scholarly journals The retrograde technique for recanalization of chronically occluded coronary arteries: Case series report

2020 ◽  
pp. 124-124
Author(s):  
Stefan Juricic ◽  
Milorad Tesic ◽  
Milan Dobric ◽  
Srdjan Aleksandric ◽  
Zlatko Mehmedbegovic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Case Series ◽  
Interventional Cardiology ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Special Technique ◽  
Retrograde Approach ◽  
Total Occlusion ◽  
Antegrade Approach ◽  
Increased Risk

Background. Chronic total occlusion (CTO) of coronary artery still represents one of the most challenging lesion subset in field of interventional cardiology. Considering the complexity and increased risk posed by the retrograde approach, it is most often performed after a failed antegrade approach. Methods. We present a series of cases dedicated to the retrograde approach as a special technique for the treatment of chronic total coronary artery occlusion. All cases have some special characteristics that are today part of a dedicated portfolio in every cath lab. Results. In our series of cases all of three percutaneous coronary interventions (PCI) with retrograde approach finished with successful recanalization of CTO with different strategy and supported with rotational atherectomy (RA) or intravascular ultrasound (IVUS). Conclusion. In cases where there is the presence of interventional collaterals, as well as when the anterograde approach is very difficult, the retrograde approach can increase the success rate of procedures. The retrograde approach requires a long learning curve as well as very skilled and experienced operators who are able to perform the procedure independently.

Early time course of myocardial electrical impedance during acute coronary artery occlusion in pigs, dogs, and humans

2005 ◽  
Vol 99 (4) ◽  
pp. 1576-1581 ◽  
Author(s):  
Carlos L. del Rio ◽  
Patrick I. McConnell ◽  
Bradley D. Clymer ◽  
Roger Dzwonczyk ◽  
Robert E. Michler ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Time Course ◽  
Electrical Impedance ◽  
Early Time ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Acute Ischemia ◽  
Collateral Flow ◽  
Total Occlusion ◽  
Interspecies Differences

Changes in myocardial electrical impedance (MEI) and physiological end points have been correlated during acute ischemia. However, the importance of MEI's early time course is not clear. This study evaluates such significance, by comparing the temporal behavior of MEI during acute total occlusion of the left anterior descending coronary artery in anesthetized humans, dogs, and pigs. Here, interspecies differences in three MEI parameters (baseline, time to plateau onset, and plateau value normalized by baseline) were evaluated using Kruskal-Wallis ANOVA and post hoc tests ( P < 0.05). Noteworthy differences in the MEI time to plateau onset were observed: In dogs, MEI ischemic plateau was reached after 46.3 min (SD 12.9) min of occlusion, a significantly longer period compared with that of pigs and humans [4.7 (SD 1.2) and 4.1 min (SD 1.9), respectively]. However, no differences could be observed between both animal species regarding the normalized MEI ischemic plateau value (15.3% (SD 4.7) in pigs, vs. 19.6% (SD 2.6) in dogs). For all studied MEI parameters, only swine values resembled those of humans. The severity of myocardial supply ischemia, resulting from coronary artery occlusion, is known to be dependent on collateral flow. Thus, because dogs possess a well-developed collateral system (unlike humans or pigs), they have shown superior resistance to occlusion of a coronary artery. Here, the early MEI time course after left anterior descending coronary artery occlusion, represented by the time required to reach ischemic plateau, was proven to reflect such interspecies differences.

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.

scholarly journals A Sign to Heaven: aVR Lead Elevation and Myocardial Infarction

2011 ◽  
Vol 11 ◽  
pp. 662-665
Author(s):  
Amir M. Nia ◽  
Natig Gassanov ◽  
Hannes Reuter ◽  
Fikret Er
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Proximal Part ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Correct Treatment ◽  
Total Occlusion ◽  
St Segment Elevation ◽  
St Segment ◽  
Long Time

Isolated ST-segment elevation only in the aVR lead, reflecting an acute myocardial infarction due to a left main coronary artery occlusion, was ignored as part of physicians' training in emergency medicine for a long time. The recognition of aVR lead elevation is becoming more accepted as a mandatory diagnostic tool, in particular for physicians working at emergency departments. We report a typical myocardial infarction with total occlusion of the proximal part of the left anterior coronary artery, presenting with ST-segment elevation in the aVR lead, which was misinterpreted as diffuse ischemia. The lacking mandatory awareness of this entity endangered prompt and correct treatment.

scholarly journals Recanalization of coronary artery chronic total occlusion by retrograde approach

2017 ◽  
Vol 145 (11-12) ◽  
pp. 627-631
Author(s):  
Vladimir Ivanovic ◽  
Milenko Cankovic ◽  
Igor Ivanov ◽  
Jadranka Dejanovic ◽  
Anastazija Stojsic-Milosavljevic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Blood Vessel ◽  
Chronic Total Occlusion ◽  
Myocardial Revascularization ◽  
Retrograde Approach ◽  
Total Occlusion ◽  
Antegrade Approach ◽  
Pass Through ◽  
Antegrade Flow ◽  
Vessel Dissection

Introduction. Chronic total occlusion (CTO) is defined as a 100% obstruction of the blood vessel lumen with Thrombolysis in Myocardial Infarction grade 0 flow in the occluded segment at least three months old. Advancement of technological devices and techniques used during the percutaneous coronary interventions (PCI) in the past years brought more success in blood vessel recanalization. According to the latest guidelines for myocardial revascularization, the CTO treatment should be considered when there are symptoms or objective proof of viability or ischemia in the occluded area. The aim of this work is to present two cases with a recanalization of the coronary artery CTO by the retrograde approach. Outline of cases. The first patient had a single vessel coronary disease which led to a decision to first attempt PCI. During the attempt of antegrade recanalization, the guidewire penetrated subintimally, risking blood vessel dissection below the occluded area as well as serious complications. Retrograde approach enabled easier and safer passing of guidewire through the occlusion and then successful establishment of the antegrade flow. In the second case, the antegrade approach was also first attempted. Since it could not pass through the occluded area despite changing several guidewires, the strategy was changed during the intervention. It was continued with the retrograde approach, which led to the successful revascularization. Conclusion. These two cases demonstrate that retrograde approach and new technological improvements in dedicated guidewires can be implemented in everyday angiography practice for successful recanalization of CTO lesions.

scholarly journals The significance of coronary collateral circulation in the preservation of myocardial function

2007 ◽  
Vol 60 (5-6) ◽  
pp. 287-291
Author(s):  
Vladimir Ivanovic ◽  
Nikola Jelkic ◽  
Miroslav Bikicki ◽  
Milovan Petrovic ◽  
Tibor Canji ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Blood Vessels ◽  
Collateral Circulation ◽  
Stress Test ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Left Ventricular ◽  
Vessel Occlusion ◽  
Total Occlusion ◽  
Coronary Stent Implantation

Introduction: After occlusion or subocclusion of the blood vessels, myocardial perfusion is maintained through the collateral vessels. There are two mechanisms of vessel formation: arteriogenesis and angiogenesis. The term arteriogenesis describes the growth of the existing collaterals into mature arteries. On the other hand, angiogenesis, is a process of developing new blood vessels from the preexisting ones. Collateral blood vessels have many functional roles. If they are adequately developed, they can protect the myocardium from ischemic injury. Even when a total occlusion develops, regional left ventricular motility is better in segments with developed collateral circulation. In patients with well-developed collaterals, who experience coronary artery occlusion, often there is no evidence of myocardial infarction in the area of the occluded artery. Well-developed collaterals reduce the risk of unstable cardiac events. Case report A case of right coronary artery occlusion with good collateral circulation and preserved myocardial left ventricular motility is presented. After coronary stent implantation, the patient was asymptomatic, and the maximal stress test for myocardial ischemia was negative. Conclusion: Despite coronary vessel occlusion, collateral blood flow maintains the pump function of the left ventricle.

scholarly journals Long-term Prognosis after Treatment of Total Occluded Coronary Artery is well Predicted by Neutrophil to High-Density Lipoprotein Ratio: a Comparison Study

Kardiologiia ◽  
2021 ◽  
Vol 61 (7) ◽  
pp. 60-67
Author(s):  
Mehmet Ozgeyik ◽  
Mufide Okay Ozgeyik
Keyword(s):  
Coronary Artery ◽  
Confidence Interval ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Mortality Prediction ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Increased Risk

Aim    Mortality prediction is very important for more effective treatment of patients with acute coronary syndrome. Hematological and lipid parameters have been used for this purpose, as this approach is non-invasive and cost effective. In this study, our aim was to evaluate which parameter predicts mortality most accurately.Material and Methods    Data of 554 patients with at least one total coronary artery occlusion were collected retrospectively. Receiver operating characteristic curves were used to determine the optimal cut-off points of Neu / HDL, Neu / Lym, Mono / HDL, Trig / HDL, HDL / LDL, Plt / Lym and Lym / HDL according to long-term cardiovascular survival. Median follow-up time was 520 days, and 30 patients died.Results    The mean age was 60.96±0.50 yrs. The area under the curve (AUC) for Neu / HDL was 0.830 (p<0.001, 95 % confidence interval [CI]: 0.753 to 0.908). The cut-off point was 0.269, with a sensitivity of 74.2 % and a specificity of 74.2 %. The AUC for Neu / Lym was 0.688 (p<0.001, 95 % CI: 0.586 to 0.790). The cut-off point was 5.322, with a sensitivity of 67.7 % and a specificity of 67.1 %. The Neu / HDL (hazard ratio, HR [confidence interval, CI]: 0.202 [0.075–0.545], p=0.002) and Neu / Lym (0.306 [0.120–0.777], p=0.013) were associated with increased risk of death according to multivariate Cox regression analysis.Conclusions    Neu / HDL offers a better long-term mortality prediction than Neu / Lym, Mono / HDL, Trig / HDL, HDL / LDL, Plt / Lym, or Lym / HDL after treatment of total coronary artery occlusion.

scholarly journals Chronic coronary artery occlusion: when does the benefit outweigh the risk?

2019 ◽  
pp. 116-123
Author(s):  
A. G. Badoyan ◽  
D. A. Khelimsky ◽  
A. A. Shermuk ◽  
O. V. Krestyaninov ◽  
A. S. Bobrova ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Coronary Artery ◽  
Coronary Occlusion ◽  
Interventional Cardiology ◽  
Coronary Artery Occlusion ◽  
Evidence Base ◽  
Artery Occlusion ◽  
Endovascular Recanalization ◽  
Chronic Coronary Occlusion

Today, the treatment of patients with chronic coronary occlusion is one of the most difficult problems in interventional cardiology. This is due not only to the technical difficulties of endovascular recanalization, but also to the difficulty in selecting patients for whom revascularization will be beneficial. Due to the low evidence base and the conflicting results of large clinical trials, these patients are rarely referred for endovascular recanalization. The purpose of this article is to review the literature and systematize relevant knowledge on the management of patients with chronic coronary occlusion.

scholarly journals Ritka etiológiájú fiatalkori szívinfarktus

2015 ◽  
Vol 156 (25) ◽  
pp. 1020-1025
Author(s):  
Gábor Zoltán Nagy ◽  
Gábor Gerges ◽  
Kálmán Csapó ◽  
Erika Csengő ◽  
Károly Minik
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Aortic Dissection ◽  
Young Patients ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Left Main ◽  
Diagnostic Challenge ◽  
Total Occlusion ◽  
Coronary Syndrome

Chest pain is not uncommon among young patients below the age of 35 years, however, it is rarely caused by acute coronary syndrome. The rarity of coronary artery occlusion in this population can easily lead to diagnostic mistakes. The authors present the case history of a 19-year-old young female, who was admitted to the emergency department of a local hospital due to the sudden onset of chest pain and malaise. ST-segment elevation was seen on the electrocardiogram raising the possibility of aortic dissection, therefore, emergency thoracic computed tomographic scan was performed. This proved to be negative and the patient was transferred to the coronary care unit. Urgent coronarography was carried out, which revealed the total occlusion of the left main coronary artery. The occluded artery was successfully opened with percutaneous coronary intervention, but despite revascularisation the patient died on the second postoperative day due to asystole. Autopsy revealed thrombotic embolization of the left main artery with consequent extensive haemorrhagic necrosis, involving almost the whole left ventricle. The source of embolization was not found. The authors note that left coronary artery occlusion in young patients can be a diagnostic challenge, because symptoms can be mistaken with aortic dissection or pulmonary embolism. Orv. Hetil., 2015, 156(25), 1020–1025.

scholarly journals Chronic total occlusion (CTO) revascularization a comparison from Japanese and European expert CTO operators registries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Takeshi ◽  
W.G Gerald S Werner ◽  
T.M Muramatsu ◽  
G.R Giunta ◽  
R.M Ribeiro ◽  
...  
Keyword(s):  
Success Rate ◽  
Coronary Artery Occlusion ◽  
Retrograde Approach ◽  
Technical Success ◽  
Total Occlusion ◽  
Technical Success Rate ◽  
Severe Lesion ◽  
Antegrade Approach ◽  
Procedural Time ◽  
Procedural Complications

Abstract Background Development of different strategies and devices improved CTO revascularization. However, technical and procedural success might be influenced by several factors including geographical expertise. Methods A total of 4412 CTO coronary treated lesions (Japan 1531 Europe 2881) (mean age 64.5±10.7, male 85.2%, JCTO score 2.09±1.24) were analyzed in European and Japanese registries during the year 2016. The primary endpoint was to assess technical success rate of CTO-PCI cases and procedural outcomes. Results Primary Antegrade approach and success rate were 71.5% and 90.8% respectively in Japan while 77.0% and 94.1%, respectively in Europe, (p&lt;0001). Primary Retrograde approach and success rate were 28.5% and 84.0% respectively in Japan, while 22.6% and 69.2%, in Europe (p&lt;0001). There were no differences in technical success rate between Japan and Europe (89.9% vs 88.5%, p=0.13). Procedural time was higher in Japan than in Europe 156.3±1.8 vs 107.1±1.3 mins (p&lt;0.001), but contrast media volume resulted the opposite 209.6±3.2 ml vs 267.5±2.4 ml, (p&lt;0.001). Procedural complications were higher in Japan than Europe (death: 0.4% vs 0.07%, p=0.024, myocardial infarction: 1.2% vs 0.57% p=0.045, coronary artery occlusion: 0.26% vs 0.07% p=0.026, coronary perforation: 4.22% vs 3.04% p=0.045). A multivariate analysis showed that independent predictors of failed procedure were both for Japan and Europe unsuccessful retrograde crossing channel, severe lesion calcification and occlusion length&gt;20mm. Conclusions Technical success rate was similar between Japan and Europe, but more retrograde approach was common in Japan. Unsuccessful retrograde crossing channel, severe lesion calcification and occlusion length&gt;20mm were independent predictors of failed procedures for both countries. Procedural complications were higher in Japan probably because of longer procedural time and higher frequency of retrograde approach. Funding Acknowledgement Type of funding source: None

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