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 Antegrade Chronic Total Occlusion Strategies: A Technical Focus for 2020

2020 ◽  
Vol 15 ◽  
Author(s):  
Calum Creaney ◽  
Simon J Walsh
Keyword(s):  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Initial Strategy ◽  
Percutaneous Coronary ◽  
Probability Of Success ◽  
Procedural Strategy ◽  
Low Probability ◽  
Procedural Success

Chronic total occlusions (CTOs) are common in patients with ischaemic heart disease. In many countries, patients with CTOs are underserved by percutaneous coronary intervention (PCI). One of the barriers to CTO PCI is the technical challenges of these procedures. Improvements in technique and dedicated devices for CTO PCI, combined with advances in procedural strategy, have resulted in a dramatic increase in procedural success and outcomes. Antegrade wiring (AW) is the preferred initial strategy in short CTOs, where the proximal cap and course of the vessel is understood. For many longer, more complex occlusions, AW has a low probability of success. Dissection and re-entry techniques allow longer CTOs and those with ambiguous anatomy to be crossed safely and efficiently, and CTO operators must also be familiar with these strategies. The CrossBoss and Stingray system is currently the primary targeted re-entry device used during antegrade dissection and re-entry (ADR), and there continues to be an evolution in its use to increase procedural efficiency. In contrast to older ADR techniques, targeted re-entry allows preservation of important side-branches, and there is no difference in outcomes compared to intraplaque stenting.

Chronic total occlusions

2018 ◽  
pp. 315-336
Author(s):  
Colm G. Hanratty ◽  
James C. Spratt ◽  
Simon J. Walsh
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Clinical Indication ◽  
Success Rates ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
Set Up

Chronic total occlusion (CTO) of a coronary artery remains one of the most challenging scenarios in cinical practice. There is much debate about whether opening a CTO is clinically indicated and the procedures are often considered too risky. As a result many patients with a clinical indication for percutaneous coronary intervention (the presence of angina despite medical therapy, with proven ischaemia and viability) are not offered treatment. This chapter will aim to demystify the procedure by explaining how pathophysiological features can help understand the anatomy and how cath lab set-up can increase procedural efficiency, safety, and overall success rates. There are four methods by which a CTO can be opened and we will describe these methods and the anatomically salient features to help select the most appropriate method with which to start.

P1964Impact of successful coronary intervention for chronic total occlusion on long-term clinical outcome of patients with impaired and preserved left ventricular ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Tanaka ◽  
T Tada ◽  
Y Fuku ◽  
T Goto ◽  
K Kadota
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Total Occlusion ◽  
Ventricular Ejection Fraction ◽  
Percutaneous Coronary ◽  
Procedural Success

Abstract Background Successful recanalisation of percutaneous coronary intervention for chronic total occlusion lesions has been associated with improved survival. Purpose This study aimed to assess the impact of successful percutaneous coronary intervention for chronic total occlusion lesions on the long-term outcome of patients with impaired and preserved left ventricular ejection fraction (LVEF). Methods The study sample consisted of 842 consecutive patients (928 chronic total occlusion lesions) undergoing percutaneous coronary intervention at our institution between October 2005 and December 2009. We divided them into 3 groups by the degree of LVEF: less than 40% (severely reduced LVEF, n=140), 40% to 59% (moderately reduced LVEF, n=470), and 60% and above (normal LVEF, n=232). We evaluated mortality during the 10-year follow-up period the basis of procedural success and failure. Results The overall procedural success rate was 89.1%. Median follow-up duration was 7.9 years. The 10-year cumulative incidences of cardiac death in each degree of LVEF are shown in the Figure. Conclusions Successful recanalisation for chronic total occlusion lesions in patients with impaired LVEF may be associated with reduced cardiac mortality.

The Impact of Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention (Insights From PROGRESS-CTO Registry)

Angiology ◽  
2019 ◽  
Vol 71 (3) ◽  
pp. 274-280 ◽  
Author(s):  
Iosif Xenogiannis ◽  
Fotis Gkargkoulas ◽  
Dimitri Karmpaliotis ◽  
Khaldoon Alaswad ◽  
Oleg Krestyaninov ◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Peripheral Artery ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
History Of ◽  
Artery Disease ◽  
Procedural Success ◽  
The Impact ◽  
Complex Lesions

The impact of peripheral artery disease (PAD) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We reviewed 3999 CTO PCIs performed in 3914 patients between 2012 and 2018 at 25 centers, 14% of whom had a history of PAD. We compared the clinical and angiographic characteristics and procedural outcomes of patients with versus without history of PAD. Patients with PAD were older (67 ± 9 vs 64 ± 10 years, P < .001) and had a higher prevalence of cardiovascular risk factors. They also had more complex lesions as illustrated by higher Japanese CTO score (2.7 ± 1.2 vs 2.4 ± 1.3, P < .001). In patients with PAD, the final crossing technique was less often antegrade wire escalation (40% vs 51%, P < .001) and more often the retrograde approach (23 vs 20%, P < .001) and antegrade dissection/reentry (20% vs 16%, P < .001). Technical success was similar between the 2 study groups (84% vs 87%, P = .127), but procedural success was lower for patients with PAD (81% vs 85%, P = .015). The incidence of in-hospital major adverse cardiac events was higher among patients with PAD (3% vs 2%, P = .046). In conclusion, patients with PAD undergoing CTO PCI have more comorbidities, more complex lesions, and lower procedural success.

scholarly journals Randomized Comparison of Terumo® Coated Slender™ versus Terumo® Noncoated Traditional Sheath during Radial Angiography or Percutaneous Coronary Intervention

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Birthe Sindberg ◽  
Christel Gry Aagren Nielsen ◽  
Marianne Hestbjerg Poulsen ◽  
Martin Bøhme Rasmussen ◽  
Steen Carstensen ◽  
...  
Keyword(s):  
Radial Artery ◽  
Rating Scale ◽  
Coronary Intervention ◽  
Numeric Rating Scale ◽  
Artery Occlusion ◽  
Success Rates ◽  
Femoral Access ◽  
Procedural Success ◽  
And Gender ◽  
Sheath Insertion

Background. The transradial approach is generally associated with few complications. However, periprocedural pain is still a common issue, potentially related to sheath insertion and/or arterial spasm, and may result in conversion to femoral access. Radial artery occlusion (RAO) following the procedure is also a potential risk. We evaluate whether the design of the sheath has any impact on these variables. Methods. A total of 1,000 patients scheduled for radial CAG or PCI were randomized (1:1) to the use of a Slender or a Standard sheath during the procedure. Randomization was stratified according to chosen sheath size (5, 6, 7 French) and gender. A radial band was used to obtain hemostasis after the procedure, employing a rapid deflation technique. A reverse Barbeau test was performed to evaluate radial artery patency after removal of the radial band, and level of pain was assessed using a numeric rating scale (NRS). Results. Use of the Slender sheath was associated with less pain during sheath insertion (median NRS 1 versus 2, p=0.02), whereas no difference was observed in pain during the procedure, radial procedural success rates, use of analgesics and sedatives during the procedure, and radial artery patency following the procedure. Rate of RAO was 1.5% with no difference between groups. Conclusion. The use of the hydrophilic coated Slender sheath during radial CAG or PCI was associated with less pain during sheath insertion, whereas no difference in other endpoints was observed. A rapid deflation technique was associated with RAO of only 1.5%.

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 Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion

2021 ◽  
Vol 10 (7) ◽  
pp. 1486
Author(s):  
Peter Tajti ◽  
Mohamed Ayoub ◽  
Thomas Nuehrenberg ◽  
Miroslaw Ferenc ◽  
Michael Behnes ◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Pericardial Tamponade ◽  
Fluoroscopy Time ◽  
Technical Failure ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Procedural Success ◽  
The Impact

Background: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy time (FT) on procedural outcomes is poorly studied. Methods and Results: We analyzed the outcomes of 12,538 consecutive elective PCIs. The primary endpoint was procedure failure (PF), the composite of technical failure, and adverse in-hospital events including all-cause death, myocardial infarction, stroke, and target vessel revascularization (MACCE), as well as pericardial tamponade. We stratified the procedures as PCI for chronic total occlusion (CTO, n = 2720) and PCI for non-CTO (n = 9818). Logistic regression demonstrated a significant association between fluoroscopy time and procedural failure with a significant interaction with PCI type (both p < 0.001). The odds ratios (OR) of procedural failure for a 10-min increment in FT were 1.15 (confidence interval (CI) 95% 1.12–1.18, p < 0.001) in non-CTO PCI and 1.05 (CI 95% 1.03–1.06, p < 0.001) in CTO PCI. The optimal cut-point for prediction of PF was 21.1 min in non-CTO PCI (procedural success in 98.4% versus 95.3%, adjusted OR for PF 2.79 (CI 95% 1.93–4.04), p < 0.001) and 41 min in CTO PCI (procedural success in 92.3% versus 83.8%, adjusted OR for PF 2.18 (CI 95% 1.64–2.94), p < 0.001). In CTO PCI, the increase in PF with FT was largely driven by technical failure (adjusted OR 2.25 (CI 95% 1.65–3.10), p < 0.001), whereas in non-CTO PCI, it was driven by major complications (adjusted OR 2.94 (CI 95% 1.93–4.53), p < 0.001). Conclusions: Prolonged FT is strongly associated with procedural failure in both non-CTO and CTO PCI. In CTO PCI, this relation is shifted towards longer FT. The mechanisms of procedural failure differ between CTO and non-CTO PCI.

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.

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