scholarly journals Prevalence and Characteristics of Acquired Coronary Fistulas After Successful Revascularization of Chronic Total Occlusion

2021 ◽  
Vol 8 ◽  
Author(s):  
Rong Fan ◽  
Haipeng Tan ◽  
Yanan Song ◽  
Wang Yao ◽  
Min Fan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Complete Revascularization ◽  
Total Occlusion ◽  
Coronary Artery Abnormalities ◽  
Coronary Perforation ◽  
Percutaneous Coronary ◽  
History Of ◽  
Male Patients

Background and Objectives: Acquired coronary fistulas (ACFs) are rare coronary artery abnormalities in patients with chronic total occlusion (CTO). It has been found after revascularization, and it may cause fluster during the CTO percutaneous coronary intervention (CTO PCI). How to distinguish between ACFs and coronary perforation (CP) is very important for CTO operators. Chronic total occlusion reopening may reveal the microchannel of the adventitial vascular layers. Some of ACFs have been seen after revascularization. This study aimed to investigate the characteristics of ACFs after successful CTO PCI.Methods: The clinical and procedural characteristics, medical history, and findings in electrocardiography (ECG), echocardiography, and coronary angiography were collected from 2,169 consecutive patients undergoing CTO PCI between January 2018 and December 2019 and analyzed retrospectively.Results: About 1,844 (85.02%) underwent successful CTO PCI with complete revascularization. Acquired coronary fistulas were found in 49 patients (2.66%): the majority of patients with ACFs were men (81.63 vs. 60.78%; p = 0.016) and younger (62.8 vs. 66.69 years; p = 0.003), and had a history of myocardial infarction (MI) or Q-wave (69.39 vs. 54.21%; p = 0.035); 38 (77.55%) patients had multiple fistulas (≥3), and ACFs affected multiple branches of the CTO vessel (≥3) in 29 (59.18%) patients. None had pericardial effusion, tamponade, and hemodynamic abnormality before or after PCI.Conclusion: Acquired coronary fistulas after successful CTO PCI are mainly present in young and male patients with a history of MI, and they often involve multiple fistulas and distal CTO vessels.

Dose All of the Coronary Fistulas been Created by the Reopening Wire After Successful Revascularization of Chronic Total Occlusion?

2020 ◽  
Author(s):  
Rong Fan ◽  
Haipeng Tan ◽  
Yanan Song ◽  
Wang Yao ◽  
Yawei Yang ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Complete Revascularization ◽  
Total Occlusion ◽  
Left Anterior Descending Artery ◽  
Percutaneous Coronary ◽  
History Of ◽  
The Right

Abstract Background: Coronary fistulas may be congenital or acquired generally as consequence of coronary interventions, mainly chronic total occlusion (CTO) reopening. When the reopening wire passes through the occlusion it may microperforate the advential vascular layers, favoring the fistulous communication between coronary vessel and cardiac chambers. But some of acquired coronary fistulas (ACFs) had been already present at the CTO vessels and would been seen after revascularization. This study was designed to investigate the characteristics of ACFs, which albeit mostly benign can cause concern and unnecessary treatment post successful CTO percutaneous coronary intervention (PCI).Methods: Data, including clinical and procedural characteristics, medical history, and findings in electrocardiography, echocardiography and coronary angiography, from 2169 consecutive patients undergoing CTO PCI between January 2018 and December 2019 were analyzed retrospectively. Results: 1844 (85.0%) underwent successful CTO PCI with complete revascularization. Among them, there were 49 cases (mean age, 62.80 ± 11.24 years; 40 men) of ACFs: 24 (49%) involved the right coronary artery, 19 (38.8%) the left anterior descending artery, and 6 (12.2%) the circumflex branch; and 38 (77.6%) were coupled with multiple fistulas (>3), and 29 (59.2%) affected multiple branches of the CTO vessel (>3). The majority of patients with ACFs had a history of MI or Q-wave (n=34, 69.4%), and angina was the most common complaint (n=41, 83.7%). None of them had pericardial effusion, tamponade and Hemodynamic abnormalities before or after PCI.Conclusion: ACFs after successful CTO PCI mostly developed in patients with MI history, originated from the right coronary artery or left anterior descending artery, and involved multiple fistulas and CTO vessel branches.

The Impact of Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention (Insights From PROGRESS-CTO Registry)

Angiology ◽  
2019 ◽  
Vol 71 (3) ◽  
pp. 274-280 ◽  
Author(s):  
Iosif Xenogiannis ◽  
Fotis Gkargkoulas ◽  
Dimitri Karmpaliotis ◽  
Khaldoon Alaswad ◽  
Oleg Krestyaninov ◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Peripheral Artery ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
History Of ◽  
Artery Disease ◽  
Procedural Success ◽  
The Impact ◽  
Complex Lesions

The impact of peripheral artery disease (PAD) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We reviewed 3999 CTO PCIs performed in 3914 patients between 2012 and 2018 at 25 centers, 14% of whom had a history of PAD. We compared the clinical and angiographic characteristics and procedural outcomes of patients with versus without history of PAD. Patients with PAD were older (67 ± 9 vs 64 ± 10 years, P < .001) and had a higher prevalence of cardiovascular risk factors. They also had more complex lesions as illustrated by higher Japanese CTO score (2.7 ± 1.2 vs 2.4 ± 1.3, P < .001). In patients with PAD, the final crossing technique was less often antegrade wire escalation (40% vs 51%, P < .001) and more often the retrograde approach (23 vs 20%, P < .001) and antegrade dissection/reentry (20% vs 16%, P < .001). Technical success was similar between the 2 study groups (84% vs 87%, P = .127), but procedural success was lower for patients with PAD (81% vs 85%, P = .015). The incidence of in-hospital major adverse cardiac events was higher among patients with PAD (3% vs 2%, P = .046). In conclusion, patients with PAD undergoing CTO PCI have more comorbidities, more complex lesions, and lower procedural success.

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