scholarly journals Incidence, Predictors, and Prognosis of Coronary Slow-Flow and No-Reflow Phenomenon in Patients with Chronic Total Occlusion Who Underwent Percutaneous Coronary Intervention

2020 ◽  
Vol Volume 16 ◽  
pp. 95-101
Author(s):  
Yong Wang ◽  
Hong-wei Zhao ◽  
Cheng-fu Wang ◽  
Xiao-jiao Zhang ◽  
Jie Tao ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Slow Flow ◽  
Total Occlusion ◽  
No Reflow ◽  
Percutaneous Coronary ◽  
Coronary Slow Flow ◽  
No Reflow Phenomenon

scholarly journals Correlates of the “No-Reflow” or “Slow-Flow” Phenomenon in Patients Undergoing Primary Percutaneous Coronary Intervention

2018 ◽  
Author(s):  
Mohammad Alidoosti ◽  
Reza Lotfi ◽  
Masoumeh Lotfi-Tokaldany ◽  
Ebrahim Nematipour ◽  
Mojtaba Salarifar ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Slow Flow ◽  
Primary Pci ◽  
No Reflow ◽  
Timi Flow ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon ◽  
Infarct Related Artery

Background: Despite recent advances in interventional equipment and techniques, the angiographic no-reflow phenomenon occurs in a considerable number of patients undergoing primary percutaneous coronary intervention (PCI). We investigated the clinical, angiographic, preprocedural, and procedural characteristics associated with the no-reflow phenomenon among patients undergoing primary PCI. Methods: Between March 2008 and April 2013, 530 patients (78.5% male, mean age=58.11±12.39 y) with ST-segment-elevation myocardial-infarction who underwent primary PCI were categorized in 2 groups according to their postprocedural thrombolysis-in-myocardial infarction (TIMI) flow grades:  those with a maximum score of 2 (the no-reflow or slow-flow group) and the ones with a score of 3 (the reflow group). A multivariable logistic regression model was used to find the multiple correlates of the no-reflow phenomenon after PCI. Results: There were 166 (31.3%) patients in the no-reflow group and 364 (68.7%) in the reflow group. The no-reflow patients were older and had significantly longer target lesion lengths, higher SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) scores, higher infarct-related artery SYNTAX scores, more thrombus burden, and a higher frequency of initial TIMI flow grades of 2 or lower. Our multivariable logistic regression analysis demonstrated that older age, higher numbers of Q waves, not using statin, longer target lesion lengths, higher thrombus grades, and higher infarct-related artery SYNTAX scores remained the independent correlates of increased no-reflow rates after primary PCI (area under the ROC curve=0.784,  95% CI: 0.742–0.826; P<0.001). Conclusion: Clinical, angiographic, and procedural features of patients undergoing primary PCI may be correlated with the occurrence of the no-reflow phenomenon. The thrombus grade and the infarct-related artery SYNTAX score could be among these factors.

scholarly journals Late survival benefit of percutaneous coronary intervention compared with medical therapy in patients with coronary chronic total occlusion: a 10-year follow-up study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.K Park ◽  
S.H Choi ◽  
J.M Lee ◽  
J.H Yang ◽  
Y.B Song ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Treatment Strategy ◽  
Initial Treatment ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary

Abstract Background As an initial treatment strategy, percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) did not show mid-term survival benefits compared with optimal medical therapy (OMT). Purpose To compare 10-year clinical outcomes between OMT and PCI in CTO patients. Methods Between March 2003 and February 2012, 2,024 patients with CTO were enrolled in a single center registry and followed for about 10 years. We excluded CTO patients who underwent coronary artery bypass grafting, and classified patients into the OMT group (n=664) or PCI group (n=883) according to initial treatment strategy. Propensity-score matching was performed to minimize potential selection bias. The primary outcome was cardiac death. Results In the PCI group, 699 patients (79.2%) underwent successful revascularization. Clinical and angiographic characteristics revealed more comorbidities and more complex lesions in the OMT group than in the PCI group. At 10 years, the PCI group had lower risks of cardiac death (10.4% versus 22.3%; HR 0.43; 95% CI 0.32 to 0.57; p&lt;0.001) than the OMT group. After the propensity-score matching analyses, the PCI group had lower risks of cardiac death (13.6% versus 20.8%; HR 0.62; 95% CI 0.44 to 0.88; p=0.007), acute myocardial infarction (6.3% versus 11.2%; HR 0.55; 95% CI 0.34 to 0.91; p=0.02), any revascularization (23.9% versus 32.2%; HR 0.67; 95% CI 0.51 to 0.88; p=0.004) than the OMT group. The beneficial effects of CTO PCI were consistent across various subgroups (all p-values for interaction: non-significant). Conclusions As an initial treatment strategy, PCI reduced late cardiac death compared with OMT in CTO patients. Cardiac death in matched population Funding Acknowledgement Type of funding source: None

scholarly journals Antegrade Approach of Percutaneous Coronary Intervention for Chronic Total Occlusion

2021 ◽  
Author(s):  
C. Raghu ◽  
Rahul K. Ghogre ◽  
Alekhya Mandepudi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Chronic Total Occlusion ◽  
Bypass Surgery ◽  
Coronary Intervention ◽  
Technical Expertise ◽  
Total Occlusion ◽  
Antegrade Approach ◽  
Percutaneous Coronary ◽  
Coronary Lesions

AbstractChronic total occlusion (CTO) is a common challenge accounting for 10% of coronary lesions found on coronary angiography. Patients are frequently referred for bypass surgery because percutaneous coronary intervention is challenging in this subset. Recent advances in the hardware as well as the technical expertise and an algorithm approach have improved the success to more than 90%.Antegrade approach is the cornerstone for managing CTO and has two distinct strategies: antegrade wire escalation, and antegrade dissection and reentry strategy. Step-wise approach to perform these procedures and the use of adjunct imaging are discussed.

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