scholarly journals Rational guidewire use in the coronary chronic total occlusion interventions

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Ahmet Karabulut ◽  
Sevket Gorgulu ◽  
Tanıl Kocagoz
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Statistical Analysis ◽  
Success Rate ◽  
Chronic Total Occlusion ◽  
Success Rates ◽  
Total Occlusion ◽  
Clinical Challenge ◽  
The Mean ◽  
Procedural Success

Abstract Background Procedures for coronary chronic total occlusion (CTO) are still a clinical challenge with relatively lower success rates. Recent advances in the biotechnology and introduction of CTO-dedicated guidewires have increased the procedural success rate of CTO interventions. Herein, we aimed to reveal the clinical and angiographic predictors of the crossability of the initial guidewire choice and rational guidewire usage in CTO interventions. A total of 177 patients with an indication for a coronary CTO procedure were included in this study. The use of 1–3 guidewires and crossing of the CTO lesion with the initial guidewire choice was defined as rational guidewire usage. The CTO lesions were classified according to the Japanese chronic total occlusion registry (J-CTO) and EuroCTO scores for evaluating the difficulty of the procedures. Then, a statistical analysis was performed to assess the initial guidewire choice, crossability, and contributors to rational guidewire usage. Results The mean J-CTO score was 1.42 ± 1.16, and the mean EuroCTO score was 1.44 ± 1.18. The success rate of the procedures was 90.4%. The initial guidewire choice crossed the lesion in 44.1% of the cases, in which 1–3 guidewires were used (82.1%). The crossability of the polymeric and moderate stiff tip guidewires was higher (82.1% and 64.1%, respectively), and the Pilot series was the most successful brand (36.2%). Logistic regression analysis confirmed that J-CTO score, procedural technique, guidewire type, and stiffness of the tip were the major predictors of rational guidewire usage. Conclusion Our analysis showed that the use of polymeric and moderate stiff tip guidewires, particularly the Pilot brand, were associated with rational guidewire usage in easy and intermediate difficulty CTO cases.

Abstract 16117: Clinical and Angiographic Scoring System to Predict the Probability of Successful First Attempt PCI in Patients With Coronary Chronic Total Occlusion

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Giuseppe Alessandrino ◽  
Yves Louvard ◽  
Thierry Lefevre ◽  
Philippe Garot ◽  
Francesca Sanguineti ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Success Rate ◽  
Scoring System ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Stepwise Logistic Regression ◽  
Total Occlusion ◽  
Class 1 ◽  
Procedural Success ◽  
Procedural Outcome

Background: Coronary chronic total occlusion (CTO) remains the lesion subtype in which angioplasty has the lowest success rate. Although many independent predictors of final procedural success have been identified, no studies have yet analyzed their combined impact on final procedural outcome. In order to obtain a scoring model to predict final CTO-PCI success, we analyzed a population of patients who underwent a percutaneous coronary intervention for a chronic total occlusion (CTO-PCI) at our institution. Methods: We included 1,657 consecutive patients who underwent a first-attempt CTO-PCI at ICPS from January 2004 to December 2013. Clinical, angiographic procedural and technical characteristics were prospectively collected. A backword stepwise logistic regression including clinical and angiographic variables was used to create a multivariable model of independent predictors of CTO-PCI success. Independent variables were then scored. Results: Overall procedural success rate was 72.5%. The backward logistic regression model showed that two clinical variables: previous CABG (OR2.28, 95%CI1.53-3.4), previous MI (1.56, 95%CI 1.19-2.0) and four angiographic variables: severe lesion calcification (OR 2.95, 95%CI 2.08-4.2), longer CTOs (≥20 mm: OR 2.04, 95%CI 1.62-2.58), non LAD location (OR 1.58, 95%CI 1.21-2-06) and blunt stump morphology (OR 1.57, 95%CI 1.24-1.99) were independent predictors of CTO-PCI failure. The OR values of these variables were used to create the Clinical and Angiographic Scoring System (CL-SCORE). CL-Score values of 0, 1-3, >3 and ≤5 and >5 indentified subgroups at high (class 0), intermediate (class 1), low (class 2), very low (class 3) probability of CTO-PCI success (80.3%, 64.2%, 49.4 and 29% respectively; p<0,0001) Figure 1. The probability of CTO-PCI failure increased significantly from class 0 to class 1 (19.7% to 35.8%, p<0.0001), from class 1 to class 2 (35.8 to 50.6 p<0.0001) and from class 2 to class 3 (50.6% to 81% p=0.001), respectively. Conclusion: This clinical and angiographic score strongly predicted the final CTO-PCI procedural outcome of our study population. Further studies are required to validate this model.

scholarly journals Vascular Access and Chronic Total Occlusion Angioplasty

2015 ◽  
Vol 10 (2) ◽  
pp. 90
Author(s):  
Smith David ◽  
Hailan Ahmed ◽  
Chase Alexander ◽  
◽  
◽  
...  
Keyword(s):  
Vascular Access ◽  
Chronic Total Occlusion ◽  
Best Practice ◽  
New Technologies ◽  
Coronary Intervention ◽  
Success Rates ◽  
Total Occlusion ◽  
Femoral Access ◽  
Arterial Access ◽  
Procedural Success

The hybrid algorithim approach, together with innovative new technologies, has lead to increased interest in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and increasing procedural success rates. Unlike non-CTO PCI, there is an increased rate of femoral access. When considering arterial access in CTO PCI, a balance is needed between anticipated procedural difficulty, planned CTO strategy and the desire to minimise the risk of vascular access-related complications. We review the evidence for best practice with respect to femoral puncture technique and also assess the technologies and techniques available to place larger inner diameter catheters into the radial artery.

scholarly journals Factors Associated with the Success of Orthodontic Miniscrews

2018 ◽  
Vol 7 (2) ◽  
pp. 55-60 ◽  
Author(s):  
Amir Mohammadi ◽  
Sareh Keshavarz Meshkinfam ◽  
Saeid Foroughi Moghaddam
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Success Rate ◽  
Logistic Regression Analysis ◽  
Age Groups ◽  
Insertion Torque ◽  
Success Rates ◽  
Factors Associated ◽  
Osseointegrated Implants ◽  
Effect Of Age

Background and aims. Nowadays miniscrews are widely used as skeletal anchorage in orthodontics. However, the success rate of miniscrews is less than that of osseointegrated implants. The aim of this retrospective study was to evaluate factors influencing the success rate of orthodontic miniscrews. Materials and methods. Data of 244 miniscrews in 122 patients (99 females and 23 males, with a mean age of 19 years and 6 months) were collected. Logistic regression analysis was used to evaluate the effect of age, gender, placement side and insertion torque on the success rates of miniscrews. Results. The overall success rate of miniscrews was 90.6% in the present study (221/244). Logistic regression analysis showed that the success rate of miniscrews was not under the influence of variables such as gender, placement side and miniscrew brand. However, age groups and insertion torques over 10 Ncm decreased miniscrew success rates. In this context, the success rates of miniscrews in patients under 16 years of age was less than those in patients over 16 years of age (P<0.001) and the success rates of miniscrews with insertion torques ≤10 Ncm were higher than those with insertion torques over 10 Ncm (P=0.019). Conclusion. We concluded that patients under 16 years of age and insertion torques over 10 were increased the failure of orthodontic miniscrews.

scholarly journals Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access

2021 ◽  
Vol 8 ◽  
Author(s):  
Cheng-Jui Lin ◽  
Wei-Chieh Lee ◽  
Chieh-Ho Lee ◽  
Wen-Jung Chung ◽  
Shu-Kai Hsueh ◽  
...  
Keyword(s):  
Radial Artery ◽  
Chronic Total Occlusion ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Procedural Success

Aims: The current study aims to verify the feasibility and safety of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) via the distal transradial access (dTRA).Methods: Between April 2017 and December 2019, 298 patients who underwent CTO PCI via dTRA were enrolled in this study. The baseline demographic and procedural characteristics were listed and compared between groups. The incidences of access-site vascular complications and procedural complications and mortality were recorded.Results: The mean J-CTO (Japanese chronic total occlusion) score was 2.6 ± 0.9 points. The mean access time was 4.6 ± 2.9 min, and the mean procedure time was 115.9 ± 55.6 min. Left radial snuffbox access was performed successfully in 286 patients (96.5%), and right radial snuffbox access was performed successfully in 133 patients (97.7%). Bilateral radial snuffbox access was performed in 107 patients (35.9%). 400 dTRA (95.5%) received glidesheath for CTO intervention. Two patients (0.7%) developed severe access-site vascular complications. None of the patients experienced severe radial artery spasm and only 2 patients (0.5%) developed radial artery occlusion during the follow-up period. The overall procedural success rate was 93.5%. The procedural success rate was 96.5% in patients with antegrade approach and 87.7% in patients with retrograde approach.Conclusions: It is both safe and feasible to use dTRA plus Glidesheath for complex CTO intervention. The incidences of procedure-related complications and severe access-site vascular complications, and distal radial artery occlusion were low.

scholarly journals Prospective randomized study of coronary chronic total occlusion recanalization using the CHOICE score

2018 ◽  
Vol 22 (4) ◽  
pp. 72 ◽  
Author(s):  
D. A. Khelimskiy ◽  
O. V. Krestyaninov ◽  
A. G. Badoyan ◽  
D. N. Ponomarev ◽  
E. A. Pokushalov
Keyword(s):  
Conflict Of Interest ◽  
Chronic Total Occlusion ◽  
Randomized Study ◽  
Strategy Group ◽  
Success Rates ◽  
Total Occlusion ◽  
Single Center Study ◽  
Periprocedural Myocardial Infarction ◽  
Procedural Success ◽  
Primary Strategy

<p><strong>Background.</strong> Today there is no clear recommendations regarding the choice of a technique for coronary chronic total occlusion recanalization.<br /><strong>Aim.</strong> The article aims to evaluate the efficacy of choosing the coronary chronic total occlusion primary recanalization strategy according to the CHOICE score in comparison with primary antegrade recanalization.<br /><strong>Methods.</strong> This prospective single-center study included 160 patients with chronic total occlusion. The patients were randomized into two groups: in the first, the recanalization strategy was selected on the basis of the previously developed CHOICE score, in the second, antegrade recanalization technique was used as the primary strategy.<br /><strong>Results.</strong> In the group where the choice of primary recanalization strategy was based on the CHOICE score, technical and procedural success rates were 90% and 88.8% and were significantly higher compared to those in the primary antegrade recanalization group, 76.3% and 75%, respectively. The success rate of the primary recanalization strategy was also higher in the group where choice of the primary recanalization strategy was based on the score (80% vs. 58.8%). At the hospital stage, 2 complications were recorded, one in each group. Thus, a patient in the CHOICE score-based strategy group developed periprocedural myocardial infarction, while the primary antegrade recanalization group there was 1 case complicated by perforation of the coronary artery, which required pericardiocentesis. The average number of stents and contrast did not differ between groups. However, the intervention time was longer in the group with primary antegrade recanalization (47.6 ± 28.2 vs. 39.2 ± 23.4).<br /><strong>Conclusion.</strong> Selecting the CHOICE score-based recanalization can significantly increase the probability of procedural success and reduce the intervention time.<br />Received 17 October 2018. Revised 13 December 2018. Accepted 18 December 2018.<br /><strong>Funding:</strong> The study did not have sponsorship.<br /><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

scholarly journals A comparison of procedural success rate and long-term clinical outcomes between in-stent restenosis chronic total occlusion and de novo chronic total occlusion using multicenter registry data

2019 ◽  
Vol 109 (5) ◽  
pp. 628-637 ◽  
Author(s):  
Seung Hun Lee ◽  
Jae Young Cho ◽  
Je Sang Kim ◽  
Hyun Jong Lee ◽  
Jeong Hoon Yang ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Outcomes ◽  
Chronic Total Occlusion ◽  
De Novo ◽  
Drug Eluting Stent ◽  
Total Occlusion ◽  
Stent Restenosis ◽  
Procedural Success ◽  
In Stent Restenosis

Abstract Background There have been little data about outcomes of percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) chronic total occlusion (CTO) in the drug eluting stent (DES) era. This study aimed to compare the procedural success rate and long-term clinical outcomes of ISR CTO and de novo CTO. Methods and results Patients who underwent PCI for ISR CTO (n = 164) versus de novo CTO (n = 1208) were enrolled from three centers in Korea between January 2008 and December 2014. Among a total of ISR CTO, a proportion of DES ISR CTO was 79.3% (n = 130). The primary outcome was major adverse cardiac events (MACEs); a composite of all-cause death, non-fatal myocardial infarction (MI), or target lesion revascularization (TLR). Following propensity score-matching (1:3), the ISR CTO group (n = 156) had a higher success rate (84.6% vs. 76.0%, p = 0.035), mainly driven by high success rate of PCI for DES ISR CTO (88.6%), but showed a higher incidence of MACEs [hazard ratio (HR): 2.06; 95% confidence interval (CI) 1.37–3.09; p < 0.001], mainly driven by higher prevalence of MI [HR: 9.71; 95% CI 2.06–45.81; p = 0.004] and TLR [HR: 3.04; 95% CI 1.59–5.81; p = 0.001], during 5 years of follow-up after successful revascularization, as compared to the de novo CTO group (n = 408). Conclusion The procedural success rate was higher in the ISR CTO than the de novo CTO, especially in DES ISR CTO. However, irrespective of successful revascularization, the long-term clinical outcomes for the ISR CTO were significantly worse than those for the de novo CTO, in terms of MI and TLR. Graphic abstract

Abstract 16435: Contemporary In-Hospital Outcomes of Chronic Total Occlusion Interventions: Update From the PROGRESS-CTO (prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Multicenter International Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Judit Karacsonyi ◽  
Khaldoon Alaswad ◽  
Dimitrios Karmpaliotis ◽  
Oleg Krestyaninov ◽  
James Choi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Complication Rates ◽  
Success Rates ◽  
Circumflex Artery ◽  
Total Occlusion ◽  
Left Circumflex Artery ◽  
Procedural Success

Introduction: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been advancing due to improvement of equipment, operator experience, and techniques. Methods: We examined contemporary outcomes of CTO PCI by analyzing the clinical, angiographic, and procedural characteristics of 7,031 CTO interventions performed in 6,984 patients at 35 participating centers between 2012 and 2020. Results: Mean age was 64.5 ± 10 years and 82% of the patients were men. The patients had high prevalence of comorbidities, such as diabetes (42%), prior coronary artery bypass graft surgery (29%), prior myocardial infarction (45%), and prior heart failure (29%). The most common CTO target vessel was the right coronary artery (53%), followed by the left anterior descending artery (26%), and left circumflex artery (20%). The mean J-CTO and PROGRESS scores were 2.41 ± 1.28 and 1.09 ± 1.01, respectively. The overall technical and procedural success rates were 85.9% and 83.8% and the rate of in-hospital major cardiac adverse events (MACE) was 2.06%. Technical success and procedural success rates were lower for higher values of J-CTO and PROGRESS scores, and MACE rate was higher ( Figure 1 ). The final successful crossing strategy was antegrade wire escalation in 53.7%, retrograde in 19.9%, and antegrade dissection reentry in 14.6%. The overall median air kerma radiation dose, contrast volume, procedure and fluoroscopy time were 2.30 (1.30, 3.90) Gray, 225 (160, 305) ml, 115 (75, 170) and 43 (26, 70) minutes, respectively. Conclusions: Using a combination of crossing strategies, high success and acceptable complication rates can be achieved in CTO PCI among various centers and patient populations.

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 Impact of Chronic Kidney Disease on Chronic Total Occlusion Revascularization Outcomes: A Meta-Analysis

2021 ◽  
Vol 10 (3) ◽  
pp. 440
Author(s):  
Wei-Chieh Lee ◽  
Po-Jui Wu ◽  
Chih-Yuan Fang ◽  
Huang-Chung Chen ◽  
Chiung-Jen Wu ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Success Rate ◽  
Clinical Outcomes ◽  
Chronic Total Occlusion ◽  
Systemic Review ◽  
Total Occlusion ◽  
Procedural Success ◽  
Long Term Mortality

Objectives: To examine the impact of revascularization and associated clinical outcomes of chronic kidney disease (CKD) chronic total occlusion (CTO) and non-CKD CTO groups. Background: The influence of CKD on clinical outcomes after percutaneous coronary intervention (PCI) for CTO lesions is unknown, and there is no systemic review of this topic to date. Methods: We searched the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials Databases for articles published between 1 January 2010 and 31 March 2020. CKD was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2 according to the Modification of Diet in Renal Disease formula. Data included demographics, lesion distributions, incidence of contrast-induced nephropathy (CIN), acute kidney injury (AKI), procedural success rate, mortality, and target lesion revascularization (TLR)/target vessel revascularization (TVR). Results: Six studies were ultimately included in this systematic review. A high prevalence (25.5%; range, 19.6–37.9%) of CKD was noted in the CTO population. In the non-CKD group, outcomes were better: less incidence of CIN or AKI (odds ratio (OR), 2.860; 95% confidence interval (CI), 1.775–4.608), higher procedural success rate (OR, 1.382; 95% CI, 1.036–1.843), and lower long-term mortality (OR, 4.502; 95% CI, 3.561–5.693). The incidence of TLR/TVR (OR, 1.118; 95% CI, 0.888–1.407) did not differ between groups. Conclusions: In the CKD CTO PCI population, a lower procedural success rate, a higher incidence of CIN or AKI, and higher in-hospital and long-term mortality rate were noted due to more complex lesions and more comorbidities. However, the incidence of TLR/TVR did not differ between groups.

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

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