Acute and Midterm Outcomes of Antegrade vs Retrograde Crossing Strategies for Endovascular Treatment of Iliac Artery Chronic Total Occlusions

2019 ◽  
Vol 26 (3) ◽  
pp. 342-349 ◽  
Author(s):  
Damianos G. Kokkinidis ◽  
T. Raymond Foley ◽  
Ryan Cotter ◽  
Prio Hossain ◽  
Bejan Alvandi ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Regression Models ◽  
Target Lesion ◽  
Retrograde Approach ◽  
Initial Attempt ◽  
Iliac Arteries ◽  
Chronic Total Occlusions ◽  
Logistic Regression Models ◽  
Antegrade Approach ◽  
Procedural Complications

Purpose: To examine whether an antegrade or retrograde crossing strategy for treatment of iliac artery chronic total occlusions (CTOs) is associated with differences in procedural or midterm outcomes. Materials and Methods: A dual-center retrospective cohort study was conducted in 168 patients (mean age 66.4±10.6 years; 116 men) treated for CTOs in 110 common iliac arteries (CIA), 52 external iliac arteries (EIA), and 26 combined CIA/EIAs. Logistic regression models were developed to determine the association between crossing strategy and procedural complications, 1- and 3-year target lesion revascularization (TLR), and major adverse limb events (MALE). Results are presented as the odds ratio (OR) and 95% confidence interval (CI). Results: An initial antegrade strategy was more common for EIA CTOs (p<0.005), and an initial retrograde strategy was more often used in CIA (p<0.005) and combined CIA/EIA (p<0.005) CTOs. Crossover to an alternate approach was required in 27.6% of initial antegrade attempts and 9.6% of initial retrograde attempts. EIA CTOs were the most likely lesions to be treated successfully with the initial attempt (either strategy). In all, 123 (65.4%) lesions were successfully crossed with a final retrograde approach and 65 with a final antegrade approach. Overall target lesion success was high for both groups (95.1% vs 93.2%, p=0.456). Lesions treated with a final retrograde approach were shorter (75.3±34.9 vs 87.6±31.3 mm, p=0.005) and were more likely to be treated with a reentry device (34.2% vs 9.2%, p<0.001) and with balloon-expandable stents (39.2% vs 17.7%, p=0.005). The final antegrade approach was associated with a lower risk of target lesion complications (OR 0.07, 95% CI 0.01 to 0.81, p=0.034). The two crossing approaches were associated with similar estimates of 1- and 3-year TLR and MALE. Conclusion: A final antegrade approach was associated with lower rates for complications but the 2 approaches were similar in terms of lesion success, TLR, and MALE. The EIA CTOs were more likely to be treated with an antegrade approach and more likely to be crossed successfully with the initial approach irrespective of the crossing direction.

scholarly journals Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of  Iliac Artery Chronic Total Occlusions

2020 ◽  
Author(s):  
Huan Zhang ◽  
Xiangtao Li ◽  
Luyuan Niu ◽  
Yaping Feng ◽  
Xiaoyun Luo ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Target Lesion ◽  
Primary Patency ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Antegrade Approach

Abstract Background: The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods: We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR ) and major adverse limb events (MALEs ). Results: Common iliac artery (CIA ) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/ external iliac artery (EIA ) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion: The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

scholarly journals Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Iliac Artery Chronic Total Occlusions

2020 ◽  
Author(s):  
Huan Zhang ◽  
Xiangtao Li ◽  
Luyuan Niu ◽  
Yaping Feng ◽  
Xiaoyun Luo ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Target Lesion ◽  
Primary Patency ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Antegrade Approach

Abstract Background: The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods: We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR ) and major adverse limb events (MALEs ). Results: Common iliac artery (CIA ) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/ external iliac artery (EIA ) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion: The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

scholarly journals Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Iliac Artery Chronic Total Occlusions

2020 ◽  
Author(s):  
Huan Zhang ◽  
Xiangtao Li ◽  
Luyuan Niu ◽  
Yaping Feng ◽  
Xiaoyun Luo ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Target Lesion ◽  
Primary Patency ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Antegrade Approach

Abstract Background: The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods: We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR ) and major adverse limb events (MALEs ). Results: Common iliac artery (CIA ) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/ external iliac artery (EIA ) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion: The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

scholarly journals Effectiveness and long-term outcomes of different crossing strategies for the endovascular treatment of iliac artery chronic Total occlusions

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Huan Zhang ◽  
Xiangtao Li ◽  
Luyuan Niu ◽  
Yaping Feng ◽  
Xiaoyun Luo ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Target Lesion ◽  
Primary Patency ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Antegrade Approach

Abstract Background The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and methods We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0 ± 11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR) and major adverse limb events (MALEs). Results Common iliac artery (CIA) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p = 0.005), while lesions in the CIA/ external iliac artery (EIA) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p = 0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

scholarly journals Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Complex Iliac Artery Chronic Total Occlusions

2020 ◽  
Author(s):  
Huan Zhang ◽  
Xiangtao Li ◽  
Luyuan Niu ◽  
Yaping Feng ◽  
Xiaoyun Luo ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Target Lesion ◽  
Primary Patency ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Antegrade Approach

Abstract Purpose To explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, TLR (target lesion revascularization) and MALEs (major adverse limb events). Results CIA (common iliac artery) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/EIA (external iliac artery) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). Considering EIA lesions, there were no significant differences in the crossing approach between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

scholarly journals Recanalization of Chronic Total Occlusions Using Modern Endovascular Techniques

Kardiologiia ◽  
2019 ◽  
Vol 59 (2) ◽  
pp. 10-16
Author(s):  
D. A. Khelimskii ◽  
O. V. Krestyaninov ◽  
A. G. Badoyan ◽  
D. N. Ponomarev ◽  
E. A. Pokushalov
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Retrograde Approach ◽  
Endovascular Techniques ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
National Medical ◽  
Antegrade Approach ◽  
Percutaneous Coronary

Purpose:to assess results of percutaneous coronary intervention (PCI) with contemporary endovascular techniques of recanalization of chronic total coronary artery occlusions (CTO) in patients with ischemic heart disease (IHD). Occlusion (CTO) he procedural and in-hospital outcomes of consecutive patients undergoing chronic total occlusion percutaneous coronary intervention.Materials and methods.We retrospectively analyzed data from 456 consecutive patients (mean age 59.9±7.1 years, 18.2 % women) who underwent CTO PCI procedures (n=477) during 2014–2016 in the E. N. Meshalkin National Medical Research Center. CTO was localized in the right (61.2 %), left anterior descending (23.2 %) and left circumflex (15.3 %) coronary arteries. In one patient CTO was located in the left main coronary artery. According to the J-CTO score, 30 % of lesions were classified as easy, 36.4 % intermediate, 23.7 % difficult, and 18.9 % very difficult.Results.Technical and procedural successes were achieved in 374 (78.4 %) and 366 patients (76.7 %), respectively. Antegrade approach was used in 378 (79.2 %), retrograde approach – in 99 (20.7 %) cases. Retrograde approach as primary strategy was used in 27 cases (5.7 %). Most frequent access for CTO PCI was radial artery, contralateral injection was used in 151 cases (31.6 %). Total number of stents per lesion was 1.6±0.98. The mean fluoroscopy time was 36.2±31 min.Conclusions.The rate of procedural adverse events in our study was low and similar to the non-CTO PCI series. However, despite the large number of CTO PCIs, the procedural success rate was still lower than in centers with dedicated programs for the management of such patients. Thus, further work is required to overcome this difference. Possible solution of this problem might be development and introduction in clinical practice of an algorithm for CTO recanalization.

scholarly journals Differences in Temporal Relapse Characteristics Between Affective and Non-affective Psychotic Disorders: Longitudinal Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Sarah A. Immanuel ◽  
Geoff Schrader ◽  
Niranjan Bidargaddi
Keyword(s):  
Mental Health ◽  
Regression Models ◽  
Psychotic Disorders ◽  
Temporal Characteristic ◽  
Random Regression ◽  
Initial Attempt ◽  
Significant Group ◽  
Logistic Regression Models ◽  
Patient Groups ◽  
Time To Relapse

Objective: Multiple relapses over time are common in both affective and non-affective psychotic disorders. Characterizing the temporal nature of these relapses may be crucial to understanding the underlying neurobiology of relapse.Materials and Methods: Anonymized records of patients with affective and non-affective psychotic disorders were collected from SA Mental Health Data Universe and retrospectively analyzed. To characterize the temporal characteristic of their relapses, a relapse trend score was computed using a symbolic series-based approach. A higher score suggests that relapse follows a trend and a lower score suggests relapses are random. Regression models were built to investigate if this score was significantly different between affective and non-affective psychotic disorders.Results: Logistic regression models showed a significant group difference in relapse trend score between the patient groups. For example, in patients who were hospitalized six or more times, relapse score in affective disorders were 2.6 times higher than non-affective psychotic disorders [OR 2.6, 95% CI (1.8–3.7), p &lt; 0.001].Discussion: The results imply that the odds of a patient with affective disorder exhibiting a predictable trend in time to relapse were much higher than a patient with recurrent non-affective psychotic disorder. In other words, within recurrent non-affective psychosis group, time to relapse is random.Conclusion: This study is an initial attempt to develop a longitudinal trajectory-based approach to investigate relapse trend differences in mental health patients. Further investigations using this approach may reflect differences in underlying biological processes between illnesses.

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