scholarly journals Percutaneous Coronary Intervention in Chronic Total Occlusion - In Hospital Outcome

1970 ◽  
Vol 1 (2) ◽  
pp. 156-160
Author(s):  
N Kar ◽  
M Ullah ◽  
PK Karmakar ◽  
AEM Mazharul Islam ◽  
AQM Reza ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Chronic Stable Angina ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Hospital Outcome ◽  
Number Of Patients ◽  
Percutaneous Coronary ◽  
Cardiac Catheterizations

Background- Although a total coronary occlusion is identified approximately in one third of the diagnostic cardiac catheterizations, still an attempted revascularization of total occlusion accounts for less than 8% of all percutaneous coronary interventions (PCI). Percutaneous Coronary Intervention (PCI) of chronic total occlusion (CTO) is one of the major challenges in interventional cardiology. It is now an well-accepted revascularization procedure.  Methods: It was a prospective observational study conducted in National Institute of Cardiovascular Diseases, Dhaka, from July 2004 to June 2005. 50 consecutive patients with chronic total occlusion undergoing PCI were included in the study. Patients were observed during procedure and during the hospital stay. Result: The mean age of the patients was 46.7 ± 9.3 and 48.0% were in the age range of 45-54 years. 24 patients had post MI angina, 20 patients had chronic stable angina and 6 patients had unstable angina. Technical success was in 98% cases and procedural success was in 94% cases. One patient developed vessel perforation and was treated by prolonged balloon inflation. There was no death or STEMI and only 2 patients developed NSTEMI. Conclusion: In our study with the use of available facilities PCI in CTOs was possible with a high success rate. But dealing of more complicated lesion will require more improved technology and hardware. A study with larger number of patients and longer duration of follow up to determine the efficacy of the procedure in improving morbidity and mortality is needed. Keywords : Chronic total occlusion; Percutaneous Coronary Intervention; In hospital outcome DOI: http://dx.doi.org/10.3329/cardio.v1i2.8122 Cardiovasc. j. 2009; 1(2) : 156-160

Acute, in-Hospital Outcome of Percutaneous Coronary Intervention for In-Stent Chronic Total Occlusion

2019 ◽  
Vol 20 (11) ◽  
pp. 997-1000 ◽  
Author(s):  
Jan-Erik Guelker ◽  
Alexander Bufe ◽  
Christian Blockhaus ◽  
Jan Gesenberg ◽  
Julian Kuervers ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Hospital Outcome ◽  
Percutaneous Coronary

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<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.

P3587Tip detection method using the new short-tip IVUS with pull-back system which facilitates the 3D wiring technique in percutaneous coronary intervention for chronic total occlusion

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Tanaka ◽  
A Okamura ◽  
M Iwakura ◽  
H Nagai ◽  
A Sumiyoshi ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Intravascular Ultrasound ◽  
Chronic Total Occlusion ◽  
Distal Part ◽  
Detection Method ◽  
Coronary Intervention ◽  
Procedure Time ◽  
True Lumen ◽  
Total Occlusion ◽  
Percutaneous Coronary

Abstract Background The strategy of intravascular ultrasound (IVUS)-guided wiring for CTO PCI, that is, leading the second guidewire into the true lumen under observing by IVUS from subintimal space, is the last resort. We developed the angiography-based 3D wiring method. During establishment of the angiography-based 3D wiring method, we deduced that observation of the guidewire tip as well as the shaft named “The tip detection method” simplifies and facilitates 3D wiring under IVUS-guided wiring. Therefore, we produced New CTO IVUS which is the upgraded version of Navifocus WR IVUS by adding the pull-back transducer system. This pull-back system enables us to detect the tip as well as the shaft of the second guidewire in real time (tip detection method), which facilitates the 3D wiring technique under IVUS-guided wiring. Objective We evaluated the efficacy of the tip detection method during 3D wiring for CTO PCI with New CTO IVUS. Method We created a target pinpoint penetration model and performed the procedures using an experimental heartbeat model. The target (a tube with a lumen 0.6 mm in diameter) was placed in the distal part of a CTO 20 mm in length made of 2.5% agar. After the second guidewire (Conquest-12g) was advanced into the CTO lesion to within 5mm of the target using the angiography-based wiring, IVUS-guided wiring was performed by using Navifocus WR or New CTO IVUS each five times. Result The frequency of the puncture time was reduced using the new CTO IVUS compared to the Navifocus WR (1.7±0.8 vs. 28.8±23.2, p=0.17). The procedure time was significantly shorter using the new CTO IVUS compared to the Navifocus WR (103±61 vs. 459±373 seconds, p=0.04). Conclusion The tip detection method during 3D wiring with the new short tip IVUS with the pull-back system enables us to easily perform 3D wiring and will change the CTO PCI strategy.

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