scholarly journals Japanese multicenter registry evaluating the antegrade dissection reentry with cardiac computerized tomography for chronic coronary total occlusion

2021 ◽  
Author(s):  
Maoto Habara ◽  
◽  
Etsuo Tsuchikane ◽  
Kazuki Shimizu ◽  
Yoshifumi Kashima ◽  
...  
Keyword(s):  
Success Rate ◽  
Cardiac Computed Tomography ◽  
Coronary Intervention ◽  
Technical Failure ◽  
Technical Success ◽  
Conventional Angiography ◽  
Total Occlusion ◽  
Cardiac Computed Tomography Angiography ◽  
Technical Success Rate ◽  
Ct Evaluation

AbstractRecently, antegrade dissection re-entry (ADR) with re-entry device for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has evolved to become one of the pillar techniques of the hybrid algorithm. Although the success rate of the device is high, it could be improved. We sought to evaluate the current trends and issues associated with ADR in Japan and evaluate the potential of cardiac computed tomography angiography (CCTA) for ADR procedure. A total 48 patients with CTO suitable for ADR evaluated by baseline conventional angiography and CCTA were enrolled. Procedural success and technical success were evaluated as the primary and secondary observations. Furthermore, all puncture points were analyzed by CCTA. CT score at each punctured site depended on the location of plaque deposition (none; + 0, at isolated myocardial site; + 1, at epicardial site; + 2) and the presence of calcification (none; + 0, presence; + 1) was analyzed and calculated (score 0–3). Overall procedure success rate was 95.8%. Thirty-two cases were attempted with the ADR procedure and 25 cases of them were successful. The technical success rate was 78.1% and myocardial infarction or other major complications were not observed in any cases. CT score at 60 puncture sites in 32 cases were analyzed and the score at technical success points was significantly smaller compared to that at technical failure points (0.68 ± 1.09 vs 1.77 ± 1.09, p < 0.0001). CTO-PCI with Stingray device in Japan could achieve a high procedure success and technical success rate. Pre procedure cardiac CT evaluation might support ADR procedure for appropriate patient selection or puncture site selection.

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.

Japanese multicenter registry evaluating the antegrade dissection reentry with cardiac computed tomography for chronic coronary total occlusion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Habara ◽  
E Tsuchikane ◽  
K Shimizu ◽  
T Kawasaki
Keyword(s):  
Computed Tomography ◽  
Success Rate ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
Coronary Intervention ◽  
Puncture Site ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Failure Point ◽  
Procedural Success

Abstract Objective This study was performed to evaluate the efficacy of cardiac computed tomography (CT) for antegrade dissection re-entry (ADR) technique in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background Although PCI of CTO is a rapidly evolving field, procedure success rate remains suboptimal. Recently, ADR with Stingray device for CTO-PCI has also evolved to one of the pillar technique of the hybrid algorithm. Although the success rate of the device could be improved, it also remains not always high especially as first crossing strategy. Methods Forty eight patients with total occlusion suitable for revascularization evaluated by baseline coronary angiography and cardiac CT were enrolled in this study from April 2017 to April 2019 from 30 enrolled centers. The primary observation was procedural success. Furthermore, all puncture point with Stingray were analyzed by cardiac CT. In each point, 1) plaques on the isolated myocardial side at distal puncture site (+1 point), 2) any plaques excluded above definition at distal puncture site (+2 points), 3) calcification on both 1 and 2 at distal puncture site (+1 point) were analyzed and calculated the score (Score 0–3) (Figure 1). Results Overall procedure success rate was 95.8% (46/48) and antegrade success rate was 91.3% (42/46). Sixteen cases were succeeded with single guidewire escalation and 32 cases were attempted ADR with Stingray system. Within them, 25 cases were succeeded and 7 cases were observed puncture failure. And 3cases were succeeded with IVUS guide and 2 cases were with retrograde appTechnical success rate with stingray was 78.1% (25/32). Cardiac CT was analyzed 60 puncture sites in 32 cases which were attempted ADR with stingray system (1.88 sites/case). CT score at ADR success point was significantly smaller compare to that at ADR failure point (0.68±1.09 vs 1.77±1.09, p&lt;0.0001). Conclusions Pre procedure Cardiac CT and CT score might be useful for ADR technique in CTO PCI not only for case selection but also for puncture site selection. Figure 1 Funding Acknowledgement Type of funding source: None

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.

Extravascular Recanalization of Chronic Total Occlusions

2018 ◽  
Author(s):  
S. Lowell Kahn
Keyword(s):  
Lower Extremity ◽  
Success Rate ◽  
Technical Failure ◽  
Technical Success ◽  
Contrast Injection ◽  
True Lumen ◽  
Chronic Total Occlusions ◽  
Technical Success Rate ◽  
The Wire

Subintimal revascularization is a mainstay of therapy for lower extremity interventions. This stems from the realization that true lumen traversal is not always possible, subintimal revascularization has a high technical success rate, and the subintimal space may confer advantages over a heavily calcified true lumen. Most commonly in the tibial vasculature, there are times when subintimal recanalization is not possible because the wire and catheter may leave the subintimal plane and enter the periadventitial tissue. Although this is not intentional, exit from the vessel historically results in a technical failure because future passes of the wire and catheter are likely to follow suit, as evidenced by extravasation on contrast injection. This chapter describes two techniques to salvage this scenario and accept an extravascular tract for revascularization: the Outback® extravascular revascularization technique and the percutaneous gun-sight extravascular revascularization technique.

scholarly journals Tibiopedal and distal femoral retrograde vascular access for challenging chronic total occlusions: predictors for technical success, and complication rates in a large single-center cohort

2020 ◽  
Vol 31 (1) ◽  
pp. 535-542
Author(s):  
Gerd Grözinger ◽  
Jan Hallecker ◽  
Ulrich Grosse ◽  
Roland Syha ◽  
Dominik Ketelsen ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Success Rate ◽  
Vascular Access ◽  
Chronic Total Occlusion ◽  
Lesion Length ◽  
Complication Rates ◽  
Technical Success ◽  
Total Occlusion ◽  
Femoral Access ◽  
Technical Success Rate

Abstract Objective To evaluate the safety and effectiveness of tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion (CTO) in Rutherford stage III to VI peripheral arterial occlusive disease, and to determine factors that correlate with technical success. Material and methods One hundred seventy-one consecutive patients were included in this retrospective study. Rutherford stages were III, IV, and V/VI in 24%, 8%, and 67% of patients. Inclusion criteria were CTO at the superficial femoral (SFA), popliteal (PA), and/or below-the-knee (BTK) level, and a failed antegrade treatment followed by a distal retrograde approach. The numbers of occluded vascular levels (OVL), lesion length, degree of calcification, technical success rate, complications, and clinical outcome were noted. Results OVL were 1 in 72%, 2 in 20%, and 3 in 8% of patients. CTOs were longer than 20 cm in 45.6% of cases and showed severe calcifications in 50.3%. Target vessels for distal access were the distal SFA/PA in 17% and BTK in 83%. The overall technical success rate was 82%. Severe calcification decreased technical success (p = 0.01) despite lesion length and Rutherford stage. Clinical outcome improved in 123/152 patients with a significant increase of the median ABI (N = 158) from 0.53 (interquartile range 0.39 to 0.61) to 0.85 (0.59 to 1.03; p < 0.001). Complications were reported in 7.6% cases with 2.3% related to the distal vascular access. Conclusion The tibiopedal and distal femoral retrograde access presents a safe and effective treatment option of CTOs at the thigh and/or BTK after a failed antegrade attempt improving clinical outcome. Technical success decreased with lesion’s degree of calcification. Key Points • Safety and effectiveness of the tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion. • Target lesion’s degree of calcification decreases technical success. • Complications related to the distal vascular access were rare.

scholarly journals Trans-Scapular Approach Coil Localization for Scapular-Blocked Pulmonary Nodules: A Retrospective Study

2020 ◽  
Author(s):  
Juan Wu ◽  
Min-Ge Zhang ◽  
Jin Chen ◽  
Wen-Bin Ji
Keyword(s):  
Success Rate ◽  
Thoracoscopic Surgery ◽  
Pulmonary Nodules ◽  
Adenocarcinoma In Situ ◽  
Technical Failure ◽  
Technical Success ◽  
Ct Guided ◽  
Technical Success Rate ◽  
Preoperative Ct ◽  
The Mean

Abstract Background: Preoperative computed tomography (CT)-guided coil localization (CL) is commonly employed to facilitate the video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection (WR) of pulmonary nodules (PNs). When a scapular-blocked PN (SBPN) will be localized, the trans-scapular CL (TSCL) should be performed. In this study, we investigated the safety, feasibility, and clinical efficacy of preoperative CT-guided TSCL for SBPNs.Materials and Methods: From January 2014 to September 2020, a total of 152 patients with PNs underwent CT-guided CL prior to VATS-guided WR. Among them, 14 patients had the SBPNs and underwent TSCL procedure. Results: A total of 14 SBPNs were localized in the 14 patients. The mean diameter of the 14 SBPNs was 7.4 ± 2.4 mm. Technical success rate of puncture of the scapula was 100%. No complications occurred near the scapula. Technical success rate of CL was 92.9%. One coil dropped off when performing the VATS procedure. The mean duration of the TSCL was 14.2 ± 2.7 min. Two patient (14.3%) developed aysmptomatic pneumothorax after TSCL. Technical success rate of VATS-guided WR was 92.9%. The patient who experienced technical failure of TSCL directly underwent lobectomy. The mean VATS procedure duration and blood loss were 90.0 ± 42.4 min and 62.9 ± 37.2 ml, respectively. The final diagnoses of the 14 SBPNs included invasive adenocarcinoma (n = 4), adenocarcinoma in situ (n = 9), and benign (n = 1).Conclusions: Preoperative CT-guided TSCL can be safely and simply used to facilitate high successful rates of VATS-guided WR of SBPNs.

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.

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