scholarly journals Development and first results of a dedicated chronic total occlusion programme

2019 ◽  
Vol 29 (1) ◽  
pp. 14-21 ◽  
Author(s):  
H. W. van der Werf ◽  
P. J. Vlaar ◽  
P. van der Harst ◽  
E. Lipšic
Keyword(s):  
Chronic Total Occlusion ◽  
High Volume ◽  
Coronary Intervention ◽  
Technical Success ◽  
Total Occlusion ◽  
Technical Success Rate ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
First Results ◽  
Hospital Deaths

Abstract Objective To describe the development and first results of a dedicated chronic total occlusion (CTO) programme in a tertiary medical centre. Background Because of the complexity and the increased risk of complications during percutaneous coronary intervention (PCI) for CTO, it is essential that less experienced and evolving CTO centres perform regular quality analyses. Methods We therefore performed analyses to describe the results during the first 3 years of a dedicated CTO programme at a high-volume PCI centre. In addition, we discuss the strategies employed to develop such a programme. Results A total of 179 consecutive patients undergoing 187 CTO procedures were included in the study. The complexity of the CTO lesions increased from a mean J‑CTO (Japanese Multicentre CTO Registry) score of 1.3 in 2015 to 2.1 in 2017. In the majority of cases, the antegrade wire escalation technique was performed. Final technical success rate was 78.5% in 175 patients with a single CTO and 80.2% of all 187 CTO procedures. No peri-procedural or in-hospital deaths occurred. One peri-procedural myocardial infarction occurred. Cardiac tamponade occurred in 2 cases, both managed by pericardiocentesis. No urgent cardiac surgery was necessary. Survival and revascularisation rates at 30 days and 1 year were excellent. Conclusion Following initiation of a dedicated CTO programme, using up-to-date techniques and strategies, procedural and clinical outcome were comparable with current standards in established centres.

scholarly journals Angiographic Characteristics and Outcomes of Percutaneous Coronary Intervention of Reattempted Chronic Total Occlusion: Potential Contributing Factors to Procedural Success

2021 ◽  
Vol 10 (23) ◽  
pp. 5661
Author(s):  
Mohsen Mohandes ◽  
Cristina Moreno ◽  
Mónica Fuertes ◽  
Sergio Rojas ◽  
Alberto Pernigotti ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Success Rate ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Technical Success ◽  
Contributing Factors ◽  
Total Occlusion ◽  
Entire Cohort ◽  
Technical Success Rate ◽  
Percutaneous Coronary

This study aimed to analyze angiographic characteristics of new attempted percutaneous coronary intervention (PCI) on chronic total occlusion (CTO) compared to first attempt group. The cohort of 527 CTO-PCIs was divided into first-attempt and re-attempt groups, and angiographic characteristics, level of complexity, and contributing factors to failure were analyzed. Between-group success rate difference and potential angiographic and technical aspects contributing to the success in new attempts were scrutinized. A total of 47 new PCIs in 39 patients were performed. The reattempt group showed higher J-CTO score compared to the first-attempt group (2.4 ± 1.06 vs. 1.2 ± 1.06; p < 0.001). The use of more complex techniques and devices such as retrograde approach (29.8% vs. 12.9%) and IVUS (48.9 vs. 27.3%; p: 0.002) were more frequent in the reattempt group. Both procedural and fluoroscopy time were higher in the reattempt group (197 ± 83.9 vs. 150.1 ± 72.3 and 97.7 ± 55.4 vs. 68.7 ± 43, respectively; p < 0.001). There was no between-group difference in terms of technical success (79.8 vs. 76.6% for first attempt vs. reattempt group, respectively; p: 0.6). The overall success rate increased by 6.1%, achieving 85.9% in the entire cohort. Reattempted CTO-PCIs required more complex techniques and had comparable technical success rate with regard to the first-attempt group.

scholarly journals Predicting the success rate of elective percutaneous coronary intervention for prior failure chronic total occlusion: a novel scoring

2021 ◽  
Author(s):  
Wenzheng Li ◽  
Zheng Wu ◽  
Hongyu Peng ◽  
Donghui Zhao ◽  
Yejing Zhao ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Logistic Regression ◽  
Success Rate ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Technical Success ◽  
Multivariate Logistic Regression ◽  
Total Occlusion ◽  
Technical Success Rate ◽  
Percutaneous Coronary

Abstract Background: There is limited data on percutaneous coronary intervention for chronic total occlusion (CTO) with previous failed attempt. The objective of this study is to investigate a risk score for prediction of successful percutaneous coronary intervention for prior failure CTO. Methods: Patients with previous attempt were enrolled in our study retrospectively from Jan. of 2016 to Dec. of 2019. All clinical and procedural data was collected and analyzed. Univariate and multivariate logistic regression was performed to investigate the predictors of technical success. Results: A total of 194 patients/CTO lesions were studied. The technical success rate was 66.0%. The multivariate logistic regression showed that occlusion length <20mm (OR= 2.94, 95% CI= 1.36±6.37, score= 1), non-calcification (OR= 2.93, 95% CI= 1.36±6.30, score=1), adequate distal landing zone (OR= 4.46, 95% CI= 2.06±9.66, score=1), Rentrop grade ≥2 (OR= 5.98, CI= 2.46±14.51, score =1), and retrograde approach as initial strategy (OR= 10.28, 95% CI= 3.58±29.50, score =2) was the predictor of re-attempt success of PCI. The technical success rate for a score from 0 to ≥4 was 0%, 17.9%, 46.2%, 77.8%, 93.3% respectively. The area under the receiver operating characteristic curve for the five predictors and integers was 0.837 and 0.832 respectively. Conclusions: The technical success rate for CTO PCI with previous failure was acceptable. Our score system can be used to predict the success rate of re-attempt CTO PCI.

scholarly journals Complications of chronic total occlusion percutaneous coronary intervention

2020 ◽  
Vol 29 (1) ◽  
pp. 60-67 ◽  
Author(s):  
J. Karacsonyi ◽  
E. Vemmou ◽  
I. D. Nikolakopoulos ◽  
I. Ungi ◽  
B. V. Rangan ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Patient Monitoring ◽  
Coronary Intervention ◽  
Percutaneous Coronary Interventions ◽  
Total Occlusion ◽  
Prompt Treatment ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Vessel Closure

AbstractChronic total occlusion percutaneous coronary interventions can be highly complex and are associated with an increased risk of complications, such as perforation, acute vessel closure (which can lead to rapid haemodynamic compromise if it involves the donor vessel), and equipment loss or entrapment. Awareness of the potential complications and meticulous attention to equipment position and patient monitoring can help minimise the risk of complications and allow prompt treatment should they occur.

scholarly journals Prognostic Impact of Percutaneous Coronary Intervention of Chronic Total Occlusion in Acute and Periprocedural Myocardial Infarction

2021 ◽  
Vol 10 (2) ◽  
pp. 258
Author(s):  
Seung-Hyun Kim ◽  
Michael Behnes ◽  
Kambis Mashayekhi ◽  
Alexander Bufe ◽  
Markus Meyer-Gessner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Prognostic Impact ◽  
Total Occlusion ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Periprocedural Myocardial Infarction

Coronary chronic total occlusion (CTO) has gained increasing clinical attention as the most advanced form of coronary artery disease. Prior studies already indicated a clear association of CTO with adverse clinical outcomes, especially in patients with acute myocardial infarction (AMI) and concomitant CTO of the non-infarct-related coronary artery (non-IRA). Nevertheless, the prognostic impact of percutaneous coronary intervention (PCI) of CTO in the acute setting during AMI is still controversial. Due to the complexity of the CTO lesion, CTO-PCI leads to an increased risk of complications compared to non-occlusive coronary lesions. Therefore, this review outlines the prognostic impact of CTO-PCI in patients with AMI. In addition, the prognostic impact of periprocedural myocardial infarction caused by CTO-PCI will be discussed.

scholarly journals Percutaneous Coronary Intervention to Treat Chronic Total Occlusion: Predictors of Technical Success and One-Year Clinical Outcome

2014 ◽  
Vol 41 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Mojtaba Salarifar ◽  
Mohammad-Reza Mousavi ◽  
Sepideh Saroukhani ◽  
Ebrahim Nematipour ◽  
Seyed Ebrahim Kassaian ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Clinical Outcome ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Technical Failure ◽  
Technical Success ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Procedural Success ◽  
One Year

We investigated the overall success rate of percutaneous coronary intervention (PCI) as a treatment for coronary chronic total occlusion and sought to determine the predictive factors of technical success and of one-year major adverse cardiac events (MACE). These factors have not been conclusively defined. Using data from our single-center PCI registry, we enrolled 269 consecutive patients (mean age, 56.13 ± 10.72 yr; 66.2% men) who underwent first-time PCI for chronic total occlusion (duration, ≥3 mo) from March 2006 through September 2010. We divided them into 2 groups: procedural success and procedural failure. We compared occurrences of in-hospital sequelae and one-year MACE between the groups, using multivariate models to determine predictors of technical failure and one-year clinical outcome. Successful revascularization was achieved in 221 patients (82.2%). One-year MACE occurred in 13 patients (4.8%), with a predominance of target-vessel revascularization (3.7%). The prevalence of MACE was significantly lower in the procedural-success group (1.8% vs 18.8%; P &lt;0.001). In the multivariate model, technical failure was the only predictor of one-year MACE. The predictors of failed procedures were lesion location, multivessel disease, the occurrence of dissection, a Thrombolysis In Myocardial Infarction flow grade of 0 before PCI, the absence of tapered-stump arterial structure, and an increase in serum creatinine level or lesion length. In our retrospective, observational study, PCI was successful in a high percentage of chronic total occlusion patients and had a low prevalence of complications. This suggests its safety and effectiveness as a therapeutic option.

scholarly journals Nomogram to Predict Successful Septal Collateral Crossing during Percutaneous Coronary Intervention of Chronic Total Occlusion by retrograde approach: The Sep-CTO score

2021 ◽  
Author(s):  
Tong Liu ◽  
Yuchao Zhan ◽  
Zheng Wu ◽  
Yun Lv ◽  
Wenzheng Li ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Success Rate ◽  
Chronic Total Occlusion ◽  
Multivariate Logistic Regression Analysis ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Clinical Tool ◽  
Total Occlusion ◽  
Technical Success Rate ◽  
Percutaneous Coronary

Abstract Septal collaterals are the main collaterals used in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, there is little evidence regarding the selection of an interventional septal collateral (SC). we aimed to identify the predictors of successful guidewire crossing using clinical and anatomical characteristics. Overall, 216 derivation cases and 86 validation cases that included retrograde CTO PCI were analyzed. The technical success rate was 79.1% and there were no significant differences in the Gensini score, SYNTAX score, J-CTO score and Progress Score between two groups. Multivariate logistic regression analysis revealed that diabetes, small size, corkscrew, and side branch at tortuosity were independent factors of success in crossing SCs. We developed a nomogram to predict the success rate, which demonstrates favorable calibration and formed the Sep-CTO score. The calibration and decision curve analysis also demonstrated the reliability and accuracy of this clinical prediction model. The receiver-operating characteristic area of the nomogram was 0.870. Compared to the aforementioned scoring systems, Sep-CTO score was the most powerful. The nomogram may be a useful clinical tool. We found four independent variables to predict the successful guidewire crossing in septal collaterals.

scholarly journals Application of the Hybrid Approach to Chronic Total Coronary Occlusion Percutaneous Coronary Intervention

2019 ◽  
Author(s):  
Péter Tajti
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Success Rate ◽  
Chronic Total Occlusion ◽  
Hybrid Approach ◽  
Coronary Intervention ◽  
Complication Rates ◽  
Total Occlusion ◽  
Technical Success Rate ◽  
Percutaneous Coronary ◽  
Chronic Total Coronary Occlusion

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) continues to evolve constantly with developing equipment and techniques. The hybrid approach to CTO PCI advocates dual coronary injection, careful and structured review of the angiogram, and flexibility. Use of all crossing strategies [antegrade wire escalation, antegrade dissection re-entry and retrograde approach] is encouraged, with initial and subsequent choices influenced by the CTO anatomic characteristics and the outcomes of the originally selected approach. Application of the hybrid approach to CTO PCI has been associated with good outcomes in US and European registries, although CTO PCI outcomes in non-selected populations have been less optimal with approximately 60% success rate. We analyzed the clinical, angiographic, and procedural characteristics of 3,122 CTO PCIs performed in 3,055 patients to determine the techniques and outcomes of hybrid CTO PCI in a diverse group of patients and operators in two continents (at eighteen US, one European, and one Russian centers ) enrolled in the PROGRESS-CTO (PROspective Global REgiStry for the Study of Chronic Total Occlusion Intervention, NCT02061436) registry between January 2012 and November 2017. Technical success rate was 87% and the risk for in-hospital major complications was 3%, providing important benchmarks to use when discussing with patients and providers the risk/benefit ratio of CTO PCI. The final successful crossing strategy was antegrade wire escalation in 52%, retrograde in 27%, and antegrade dissection reentry in 21%; more than 1 crossing strategies were required in 41% of the cases. CTO PCI is currently being performed with high success and acceptable complication rates among various experienced centers in the US and Europe. Bridging the gap between what is currently achieved and what can be achieved in chronic total occlusion intervention should be a major focus of upcoming research and education efforts.

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