CTO in contemporary PCI

2021 ◽  
Vol 17 ◽  
Author(s):  
Mohamed Farag ◽  
Mohaned Egred
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Success Rate ◽  
Risk Prediction ◽  
Coronary Intervention ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
Increasing Operator ◽  
Scoring Tools ◽  
Insight Into

: Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) represents the most challenging procedure in modern endovascular treatments. In recent years, the success rate of CTO PCI has substantially improved, owing to increasing operator expertise and advancements in CTO equipment and algorithms as well as the development of expert consensus documents. In this review, we summarize existing evidence for CTO PCI, its success/ risk prediction scoring tools, procedural principles and complications and provide an insight into the future role of CTO PCI.

scholarly journals Tips and Tricks for PCI of Chronic Total Occlusions – A Review

2021 ◽  
Vol 02 (01) ◽  
pp. 031-041
Author(s):  
Rohit Mody
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Success Rate ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Tips And Tricks ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Antegrade Approach ◽  
Complex Patients ◽  
Percutaneous Coronary

Chronic total occlusion recanalization still represents the final frontier in percutaneous coronary intervention. Retrograde recanalization is one of the greatest amendments of this technique. At present, it has become an integral complement to the traditional antegrade approach. Despite being most frequently used in complex patients, it has the highest success rate with the lowest incidence of complications. Since its inception, significant iterations have occurred that made this technique safer, faster, and even more successful.

The Role of Percutaneous Coronary Intervention in the Treatment of Chronic Total Occlusions: Rationale and Review of the Literature

2019 ◽  
Vol 17 (3) ◽  
pp. 278-290
Author(s):  
Harsh Agrawal ◽  
Richard A. Lange ◽  
Ruben Montanez ◽  
Soma Wali ◽  
Khan Omar Mohammad ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Cochrane Library ◽  
Success Rates ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary

Background: Chronic total occlusion (CTO) of a coronary artery is defined as an occluded segment with no antegrade flow and a known or estimated duration of at least 12 weeks. </P><P> Objective: We considered the current literature describing the indications and clinical outcomes for denovo CTO- percutaneous coronary intervention (PCI), and discuss the role of CTO-PCI and future directions for this procedure. </P><P> Methods: Databases (PubMed, the Cochrane Library, Embase, EBSCO, Web of Science, and CINAHL were searched and relevant studies of CTO-PCI were selected for review. </P><P> Results: The prevalence of coronary artery CTO’s has been reported to be ~ 20% among patients undergoing diagnostic coronary angiography for suspected coronary artery disease. Revascularization of any CTO can be technically challenging and a time-consuming procedure with relatively low success rates and may be associated with a higher incidence of complications, particularly at non-specialized centers. However, with an increase in experience and technological advances, several centers are now reporting success rates above 80% for these lesions. There is marked variability among studies in reporting outcomes for CTO-PCI with some reporting potential mortality benefit, better quality of life and improved cardiac function parameters. Anecdotally, properly selected patients who undergo a successful CTO-PCI most often have profound relief of ischemic symptoms. Intuitively, it makes sense to revascularize an occluded coronary artery with the goal of improving cardiovascular function and patient quality of life. </P><P> Conclusion: CTO-PCI is a rapidly expanding specialized procedure in interventional cardiology and is reasonable or indicated if the occluded vessel is responsible for symptoms or in selected patients with silent ischemia in whom there is a large amount of myocardium at risk and PCI is likely to be successful.

Percutaneous coronary intervention for chronic total occlusions: the role of side-branch obstruction

2009 ◽  
Vol 4 (5) ◽  
pp. 600-606 ◽  
Author(s):  
Ioannis Paizis ◽  
Athanassios Manginas ◽  
Vassilis Voudris ◽  
Gregory Pavlides ◽  
Konstantinos Spargias ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Side Branch ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary

scholarly journals Impact of occlusion duration on the success rate and outcomes of percutaneous coronary intervention in chronic total occlusions

2015 ◽  
Vol 23 (3) ◽  
pp. 183-189
Author(s):  
Antonio de Castro Filho ◽  
Edgar Stroppa Lamas ◽  
Mário Barbosa G. Nunes ◽  
Dimytri A. Siqueira ◽  
Rodolfo Staico ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Success Rate ◽  
Coronary Intervention ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary

scholarly journals Reattempt Percutaneous Coronary Intervention of Chronic Total Occlusions after Prior Failures: A Single-Center Analysis of Strategies and Outcomes

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Mingqiang Fu ◽  
Shufu Chang ◽  
Lei Ge ◽  
Dong Huang ◽  
Kang Yao ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Success Rate ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Complication Rates ◽  
Ventricular Ejection Fraction ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
Collateral Channel

Objective. The initial recanalization rate of coronary chronic total occlusions (CTOs) is >85% when performed by experienced operators, but only 10% of prior failed CTO patients receive reattempted recanalization. This retrospective study analyzed the success rate and strategies used in reattempt percutaneous coronary intervention (PCI) of CTOs after prior failures. Methods. Overall, 206 patients with 212 CTOs were enrolled. All patients with prior recanalization failures received reattempt PCIs from January 2015 to March 2019 at Zhongshan Hospital, Fudan University. Data on clinical factors (age, sex, comorbidities, left ventricular ejection fraction, history of cigarette usage, and revascularization), angiographic characteristics of CTOs (target lesion, Japanese Chronic Total Occlusion (J-CTO) score, the morphology of CTO lesions, and collateral channel scale), strategies (procedural approach and use of devices), and major adverse events were obtained and analyzed. Results. The mean age of enrolled patients was 60.96 ± 12.36 years, with a male predominance of 90.3%. Of the patients, 47.1% had a prior myocardial infarction and 70.4% underwent stent implantation previously, while the in-stent occlusion rate was 6.6%. CTOs were primarily localized in the left anterior descending artery (43.9%) and the right coronary artery (43.9%). 80.7% of lesions were classified as very difficult (J-CTO score ≥3), and the overall success rate was 81.1%. In multivariable regression analysis, J-CTO score, collateral channel scale, application of coronary multispiral computed tomography angiography, dual injection, intravascular ultrasound, active greeting technique, parallel wiring, and CTO morphology were predictors of recanalization success. There were no significant differences in rates of procedural complications between the final recanalization success and failure groups. Conclusions. Recanalization of complex CTOs is associated with high success rate and low complication rates when performed by high-volume CTO operators and after multiple reattempts.

scholarly journals The Outcomes of Percutaneous Coronary Intervention in Chronic Total Coronary Occlusion: A Single Center Report

1970 ◽  
Vol 6 (1) ◽  
pp. 13-17
Author(s):  
AKM Fazlur Rahman ◽  
Mohammad Salman ◽  
Sajal K Banerjee ◽  
Khairul Anam ◽  
Mukhlesur Rahman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Success Rate ◽  
Clinical Success ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
Procedural Success

Chronic total occlusions (CTOs) are commonly found on diagnostic angiography, and successful percutaneous coronary intervention leads to an improvement in long-term survival rates. This study was done in the University Cardiac Center, Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2005 to December 2009. The aim of this study was to examine the trends in angiographic success, clinical success, procedural success and in-hospital outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Total 60 patients (male: female, 11:1) with Mean age 48±10 years were studied. 36 (60%) patients had prior myocardial infarction and all of them had angina (CCS-III, IV). Mean length and reference diameter of the CTO lesion was 19.7±10.4 mm and 2.8±0.5 mm respectably. Clinical success, angiographic success and procedural success rate was (78.3%), (80.0%) and (66.7%) respectably. In hospital adverse outcomes were acute myocardial infarction (5.0%), acute left ventricular failure (6.7%) and malignant arrhythmias (VT, VF) (10.0%). PCI was failed in (11.7%) cases and there was acute in-stent thrombosis in (1.7%) cases. In conclusion it is possible to obtain a relatively high success rate of PCI and favorable clinical outcomes for patients with coronary CTO lesions. Key words: Chronic total occlusions; In hospital adverse outcomes; Percutaneous coronary interventionDOI: 10.3329/uhj.v6i1.7183University Heart Journal Vol.6(1) 2010 pp.13-17

Genetic predictors for symptoms recurrenсe in coronary artery disease after percutaneous coronary intervention

2017 ◽  
pp. 81-86
Author(s):  
Г.А. Березовская ◽  
Е.С. Клокова ◽  
Н.Н. Петрищев
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Folate Metabolism ◽  
Genotype Distribution ◽  
Polymorphic Markers ◽  
Percutaneous Coronary ◽  
Artery Disease

Гены тромбообразования и фолатного обмена играют важную роль в развитии и прогрессии ишемической болезни сердца (ИБС). Однако о возможной роли полиморфных маркеров в рецидиве ИБС после чрескожного коронарного вмешательства (ЧКВ) известно недостаточно. Цель исследования: Оценить роль генетических факторов системы тромбообразования и фолатного обмена (полиморфных маркеров генов F5, F2, F13A1, PAI1, HPA1, MTHFR, FGB ), в возобновление клиники ИБС после ЧКВ. Методика: Исследование проводили с использованием выборки из 90 больных ИБС в возрасте от 40 до 75 лет: 75 пациентов после планового ЧКВ (60 мужчин и 15 женщин) и 15 лиц после экстренного ЧКВ (12 мужчин и 3 женщины). Молекулярно-генетическое исследование было выполнено с помощью комплекта реагентов «Сердечно-сосудистые заболевания СтрипМетод»® (ViennaLab Diagnostics GmbH, Австрия), выявляющие следующие варианты: F5, F2, F13A1, PAI1, HPA1, MTHFR, FGB . Результаты: В результате исследования была показана ассоциация полиморфного маркера G103T ( Val34Leu ) гена F13A1 (фактор свертываемости крови 13, субъединица A1) с развитием рецидивирующего состояния ИБС после ЧКВ. Выявлены статистически значимые различия в распределении частот генотипов полиморфного маркера Val34Leu гена F13A1 . Показано, что частота генотипа Val/Val у пациентов с осложнениями была выше, чем у пациентов без таковых: 0,700 и 0,400 соответственно (c = 7,78; p = 0,020), при этом генотип Val/Val проявил себя как фактор риска развития осложнений: ОШ = 3,50 (95%ДИ 1,37-8,93). При сравнении аллелей выявили, что частота аллеля L у больных с осложнениями была ниже, чем у лиц без таковых: 0,167 и 0,375 соответственно (p = 0,004), и носительство аллеля L уменьшало вероятность развития осложнений: ОШ = 0,33 (95%ДИ 0,15-0,72). Заключение: Носительство варианта 34V гена F13A1 , кодирующего A-субъединицу фактора свёртывания 13, предрасполагает к возобновлению клинических проявлений ИБС после ЧКВ. Genes of thrombosis and folate metabolism play an important role in development and progression of coronary artery disease (CAD). However, a possible role of polymorphic markers in CAD relapse following percutaneous coronary intervention (PCI) is not sufficiently understood. Background. Reports have indicated an association of genetic factors generally related with thrombophilia and recurrence of symptoms for coronary artery disease (CAD) following a percutaneous coronary intervention (PCI) due to restenosis and in-stent thrombosis. However, the relapse can also be caused by progression of atherosclerosis and endothelial dysfunction in unoperated blood vessels. Aim: To assess the role of genetic risk factors involved in thrombosis and folate metabolism (polymorphic markers of F5, F2, F13A1, PAI1, HPA1, MTHFR, and FGB genes) in recurrence of CAD symptoms after PCI. Methods: The study included 90 patients with CAD aged 40-75; 75 of these patients had undergone elective PCI (60 men and 15 women) and 15 patients - emergency PCI (12 men and 3 women). Molecular genetic tests were performed using a CVD StripAssays® reagent kit (ViennaLab Diagnostics GmbH, Austria) to identify the following genetic variations: F5, F2, F13A1, PAI1, HPA1, MTHFR, and FGB . Results: The study results showed a significant association of the G103T ( Val34Leu ) polymorphism in the F13A1 gene with relapses of IHD after PCI. Significant differences were found in genotype distribution frequencies of the Val34Leu polymorphism in the F13A1 gene. The frequency of Val / Val genotype was higher in patients with complications than without complications, 0.700 and 0.400, respectively (c = 7.78, p = 0.020). Furthermore, the Val/Val genotype can be classified as a risk factor for complications (OR = 3.50; 95% CI, 1.37-8.93). The L allele frequency was lower in patients with complications than in those without complications (0.167 and 0.375, respectively, p = 0.004), and carriage of the L allele reduced the likelihood of complications (OR = 0.33; 95% CI 0.15-0.72). Conclusion: Carriage of the 34V variant in the F13A1 gene that encodes the coagulation factor XIII A subunit predisposes to a relapse of CAD symptoms after PCI.

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