 23, 2018: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/29569332/the-impact-of-coronary-chronic-total-occlusion-percutaneous-coronary-intervention-upon-donor-vessel-fractional-flow-reserve-and-instantaneous-wave-free-ratio-implications-for-physiology-guided-pci-in-patients-with-cto
#11
Shah R Mohdnazri, Grigoris V Karamasis, Firas Al-Janabi, Christopher M Cook, James Hampton-Till, Jufen Zhang, Rasha Al-Lamee, Jason N Dungu, Swamy Gedela, Kare H Tang, Paul A Kelly, Justin E Davies, John R Davies, Thomas R Keeble
OBJECTIVE: To investigate the immediate and short term impact of right coronary artery (RCA) chronic total coronary occlusion (CTO) percutaneous coronary intervention (PCI) upon collateral donor vessel fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR). BACKGROUND: CTO PCI influences collateral donor vessel physiology, making the indication and/or timing of donor vessel revascularization difficult to determine. METHODS: In patients with RCA CTO, FFR, iFR, and collateral function index (FFRcoll ) were measured in LAD and LCx pre-CTO PCI, immediately post and at 4 month follow-up...
March 22, 2018: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29563377/exploration-of-bivalirudin-use-during-percutaneous-coronary-intervention-for-high-bleeding-risk-patients-with-chronic-total-occlusion
#12
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
https://www.readbyqxmd.com/read/29563016/impact-of-incomplete-revascularization-on-long-term-outcomes-following-chronic-total-occlusion-percutaneous-coronary-intervention
#13
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
https://www.readbyqxmd.com/read/29550088/update-in-the-percutaneous-management-of-coronary-chronic-total-occlusions
#14
REVIEW
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
https://www.readbyqxmd.com/read/29550046/usefulness-of-the-twin-guidewire-method-during-retrieval-of-the-broken-tip-of-a-microcatheter-entrapped-in-a-heavily-calcified-coronary-artery
#15
Sho Hashimoto, Akihiko Takahashi, Takeshi Yamada, Yukio Mizuguchi, Norimasa Taniguchi, Shunsuke Nakajima, Tetsuya Hata
During percutaneous coronary intervention performed for a stenotic lesion with heavy calcification in the left coronary artery, the microcatheter tip became transected in the vessel. The fragment was successfully retrieved using the twin guidewire method after negotiating to cross a chronic total occlusion-dedicated guidewire outside the retained tip.
February 23, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/29548677/meta-analysis-of-risk-of-ventricular-arrhythmias-and-all-cause-mortality-in-patients-with-chronic-total-occlusion-of-a-coronary-artery-and-or-implantable-cardioverter-defibrillator
#16
Zhi-Quan Wang, Hua Qiang, Xiu Luo, Wei Li, Kai Guo, Yi-Gang Li
Implantable cardioverter-defibrillator (ICD) has been increasingly used to prevent sudden death in patients with high risk of ventricular arrhythmias (VAs). Chronic total occlusion (CTO) is a severe condition of coronary artery disease. However, the prognostic impact of CTO in ICD recipients remains controversial. We systematically searched the PubMed, EMBASE, and Cochrane databases for documents published before October 1, 2017 to identify studies that investigated the prognostic impact of CTO on VAs and all-cause mortality (ACM) in ICD recipients...
February 12, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29546748/bioresorbable-scaffolds-for-complex-coronary-interventions
#17
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
https://www.readbyqxmd.com/read/29546434/percutaneous-endovascular-therapy-for-symptomatic-chronic-total-occlusion-of-the-left-subclavian-artery
#18
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
https://www.readbyqxmd.com/read/29543365/late-potentials-abolition-reduces-ventricular-tachycardia-recurrence-after-ablation-especially-in-higher-risk-patients-with-a-chronic-total-occlusion-in-an-infarct-related-artery
#19
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
https://www.readbyqxmd.com/read/29532645/coronary-chronic-total-occlusions-how-to-dilate-the-tough-ones
#20
EDITORIAL
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
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