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Stephane Rinfret

Lorenzo Azzalini, Rustem Dautov, Emmanouil S Brilakis, Soledad Ojeda, Susanna Benincasa, Barbara Bellini, Aris Karatasakis, Jorge Chavarría, Bavana V Rangan, Manuel Pan, Mauro Carlino, Antonio Colombo, Stéphane Rinfret
BACKGROUND: There are few data regarding the procedural and follow-up outcomes of different antegrade dissection/re-entry (ADR) techniques for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: We compiled a multicenter registry of consecutive patients undergoing ADR-based CTO PCI at four high-volume specialized institutions. Patients were divided according to the specific ADR technique used: subintimal tracking and re-entry (STAR), limited antegrade subintimal tracking (LAST), or device-based with the CrossBoss/Stingray system (Boston Scientific, Marlborough, MA)...
November 16, 2016: International Journal of Cardiology
Rustem Dautov, Marina Urena, Can Manh Nguyen, Claire Gibrat, Stéphane Rinfret
AIMS: Septal surfing and distal tip injections are two techniques used for septal crossing in retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI). We examined for the first time the safety and feasibility of the septal surfing technique. METHODS AND RESULTS: Among 470 consecutive CTO PCIs performed between 01/2010 and 12/2015, 240 (51%) involved a retrograde attempt. In the septal crossing subgroup, we evaluated if the Werner collateral channel (CC) classification, CTO location, tortuosity, and number of large septal CCs influenced retrograde crossing success, time, perforation...
November 2, 2016: EuroIntervention
Rustem Dautov, Henrique Barbosa Ribeiro, Omar Abdul-Jawad Altisent, Luis Nombela-Franco, Claire Gibrat, Can Manh Nguyen, Stéphane Rinfret
The experience with the transradial approach in percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) in the United States is limited. We looked at the safety and feasibility of a home-made sheathless transradial technique (STT) with regular 8Fr catheters in CTO PCI. In March 2013, we developed an 8Fr STT for CTO PCI. We compared 119 patients who had the STT versus 122 treated with a standard transradial or transfemoral approach. The primary outcomes of interest were major vascular or bleeding site access complications...
September 15, 2016: American Journal of Cardiology
Rustem Dautov, Can Manh Nguyen, Omar Altisent, Claire Gibrat, Stéphane Rinfret
BACKGROUND: The prevalence of native coronary chronic total occlusions (CTOs) after coronary artery bypass grafts (CABGs) is higher than in non-CABG population. We examined outcomes of CTO percutaneous coronary intervention (PCI) post-CABG versus without CABG. Then, we looked at feasibility and outcomes of retrograde CTO PCI via patent or occluded saphenous vein graft. METHODS AND RESULTS: We compared patient and procedural characteristics of 470 CTO cases treated from January 2010 to December 2015 depending on history of CABG...
July 2016: Circulation. Cardiovascular Interventions
Laurie J Lambert, James M Brophy, Normand Racine, Stéphane Rinfret, Philippe L L'Allier, Kevin A Brown, Lucy J Boothroyd, Dave Ross, Eli Segal, Simon Kouz, Sébastien Maire, Richard Harvey, Abbas Kezouh, James Nasmith, Peter Bogaty
BACKGROUND: Hospitals treating patients with ST-elevation myocardial infarction (STEMI) may show good results with reperfusion treatment (fibrinolysis or primary percutaneous coronary intervention [PPCI]), but a comprehensive evaluation should factor in outcomes of patients with STEMI who do not receive reperfusion. We compared outcomes of patients receiving and not receiving reperfusion within a complete system of STEMI care by hospital type: PPCI centres, fibrinolysis centres, centres that only transfer for PPCI, and centres providing a mix of fibrinolysis and PPCI transfer...
March 4, 2016: Canadian Journal of Cardiology
Rustem Dautov, Can M Nguyen, Stéphane Rinfret
The entry to the subadventitial space is not a mode of failure, but the road to success in many chronic total occlusion (CTO) percutaneous coronary intervention (PCI) cases. Long-term clinical outcomes of subadventitial stenting are favorable and similar to intraluminal stenting. However, the subadventitial space histology and physiology remains different to the coronary true intraluminal space. We report a complication specific to stenting of the subadventitial space, where overlapping stents dislocated from one another, which resulted in late non-occlusive stent thrombosis...
May 5, 2016: Catheterization and Cardiovascular Interventions
Adrien Harvey, Anil Modak, Ugo Déry, Mélanie Roy, Stéphane Rinfret, Olivier F Bertrand, Éric Larose, Josep Rodés-Cabau, Gérald Barbeau, Onil Gleeton, Can Manh Nguyen, Guy Proulx, Bernard Noël, Louis Roy, Jean-Michel Paradis, Robert De Larochellière, Jean-Pierre Déry
Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is used for the prevention of cardiovascular events following percutaneous coronary intervention (PCI). These agents increase the risk of gastrointestinal bleeding. To prevent these events, proton pump inhibitors (PPI) are routinely prescribed. It has been reported that with the exception of pantoprazole and dexlanzoprazole, PPIs can impede conversion of clopidogrel by cytochrome P450 2C19 (CYP2C19) to its active metabolite, a critical step required for clopidogrel efficacy...
January 27, 2016: Journal of Breath Research
Peter Bogaty, Philippe L L'Allier, Eli Segal, Stéphane Rinfret, Normand Racine, Richard Harvey, Dave Ross, Sébastien Maire, Simon Kouz, Céline Carroll, Lucy J Boothroyd, Abbas Kezouh, Leila Azzi, Kevin A Brown, James Nasmith, Laurie J Lambert
Patients with ST-elevation myocardial infarction (STEMI) who die in hospital before inpatient admission are generally not included in clinical studies and registries, and the clinical profiles of patients who die earlier versus later are not well defined. We aimed to characterize all patients with STEMI who arrived at emergency departments in the province of Quebec (Canada) based on inpatient admission status and when they died. All patients who presented with symptoms and core laboratory-confirmed STEMI or left bundle branch block during 6 months in 82 hospitals in Quebec were included...
February 1, 2016: American Journal of Cardiology
Bavana V Rangan, Anna Kotsia, George Christopoulos, James Spratt, Stephane Rinfret, Subhash Banerjee, Emmanouil S Brilakis
The "hybrid" approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to provide guidance on optimal crossing strategy selection. Dual angiography remains the cornerstone of clinical decision making in CTO PCI. Four angiographic parameters are assessed: (a) morphology of the proximal cap (clear-cut or ambiguous); (b) occlusion length; (c) distal vessel size and presence of bifurcations beyond the distal cap; and (d) location and suitability of location and suitability of a retrograde conduit (collateral channels or bypass grafts) for retrograde access...
September 9, 2015: Current Cardiology Reviews
Alfredo R Galassi, Emmanouil S Brilakis, Marouane Boukhris, Salvatore D Tomasello, Georgios Sianos, Dimitri Karmpaliotis, Carlo Di Mario, Bradley H Strauss, Stephane Rinfret, Masahisa Yamane, Osamu Katoh, Gerald S Werner, Nicolaus Reifart
Coronary chronic total occlusions (CTOs) are commonly encountered in patients undergoing coronary angiography. Several observational studies have demonstrated that successful CTO revascularization is associated with better cardiovascular outcomes and enhanced quality of life (QOL). However, in the absence of randomized trials, its prognostic benefit for patients remains debated. Over the past decade, the interest of the interventional community in CTO percutaneous coronary intervention (PCI) has exponentially grown due to important developments in dedicated equipment and techniques, resulting in high success and low complication rates...
September 14, 2016: European Heart Journal
Stéphane Rinfret, Suzanne J Baron, David J Cohen
No abstract text is available yet for this article.
June 16, 2015: Journal of the American College of Cardiology
Rustem Dautov, Omar Abdul Jawad Altisent, Stéphane Rinfret
When dealing with flush ostial chronic total occlusion (CTO) and no viable retrograde option, the only way to perform recanalization is through an antegrade approach. Such a procedure can be extremely difficult considering the ambiguity of the proximal cap. We demonstrate how we solved ambiguity of the proximal cap of an ostial obtuse marginal CTO with the help of cardiac multidetector computed tomography (MDCT). We also discuss several techniques including bilateral radial approach with home-made sheathless large-bore catheters, IVUS-guided cap puncture, ping-pong guide catheters engagement in the left main, and bioresorbable vascular scaffold (BVS) for an ostial left circumflex disease that we all used in our CTO case...
November 15, 2015: Catheterization and Cardiovascular Interventions
Georgios E Christakopoulos, Georgios Christopoulos, Mauro Carlino, Omar M Jeroudi, Michele Roesle, Bavana V Rangan, Shuaib Abdullah, Jerrold Grodin, Dharam J Kumbhani, Minh Vo, Michael Luna, Khaldoon Alaswad, Dimitri Karmpaliotis, Stephane Rinfret, Santiago Garcia, Subhash Banerjee, Emmanouil S Brilakis
Successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been associated with clinical benefit. There are no randomized controlled trials on long-term clinical outcomes after CTO PCI, limiting the available evidence to observational cohort studies. We sought to perform a weighted meta-analysis of the long-term outcomes of successful versus failed CTO PCI. A total of 25 studies, published from 1990 to 2014, with 28,486 patients (29,315 CTO PCI procedures) were included. We analyzed data on mortality, subsequent coronary artery bypass grafting (CABG), myocardial infarction, major adverse cardiac events, angina pectoris, stroke, and target vessel revascularization using random-effects models...
May 15, 2015: American Journal of Cardiology
Stéphane Rinfret, Brian J Potter
No abstract text is available yet for this article.
March 2015: Canadian Journal of Cardiology
Renée Atallah, Kristian B Filion, Susan M Wakil, Jacques Genest, Lawrence Joseph, Paul Poirier, Stéphane Rinfret, Ernesto L Schiffrin, Mark J Eisenberg
BACKGROUND: We conducted a systematic review to examine the efficacy of the Atkins, South Beach, Weight Watchers (WW), and Zone diets, with a particular focus on sustained weight loss at ≥12 months. METHODS AND RESULTS: We systematically searched MEDLINE, EMBASE, and the Cochrane Library of Clinical Trials to identify randomized controlled trials (RCTs) published in English with follow-up ≥4 weeks that examined the effects of these 4 popular diets on weight loss and cardiovascular risk factors...
November 2014: Circulation. Cardiovascular Quality and Outcomes
Mauro Carlino, Caroline J Magri, Barry F Uretsky, Emmanouil S Brilakis, Simon Walsh, James C Spratt, Colm Hanratty, J Aaron Grantham, Stéphane Rinfret, Craig A Thompson, William L Lombardi, Alfredo R Galassi, George Sianos, Azeem Latib, Roberto Garbo, Dimitri Karmpaliotis, David E Kandzari, Antonio Colombo
There is substantial evidence that recanalization of a chronic total occlusion is beneficial; nonetheless, it is generally underutilized in clinical practice. We consider the Aesop's fable of the "Fox and the Grapes" as analogous to the current situation in interventional cardiology. The technical challenges in achieving CTO recanalization has led interventionalists, clinical cardiologists, and sometimes even patients to believe that CTO recanalization is not effective, and, therefore, not needed. This perspective reviews available data regarding efficacy and safety of CTO percutaneous coronary intervention (PCI) in the current drug-eluting stent era, discusses areas where more studies are required, and encourages the interventional community to utilize CTO PCI where appropriate based on current evidence...
April 2015: Catheterization and Cardiovascular Interventions
Stéphane Rinfret, Henrique Barbosa Ribeiro, Can Manh Nguyen, Luis Nombela-Franco, Marina Ureña, Josep Rodés-Cabau
New techniques involving dissection of the subintimal space and re-entry into the true lumen increase success rates in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, their long-term safety and efficacy were unknown. This study included a series of consecutive patients who underwent CTO PCI. All patients who did not present events were contacted 12 to 18 months after their PCI. The combined incidence of cardiac death, myocardial infarction, ischemia-driven target-vessel revascularization (TVR), or reocclusion was assessed as our primary outcome...
November 1, 2014: American Journal of Cardiology
Kevin A Brown, Laurie J Lambert, James M Brophy, James Nasmith, Stéphane Rinfret, Eli Segal, Simon Kouz, Dave Ross, Richard Harvey, Sébastien Maire, Lucy J Boothroyd, Peter Bogaty
BACKGROUND: Many patients with ST-elevation myocardial infarction (STEMI) do not receive reperfusion therapy and are known to have poorer outcomes. We aimed to perform the first population-level, integrated analysis of clinical, ECG and hospital characteristics associated with non-receipt of reperfusion therapy in patients with STEMI. METHODS AND RESULTS: This systematic evaluation of STEMI care in 82 hospitals in Quebec included all patients with a discharge diagnosis of myocardial infarction, presenting with characteristic symptoms and an ECG showing STEMI as attested by at least one of two study cardiologists or left bundle branch block (LBBB)...
2014: PloS One
Stéphane Rinfret, Dominique Joyal, James C Spratt, Christopher E Buller
Coronary chronic total occlusions (CTO) remain a difficult lesion subset to treat. Although CTOs are present at coronary angiography in 15-20% of patients, only a small fraction of eligible patients will be offered percutaneous treatment. Recent publications from centers with dedicated CTO programs using the full range of antegrade and retrograde techniques suggest success rates in the range of 90% even when little anatomic exclusion are used. However, many patients with clinically appropriate CTO targets have simpler anatomy that can predictably be managed without the selected skills and equipment...
February 15, 2015: Catheterization and Cardiovascular Interventions
Laurie J Lambert, Kevin A Brown, Lucy J Boothroyd, Eli Segal, Sébastien Maire, Simon Kouz, Dave Ross, Richard Harvey, Stéphane Rinfret, Yongling Xiao, James Nasmith, Peter Bogaty
BACKGROUND: Interhospital transfer of patients with ST-elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PPCI) is associated with longer delays to reperfusion, related in part to turnaround ("door in" to "door out," or DIDO) time at the initial hospital. As part of a systematic, province-wide evaluation of STEMI care, we examined DIDO times and associations with patient, hospital, and process-of-care factors. METHODS AND RESULTS: We performed medical chart review for STEMI patients transferred for PPCI during a 6-month period (October 1, 2008, through March 31, 2009) and linked these data to ambulance service databases...
June 24, 2014: Circulation
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