scholarly journals Active Retrograde Extra Backup with a Mother-and-Child Catheter to Facilitate Retrograde Microcatheter Collateral Channel Tracking in Recanalization of Coronary Chronic Total Occlusion

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yong Wang ◽  
Xiao-Jiao Zhang ◽  
Hong-Wei Zhao ◽  
Cheng-Fu Wang ◽  
De-Feng Luo ◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Channel Tracking ◽  
Significant Difference ◽  
Mother And Child ◽  
Life Threatening ◽  
Procedural Complications ◽  
Collateral Channel ◽  
Vessel Dissection

Objective. To explore the feasibility and safety of the active retrograde backup (ARB) for treatment of chronic total occlusion (CTO) during retrograde percutaneous coronary intervention (PCI). Background. Guiding support plays an important role in guidewire and microcatheter coronary channel (CC) tracking in retrograde PCI therapy for patients with CTO. However, the feasibility and safety of retrograde active use of a mother-and-child catheter are still unclear. Patients and Methods. A total of 271 consecutive patients with CTO who underwent retrograde PCI between January 2015 and January 2020 were retrospectively analyzed. Clinical data of two groups were compared to evaluate the feasibility and safety of ARB. Results. Of the 271 patients, 69.0% (187/271) underwent therapy through the septal branch, 31.0% (84/271) through the epicardial collateral channel, and 47.6% (129/271) through active retrograde extra backup with a mother-and-child catheter to facilitate retrograde microcatheter collateral CC tracking. The time of wire CC tracking was shorter in the ARB group than that in the non-ARB group (25.4 ± 8.5 vs 26.4 ± 9.7, p=0.348), but there was no significant difference. The duration of the retrograde microcatheter tracking (10.2 ± 3.8 vs 15.5 ± 6.8, p=0.012) and the retrograde approach (62.8 ± 20.3 vs 70.4 ± 24.3, p=0.026) in the ARB group was significantly shorter than that in the non-ARB group. The radiation dose (223.6 ± 112.7 vs. 295.2 ± 129.3, p=0.028), fluoroscopy time (50.6 ± 21.3 vs 62.3 ± 32.1, p=0.030), and contrast volume (301.8 ± 146.7 vs 352.2 ± 179.5, p=0.032) in the ARB group were significantly lower than that in the non-ARB group. There were no life-threatening procedural complications in either group. Complications unrelated to ARB included two cases of donor-vessel dissection, one case of CC perforation, and two cases of target-vessel perforation. There was no statistically significant difference in major adverse cardiac and cerebrovascular events between the groups during hospitalization p>0.05. Conclusion. ARB is feasible, safe, and conducive to guidewire and microcatheter CC tracking in the recanalization of coronary CTO. It improves procedural efficiency and is worthy of further promotion.

Successful guidewire crossing via collateral channel at retrograde percutaneous coronary intervention for chronic total occlusion: the J-Channel score

2020 ◽  
Vol 15 (18) ◽  
pp. e1624-e1632 ◽  
Author(s):  
Wataru Nagamatsu ◽  
Etsuo Tsuchikane ◽  
Yuji Oikawa ◽  
Satoru Sumitsuji ◽  
Yasumi Igarashi ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Collateral Channel

scholarly journals Ventricular fibrillation storm after revascularization of chronic total occlusion of the left anterior descending artery: is this reperfusion arrhythmia?

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199761
Author(s):  
Xingji Liu ◽  
Binay Kumar Adhikari ◽  
Tianlong Chen ◽  
Yonggang Wang ◽  
Quan Liu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Ventricular Fibrillation ◽  
Collateral Circulation ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Electrical Storm ◽  
Total Occlusion ◽  
Reperfusion Arrhythmia ◽  
Percutaneous Coronary ◽  
Life Threatening

Electrical storm is a life-threatening emergency condition defined as three or more episodes of ventricular tachycardia or ventricular fibrillation (VF) within 24 hours requiring anti-tachycardia therapy, electrical cardioversion, or defibrillation. However, studies of the incidence of electrical storm after chronic total occlusion-percutaneous coronary intervention (CTO-PCI) are limited, 7 and post-procedural VF after revascularization of CTO has not been described. The purpose of this article was to present a case of post-operative VF electrical storm after revascularization of CTO of the left anterior descending (LAD) artery to determine whether the electrical storm was caused by reperfusion arrhythmia or compromise of either branch vessels or the collateral circulation during intervention.

Percutaneous Coronary Intervention With Drug-Eluting Stent Versus Optimal Medical Therapy for Chronic Total Occlusion: Systematic Review and Meta-Analysis

Angiology ◽  
2019 ◽  
Vol 70 (10) ◽  
pp. 908-915 ◽  
Author(s):  
Mohamed Abo-Aly ◽  
Naoki Misumida ◽  
Neil Backer ◽  
Khaled ElKholey ◽  
Sun Moon Kim ◽  
...  
Keyword(s):  
Observational Studies ◽  
Chronic Total Occlusion ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Cardiac Mortality ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Drug Eluting

The optimal treatment strategy for coronary chronic total occlusion (CTO) has not been well established. The benefit of percutaneous coronary intervention (PCI) was inferred mainly from observational studies comparing successful versus failed PCI without a control group receiving optimal medical therapy (OMT). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing PCI using drug-eluting stent (DES) versus OMT alone in patients with CTO. Eight studies were identified: 3 RCTs and 5 observational studies. Among a total of 4784 included patients, 2461 patients underwent PCI and 2323 patients received OMT. There was a significant association between PCI and lower cardiac mortality (odds ratio = 0.62; 95% confidence interval 0.42-0.93; P = .02). There was no significant difference between PCI and OMT regarding major adverse cardiac events, recurrent myocardial infarction (MI), repeat revascularization, or stroke. In the RCT subset (1399 patients), there was no significant difference between PCI and OMT regarding clinical outcomes. Compared with OMT alone, PCI with DES for CTO was associated with lower cardiac mortality, mainly driven by observational studies, without significant difference in recurrent MI or repeated revascularization. Further RCTs are needed to investigate the role of PCI for management of patients with CTO.

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