scholarly journals Successful recanalization of chronic total occlusion using retrograde approach in a patient with acute coronary syndrome due to aortosaphenous vein graft occlusion

2010 ◽  
Vol 1 (2) ◽  
pp. e112-e115 ◽  
Author(s):  
Yusuke Takagi ◽  
Masafumi Sugi ◽  
Kenichiro Hanawa ◽  
Hiroaki Shimokawa
Keyword(s):  
Acute Coronary Syndrome ◽  
Vein Graft ◽  
Chronic Total Occlusion ◽  
Graft Occlusion ◽  
Retrograde Approach ◽  
Total Occlusion ◽  
Coronary Syndrome

Canadian Multicenter Chronic Total Occlusion Registry: Ten-Year Follow-Up Results of Chronic Total Occlusion Revascularization

2021 ◽  
Vol 14 (12) ◽  
Author(s):  
Bradley H. Strauss ◽  
Merril L. Knudtson ◽  
Asim N. Cheema ◽  
P. Diane Galbraith ◽  
Gabby Elbaz-Greener ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chronic Total Occlusion ◽  
Artery Bypass ◽  
Hazard Ratio ◽  
Lower Mortality ◽  
Time Varying ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Coronary Syndrome ◽  
All Cause Mortality

Background: Chronic total occlusions (CTO) occur in nearly 20% of coronary angiograms. CTO revascularization, either by percutaneous coronary intervention (PCI) or coronary artery bypass grafting surgery (CABG), is infrequently performed, approximately one-third of cases. Long-term outcomes are unknown. The objective of the study was to determine whether early CTO revascularization of patients, either by CABG or PCI, was associated with improved clinical outcomes. Methods: One thousand six hundred twenty-four patients from the Canadian CTO registry were followed for at least 9.75 years. Revascularization was performed according to routine clinical practice. Patients were grouped according to CTO revascularization status (PCI or CABG of CTO vessel, CTO revasc) or no CTO revasc (medical therapy only, or PCI/CABG of non-CTO vessels only), within 3 months of initial angiogram. Patients were followed for mortality, revascularization procedures (PCI and CABG), and hospitalizations for acute coronary syndromes and heart failure. Results: Early CTO revasc was performed in 28.2% of patients (17.5% CABG, 10.7% PCI). The CTO revasc group was younger, with more males and generally fewer comorbidities. There was a significantly lower mortality probability at 10 years in the CTO revascularization group (22.7% [95% CI, 19.0%–26.9%]) compared with the no CTO revasc group (36.6% [95% CI, 33.8%–39.5%]). At 10 years, revascularization rates (14.0% versus 22.8%) and acute coronary syndrome hospitalization rates (10.0% versus 16.6%) were significantly lower in the CTO revasc group. Baseline-adjusted analysis showed CTO revasc was associated with significantly lower all-cause mortality (hazard ratio, 0.67 [95% CI, 0.54–0.84]). In both landmark and time varying analyses, association with lower mortality was particularly robust for CTO revascularization by CABG (hazard ratio 0.56 and 0.60, respectively), with a marginally significant result for PCI in the time varying analysis (hazard ratio 0.711 [95% CI, 0.51–0.998]). Conclusions: Early CTO revascularization was associated with significantly lower all-cause mortality, revascularization rates, and hospitalization for acute coronary syndrome at 10 years, and mainly driven by outcomes in patients with CABG.

Thrombus removal prior to recanalization in vein graft occlusion intervention

2018 ◽  
Vol 27 (2) ◽  
pp. 121-123
Author(s):  
Raymond Chi-Yan Fung ◽  
Man-Hong Jim
Keyword(s):  
Saphenous Vein ◽  
Vein Graft ◽  
Chronic Total Occlusion ◽  
Balloon Dilatation ◽  
Saphenous Vein Graft ◽  
Graft Occlusion ◽  
Total Occlusion ◽  
Aspiration Thrombectomy ◽  
Occlusion Balloon ◽  
Thrombus Removal

A saphenous vein graft chronic total occlusion intervention is uncommonly performed, partly due to the high risk of distal embolization. We described a strategy in which after successful wiring of a saphenous vein graft chronic total occlusion, balloon dilatation was performed to create a blind sac within the lesion, followed by aspiration thrombectomy to remove all the dislodged debris. Thereafter, balloon dilatation and stenting were safely performed in the distal occluded segment, to achieve complete recanalization.

Abstract 20606: Comparison of Saphenous Vein Graft Occlusion and Stent Thrombosis: Discrepancies in Clinical Presentation, Procedural Characteristics and Clinical Outcomes

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hideaki Ota ◽  
Thibault Lhermusier ◽  
Marco A Magalhaes ◽  
Sa`ar Minha ◽  
Lakshmana K Pendyala ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Stent Thrombosis ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Clinical Presentation ◽  
Saphenous Vein Graft ◽  
Coronary Intervention ◽  
Graft Occlusion ◽  
Total Occlusion ◽  
Coronary Syndrome

Background: Difference in technical complexity and clinical outcomes between percutaneous coronary intervention (PCI) for stent thrombosis (ST) and PCI for occluded saphenous vein graft (SVG) have not been systematically examined. The aim of this study was to compare clinical presentation, procedural characteristics and clinical outcomes of acute coronary syndrome (ACS) patients who underwent PCI motivated by ST with those whom PCI was motivated by SVG total occlusion. Methods: We retrospectively included all the patients admitted for ACS due to ST (ST group; n=136) or SVG occlusion (SVG group; n=279) in our institution. The SVG group was divided into the following two subgroups; patients who underwent PCI in the SVG (SVG-PCI; n=75) and those who underwent PCI in native coronary arteries (native-PCI; n=204). Clinical presentation, procedural characteristics and short-term mortality were compared between the 3 groups (ST vs SVG-PCI vs native-PCI). Results: Compared with the SVG-PCI and native-PCI groups, acute myocardial infarction (76.5% vs 58.7% vs 30.4%, p <0.001; respectively) and cardiogenic shock (24.3% vs 6.8% vs 3.5%, p <0.001; respectively) were more frequent in the ST group. Concerning procedural characteristics, SVG-PCI group had the highest number of guiding catheter, procedural time, fluoroscopic time and contrast amount, as well as the lowest angiographical success rate (Table). Patients of the ST group had the highest in-hospital mortality and a trend toward higher 30-day mortality (Table). Conclusions: The present study suggests that ST when compared to SVG occlusion although easier to treat is associated with a worse outcome especially with respect to the clinical presentation at the time of the event.

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