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By Roman Ondrejcak Interest : interventional cardiology and echocardiography
Jeong Hoon Yang, Bum Sung Kim, Woo Jin Jang, Joonghyun Ahn, Taek Kyu Park, Young Bin Song, Joo-Yong Hahn, Jin-Ho Choi, Sang Hoon Lee, Hyeon-Cheol Gwon, Seung-Hyuk Choi
BACKGROUND: Limited data are available on the long-term clinical outcomes of coronary chronic total occlusion (CTO) patients who receive optimal medical therapy (OMT) compared with percutaneous coronary intervention (PCI). METHODS AND RESULTS: Between March 2003 and February 2012, 2,024 patients with CTO were enrolled in a single-center registry. Among this patient group, we excluded CTO patients who underwent coronary artery bypass grafting and classified patients into the OMT group (n=664) or PCI group (n=883) according to initial treatment strategy...
2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Hui-Ping Zhang, Ying Zhao, Hui Li, Guo-Dong Tang, Hu Ai, Nai-Xin Zheng, Jing-Hua Liu, Fu-Cheng Sun
In the setting of primary percutaneous coronary intervention (PCI), encountering with chronic total occlusion (CTO) in a noninfarct-related artery (IRA) is not a rare situation. Limited information on the impact of CTO on clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI has raised more concerns. The aim of the present study was to evaluate the effect of concurrent CTO in a non-IRA on the clinical outcomes in patients with STEMI undergoing primary PCI.In the present prospective study, 555 consecutive patients with STEMI who underwent early primary PCI from January 2010 to December 2013 were included...
January 2016: Medicine (Baltimore)
Annemiek M J de Vos, Rene J van der Schaaf
We present the case of an 82-year-old woman undergoing high-risk chronic total occlusion percutaneous coronary intervention (CTO-PCI) of the right coronary artery. Hours after the procedure, a subepicardial haematoma was diagnosed as a result of coronary perforation during the procedure. This rare and potentially lethal complication evolved exceptionally benignly after conservative management; our patient fully recovered. Increasingly complex procedures in high-risk patient categories warrant awareness of procedural complications, especially those that are subtle and appear relatively late, and are therefore most hazardous...
2014: BMJ Case Reports
Beny Hartono, Sasmojo Widito, Muhammad Munawar
Coronary artery perforation (CAP) after percutaneous coronary intervention is a rare, but potentially life-threatening complication. The source of the bleeding is usually from one of the coronary arteries. In the era of chronic total occlusion technique, retrograde approach strategy sometimes is performed using collateral channels. When CAP occurs distal from the collateral channel, the source of bleeding can be from dual arteries, i.e., main and contra-lateral artery. Therefore, management of this bleeding should be intended to close the channel from both the arteries...
October 2015: Cardiovascular Intervention and Therapeutics
Christian-Hendrik Heeger, Andreas Busjahn, Laura Hildebrand, Maximillian Fenski, Felix Lesche, Felix Meincke, Karl-Heinz Kuck, Martin Walter Bergmann
AIMS: Following percutaneous coronary interventions (PCI) for revascularisation of chronic total occlusions (CTO) patients are at increased risk for stent thrombosis (ST). Delayed drug-eluting stent (DES) coverage has previously been shown to be related to ST. Using optical coherence tomography (OCT), we tested the hypothesis that CTO-PCI is associated with delayed DES coverage compared to non-CTO lesions. METHODS AND RESULTS: From 06/2010 to 11/2013, 105 patients (111 lesions) with clinically driven follow-up angiography after PCI with DES received an OCT analysis...
January 22, 2016: EuroIntervention
Salvatore Davide Tomasello, Pietro Giudice, Tiziana Attisano, Marouane Boukhris, Alfredo R Galassi
The treatment of coronary chronic total occlusions (CTO) continues to solicit technical innovations. As success primarily depends on crossing the lesion with a wire, all aspects regarding tip shape retention, torque precision, and penetration ability of the guide-wire have greatly influenced new techniques and strategies. The world of interventional cardiology has to look carefully at these developments, and to use them accordingly to improve the success rate in ordinary percutaneous coronary interventions...
October 2014: Journal of the Saudi Heart Association
Minh N Vo, Amir Ravandi, J Aaron Grantham
Novel techniques for percutaneous revascularization of chronic total occlusions or other complex coronary lesions utilize the subintimal space to safely and efficiently traverse the occluded coronary segment. Antegrade and retrograde dissection reentry is gaining popularity, and is an elegant method to successfully cross coronary chronic total occlusions. We describe a "subintimal space plaque modification" that involves use of antegrade and retrograde dissection reentry techniques to treat "balloon-uncrossable" coronary lesions...
October 2014: Journal of Invasive Cardiology
James Sapontis, J Aaron Grantham, Steven P Marso
Technical advances and the development of the Hybrid algorithm have been associated with higher success rates in chronic total occlusion percutaneous coronary intervention (CTO-PCI). Nevertheless, there are still intraprocedural obstacles that result in failure or prolonged procedure time. The Excimer coronary laser (EL) has been repurposed in CTO-PCI to overcome such obstacles. This case series illustrates the use of the EL in four technically complex scenarios including the balloon resistant lesion, the impenetrable proximal cap, device resistance in stent restenosis, and difficulty with device tracking in the subintima...
February 15, 2015: Catheterization and Cardiovascular Interventions
Alfredo Bardají, Judit Rodriguez-López, Mauricio Torres-Sánchez
Over the last two decades, there has been increasing interest in new techniques for the percutaneous treatment of coronary chronic total occlusions (CTO), which have a success rate that is much higher than that of a few years ago. The rise in percutaneous treatment for these lesions is due to its ability to improve the symptoms and prognosis of patients in the chronic and stable phase of coronary disease. Current data suggest that successful percutaneous coronary intervention for CTO is associated with improvement in patient symptoms, quality of life, left ventricular function, and survival, compared with those with unsuccessful CTO PCI...
July 26, 2014: World Journal of Cardiology
Viswanatha Lanka, Vishal G Patel, Bilal Saeed, Anna Kotsia, George Christopoulos, Bavana V Rangan, Atif Mohammad, Michael Luna, Santiago Garcia, Shuaib M Abdullah, Jerrold Grodin, Jeffrey L Hastings, Subhash Banerjee, Emmanouil S Brilakis
OBJECTIVE: The objective of the present study was to perform a systematic review and meta-analysis of studies reporting outcomes after first- and second-generation drug-eluting stent (DES) implantation in chronic total occlusions (CTOs). BACKGROUND: The effect of second- vs first-generation DESs on the outcomes after CTO percutaneous coronary intervention (PCI) has received limited study. METHODS: As of May 2013, thirty-one published studies reported outcomes after DES implantation in CTOs: thirteen uncontrolled studies (3161 patients), three randomized (220 patients) and ten non-randomized (2150 patients) comparative studies with bare-metal stents (BMSs), and two non-randomized (685 patients) and three randomized (489 patients) comparative studies between first- and second-generation DESs...
July 2014: Journal of Invasive Cardiology
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