scholarly journals The Impact of Calcium on Chronic Total Occlusion Management

2021 ◽  
Vol 16 ◽  
Author(s):  
Claudia Cosgrove ◽  
Kalaivani Mahadevan ◽  
James C Spratt ◽  
Margaret McEntegart
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Success Rates ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
Procedural Success ◽  
The Impact

Coronary artery calcification is prevalent in chronic total occlusions (CTO), particularly in those of longer duration and post-coronary artery bypass. The presence of calcium predicts lower procedural success rates and a higher risk of complications of CTO percutaneous coronary intervention. Adjunctive imaging, including pre-procedural computed tomography and intracoronary imaging, are useful to understand the distribution and morphology of the calcium. Specialised guidewires and microcatheters, as well as penetration, subintimal entry and luminal re-entry techniques, are required to cross calcific CTOs. The use of both atherectomy devices and balloon-based calcium modification tools has been reported during CTO percutaneous coronary intervention, although they are limited by concerns regarding safety and efficacy in the subintimal space.

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.

scholarly journals The Impact of Successful Chronic Total Occlusion Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Real World

2020 ◽  
Author(s):  
Xuhe Gong ◽  
Li Zhou ◽  
Xiaosong Ding ◽  
Hui Chen ◽  
Hongwei Li
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Real World ◽  
Cardiac Death ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
The Impact

Abstract Backgroud: Chronic total occlusions (CTOs) are an important and increasingly recognized subgroup of coronary lesions; the optimal treatment strategy for CTO has not been well established. We sought to examine the impact of CTO percutaneous coronary intervention (PCI) on long-term clinical outcome in the real world.Methods: A total of 592 consecutive patients with CTO in Beijing Friendship Hospital from June 2017 to December 2019 were enrolled. 29 patients were excluded due to Coronary artery bypass grafting (CABG), 301 patients were revascularized by PCI (CTO-R group) and 262 were not revascularized (CTO-NR group). The primary endpoint was cardiac death; Secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, cardiac death, recurrent myocardial infarction, target lesion revascularization, re-hospitalization, heart failure, and stroke. Results: Percent of Diabetes mellitus (53.4% vs 39.5), Chronic kidney disease (8.8% vs 3.7%), CABG history (7.6% vs 1%), three vessel disease(96.2% vs 90%) and LM disease(25.2% vs 13.6%) was significantly higher in the CTO-NR group than in success PCI group (all P<0.05). Moreover, the CTO-NR group has lower EF (0.58±0.11 vs 0.61±0.1, p=0.002) and FS (0.32±0.07 vs 0.33±0.07, p=0.003). At a median follow-up of 12 months, CTO-R was superior to CTO-NR in terms of cardiac death (adjusted hazard ratio [HR]: 0.32, 95% conference interval [CI] 0.11-0.94). The superiority of CTO-R was consistent for MACCE (HR: 0.57, 95% CI 0.37-0.87). At multivariable Cox hazards regression analysis, CTO-R remains one of the independent predictors of lower risk of cardiac death and MACCE.Conclusions: Successful revascularization by PCI offered CTO patients more clinical benefits. The presence of LVEF＜0.5 and LM-disease was associated with an incidence of cardiac death; CTO revascularised was a protected predictor of cardiac death.

scholarly journals New Aspects in Percutaneous Coronary Intervention of Chronic Total Occlusions

2019 ◽  
Author(s):  
Judit Karácsonyi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Intravascular Imaging ◽  
Complication Rates ◽  
Technical Failure ◽  
Success Rates ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
Procedural Success ◽  
The Impact

Coronary Chronic total occlusions (CTOs) are defined as coronary lesions with Thrombolysis in Myocardial Infarction (TIMI) grade 0 flow of at least 3-month duration. Symptomatic patients with CTOs can be managed in three ways, conservatively with medical therapy, with coronary artery bypass grafting (CABG) or with percutaneous coronary intervention (PCI). CTO PCI can be challenging to perform with variable success rates, depending on operator experience and expertise, but with the development of new techniques and equipment the success rates are getting higher and the complication rates lower. In this dissertation, we focused on three aspects of CTO PCI: (a) the impact of prior failure on the outcomes of CTO PCI, (b) balloon uncrossable lesions and (c) the frequency of use and outcomes of intravascular imaging. We examined the prevalence, clinical and angiographic characteristics, management and procedural outcomes of CTO PCIs in a contemporary, large, multicenter CTO PCI registry. Prior CTO PCI failure has been associated with lower procedural success rates and is part of the Japanese Chronic Total Occlusion (J-CTO) score that was developed to predict the likelihood of successful guidewire crossing within 30 minutes. We sought to examine the impact of prior failure on the subsequent outcomes CTO PCI. The main finding of our study is that a prior failed CTO PCI attempt is associated with higher angiographic complexity, longer procedural duration and fluoroscopy time, but not with lower success and higher complication rates of subsequent CTO PCI attempts. Balloon uncrossable lesions are lesions that cannot be crossed with a balloon after successful advancement of the guidewire distal to the lesion. These lesions can be challenging to treat, requiring specialized techniques and equipment. In our study, we found that balloon uncrossable CTOs are common, are associated with high rates of technical failure, and require specialized techniques for successful treatment. Intravascular imaging can facilitate CTO PCI. Use of intravascular ultrasound (IVUS) for stent optimization during CTO PCI has been shown to improve long-term outcomes, yet its impact on crossing has received limited study. In our study, we found that intravascular imaging is frequently performed during CTO PCI both for crossing and for stent selection/ optimization. Despite its use in more complex lesion subsets, intravascular imaging was associated with similar rates of technical and procedural success for CTO PCI.

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.

Calcium Modifications Therapies in Contemporary Percutaneous Coronary Intervention

2021 ◽  
Vol 18 ◽  
Author(s):  
Mohammad Zaidan MD ◽  
Mohammad Alkhalil MRCP DPhil ◽  
Khaldoon Alaswad MD
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Daily Basis ◽  
Response To Therapy ◽  
Total Occlusion ◽  
Stent Expansion ◽  
Percutaneous Coronary ◽  
Short And Long Term

Abstract: Coronary artery calcifications (CAC) has been known to be associated with worse Percutaneous Coronary Intervention (PCI) short- and long-term outcomes. Nowadays with the increased prevalence of the risk factors leading to CAC in the population and also more PCI procedures done in older patients and with the growing number of higher risk cases of chronic total occlusion (CTO) PCI and PCI after coronary artery bypass grafting(CABG), severe cases of CAC are now encountered on a daily basis in the catheterization lab and remain a big challenge to the interventional community, making it crucial to identify cases of severe CAC and plan a CAC PCI modification strategy upfront. Improved CAC detection with intravascular imaging helped identifying more of these severe CAC cases and predicting response to therapy and stent expansion based on CAC distribution in the vessel. Multiple available therapies for CAC modification has evolved over the years, familiarity with the specifics and special considerations and limitations of each of these tools is essential in the choice and application of these therapies when used in severe CAC treatment. In this review we discuss CAC pathophysiology, modes of detection, and different available therapies for CAC modification.

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