scholarly journals The prognostic significance of coronary flow reserve in the risk stratification of patients with chronic total occlusion of the right coronary artery and the intermediary stenosis of the left coronary artery

2020 ◽  
Vol 71 (2) ◽  
pp. 21-25
Author(s):  
Lara Hadži-Tanović ◽  
Nikola Bošković ◽  
Srđan Dedić ◽  
Branko Beleslin
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Flow ◽  
Chronic Total Occlusion ◽  
Left Coronary Artery ◽  
Prognostic Significance ◽  
Total Occlusion ◽  
Flow Reserve ◽  
The Right

Introduction: Coronary Flow Reserve (CFR) is a clinically useful, non-invasive diagnostic method for assessing the functional ability of coronary arteries and it is important for their long-term follow-up in patients. However, CFR has not always been sufficiently investigated in previous studies. Objective: To examine the prognostic significance of CFR in the risk stratification of patients with chronic total occlusion of the right coronary artery (RCA) and the intermediary stenosis of the left coronary artery (LAD). Material and Methods: Number of 71 patients, mean age 64 ± 7 years, (84%) patients male, having LAD stenosis, diameter 50-70%, and CTO of RCA, were referred for noninvasive estimation of functional significance of LAD stenosis. Transthoracic Doppler echocardiography was used to obtain coronary flow velocities in the distal segment of LAD. Patients were followed for the mean period of 18.3 ± 7.1 months for the occurrence of composite end point including cardiovascular death, myocardial infarction, bypass surgery and PCI. Results: During the follow-up period, there were a total of 23 adverse events (4 deaths, 2 myocardial infarction, 7 bypass surgeries and 10 PCI). Patients with CFR < 2 had significantly more adverse events (n = 9; 56.3% vs. n = 14; 25.5%; p = 0.021), they were significantly older (68 ± 9 vs. 62 ± 6; p = 0.011), with a higher incidence of a positive family history (14; 87.5% vs. 26; 47.3%; p = 0.039), as well as a significantly higher frequency of three-dose coronary disease (14; 87.5% vs. 30; 54.5%; p = 0.017). Using Kaplan-Meier estimator, we obtained that patients with CFR < 2 have a significantly shorter average period without unwanted event (15.4 ± 2.8 months vs 23.5 ± 1.1 months, Log Rank 7.407; p = 0.008). Conclusion: CFR plays an important role in stratifying the risk of patients with CTO of RCA and the intermediary stenosis of LAD.

scholarly journals Transcatheter Coil Embolization in 17 Patients with 22 Coronary Artery Fistulas

2020 ◽  
Vol 47 (2) ◽  
pp. 135-139
Author(s):  
Ismail Ates ◽  
Zeynettin Kaya ◽  
Deniz Mutlu ◽  
Zehra I. Akyildiz ◽  
Necmettin Korucuk ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coil Embolization ◽  
Left Coronary Artery ◽  
Success Rates ◽  
Coronary Artery Fistulas ◽  
Transcatheter Coil Embolization ◽  
The Right ◽  
Better Than

Coronary artery fistulas are rare anomalies that often become symptomatic with age. They are typically diagnosed incidentally during coronary angiography. The chief nonsurgical treatment is transcatheter coil embolization. We evaluated the outcomes of this procedure in 17 symptomatic patients who had 22 fistulas in total. The 9 men and 8 women (mean age, 52 ± 16.5 yr; range, 27–74 yr) presented at 4 Turkish hospitals from October 2008 through March 2015. Three patients had multiple fistulas. Twelve fistulas originated from the right coronary artery and 10 from the left coronary artery, draining into the pulmonary artery in 18 instances. We evaluated results postprocedurally and after 2 to 5 months, defining angiographic success as a flow better than Thrombolysis in Myocardial Infarction grade 2 in the treated artery. Twenty-one of the 22 procedures immediately produced the targeted flow. We observed 2 minor and no major complications. On follow-up, 3 symptomatic patients underwent successful repeat treatment of one fistula each. We found that transcatheter coil embolization afforded good success rates with few complications in closing coronary artery fistulas. We share our experience to add to the data on treating patients with coronary artery fistulas, and to raise awareness among clinicians.

scholarly journals Coronary physiology before and after chronic total occlusion treatment: what does it tell us?

2020 ◽  
Vol 29 (1) ◽  
pp. 22-29 ◽  
Author(s):  
D. C. J. Keulards ◽  
P. J. Vlaar ◽  
I. Wijnbergen ◽  
N. H. J. Pijls ◽  
K. Teeuwen
Keyword(s):  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Total Occlusion ◽  
Flow Reserve ◽  
Donor Artery ◽  
Before And After ◽  
Over Time

AbstractStudies performed in the last two decades demonstrate that after successful percutaneous coronary intervention (PCI) of a chronically occluded coronary artery, the physiology of the chronic total occlusion (CTO) vessel and dependent microvasculature does not normalise immediately but improves significantly over time. Generally, there is an increase in fractional flow reserve (FFR) in the CTO artery, a decrease in collateral blood supply and an increase in FFR in the donor artery accompanied by an increase in blood flow and decrease in microvascular resistance in the myocardium supplied by the CTO vessel. Analogous to these physiological changes, positive remodelling of the distal CTO artery also occurs over time, and intravascular imaging can be helpful for analysing distal vessel parameters. Follow-up coronary angiography with physiological measurements after several weeks to months can be helpful and informative in a subset of patients in order to decide upon the necessity for treatment of residual coronary artery stenosis in the vessel distal to the CTO or in the contralateral donor artery, as well as in deciding whether stent optimisation is indicated. We suggest that such physiological guidance of CTO procedures avoids unnecessary overtreatment during the initial procedure, guides interventions at follow-up, and improves our understanding of what PCI in CTO means.

scholarly journals Recovery of right ventricular function and strain in patients with ST-segment elevation myocardial infarction and concurrent chronic total occlusion

2021 ◽  
Author(s):  
Anna van Veelen ◽  
Joëlle Elias ◽  
Ivo M. van Dongen ◽  
Loes P. C. Hoebers ◽  
Bimmer E. P. M. Claessen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chronic Total Occlusion ◽  
Longitudinal Strain ◽  
Total Occlusion ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
The Right ◽  
Rv Function

AbstractThe right ventricle (RV) is frequently involved in ST-segment elevation myocardial infarction (STEMI) when the culprit or concurrent chronic total occlusion (CTO) is located in the right coronary artery (RCA). We investigated RV function recovery in STEMI-patients with concurrent CTO. In EXPLORE, STEMI-patients with concurrent CTO were randomized to CTO percutaneous coronary intervention (PCI) or no CTO-PCI. We analyzed 174 EXPLORE patients with serial cardiovascular magnetic resonance imaging RV data (baseline and 4-month follow-up), divided into three groups: CTO-RCA (CTO in RCA, culprit in non-RCA; n = 89), IRA-RCA (infarct related artery [IRA] in RCA, CTO in non-RCA; n = 56), and no-RCA (culprit and CTO not in RCA; n = 29). Tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (RVEF), RV global longitudinal strain (GLS) and free wall longitudinal strain (FWLS) were measured. We found that RV strain and TAPSE improved in IRA-RCA and CTO-RCA (irrespective of CTO-PCI) at follow-up, but not in no-RCA. Only RV FWLS was different among groups at baseline, which was lower in IRA-RCA than no-RCA (− 26.0 ± 8.3% versus − 31.0 ± 6.4%, p = 0.006). Baseline RVEF, RV end-diastolic volume and TAPSE were associated with RVEF at 4 months. RV function parameters were not predictive of 4 year mortality, although RV GLS showed additional predictive value for New York Heart Association Classification > 1 at 4 months. In conclusion, RV parameters significantly improved in patients with acute or chronic RCA occlusion, but not in no-RCA patients. RV FWLS was the only RV parameter able to discriminate between acute ischemic and non-ischemic myocardium. Moreover, RV GLS was independently predictive for functional status.

scholarly journals Prognostic value of non-invasive coronary artery flow velocity assessment in elderly patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Kalinina ◽  
A Zagatina ◽  
N Zhuravskaya ◽  
D Shmatov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Flow Velocity ◽  
Coronary Arteries ◽  
Coronary Flow ◽  
Prognostic Value ◽  
Area Under Curve ◽  
Left Coronary Artery ◽  
Maximal Velocity

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a high prevalence of coronary artery disease (CAD) in the elderly population. However, symptoms of CAD are often non-specific. Dyspnoe, non-anginal pains are among the main symptoms in older patients. Exercise tests are of limited feasibility in these patients, due to neuro-muscular weakness, physical deconditioning, and orthopaedic limitations. Pharmacological tests often are contraindicated in a substantial percentage of elderly patients. Some recent studies indicate using local flow acceleration during routine echocardiography has prognostic potential for coronary artery assessments without stress testing. The aim of the study was to define the prognostic value of coronary artery ultrasound assessment in patients ≥75 years old. Methods This is a prospective cohort study. Patients ≥ 75 years old who underwent routine echocardiography with additional scans for coronary arteries over a period of 24 months were included in the study. The study group consisted of 80 patients aged 75-90 years (56 women; mean age 79 ± 4). Initial exams were performed for other reasons, primarily for arterial hypertension. Fifteen patients had known CAD. Death, non-fatal myocardial infarction (MI), and revascularization were defined as major adverse cardiac events (MACE). All patients were followed up with at a median of 32 months. Results There were 34 patients with high local velocities in the left coronary artery. Eight deaths, two non-fatal myocardial infarctions occurred, and 13 revascularizations were performed. With a ROC analysis, a coronary flow velocity &gt;110 cm/s was the best predictor for risk of death (area under curve 0.84 [95% CI 0.74–0.92]; sensitivity 75%; specificity 88%). Only the maximal velocity in proximal left-sided coronary arteries was independently associated with death (HR 1.03, 95% CI 1.01; 1.05; p &lt; 0.002), or death/MI (HR 1.03, 95% CI 1.01; 1.04; p &lt; 0.0001). The cut-off value of 66 cm/s was a predictor of all MACE (area under curve 0.87 [95% CI 0.77–0.94]; sensitivity 80%; specificity 86%). Any causes of death or MI occurred more frequently in patients with velocities of &gt;66 cm/s (27% vs. 2%; p &lt; 0.002). The rates of MACE were 58.0% vs. 2%; p &lt; 0.0000001, respectively. Conclusion The analysis of coronary flow in the left coronary artery during echocardiography can be used as a predictor of outcomes in elderly patients. Maximal velocities in proximal left-sided coronary arteries is independently associated with further death or myocardial infarction.

One-year follow-up of myocardial perfusion and function evaluated by gated SPECT MIBI in patients with earlier myocardial infarction and chronic total occlusion

2009 ◽  
Vol 30 (1) ◽  
pp. 68-75 ◽  
Author(s):  
Smiljana V. Pavlovic ◽  
Dragana P. Sobic-Saranovic ◽  
Branko D. Beleslin ◽  
Miodrag C. Ostojic ◽  
Milan A. Nedeljkovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Perfusion ◽  
Chronic Total Occlusion ◽  
Gated Spect ◽  
Total Occlusion ◽  
One Year ◽  
And Function

scholarly journals Coil Embolization of Coronary-Cameral Fistula Complicating Revascularization of Chronic Total Occlusion

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Amy Mertens ◽  
Pratik Dalal ◽  
Michael Ashbrook ◽  
Ivan Hanson
Keyword(s):  
Coronary Artery ◽  
Right Ventricle ◽  
Coil Embolization ◽  
Chronic Total Occlusion ◽  
Potential Complication ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Coronary Cameral Fistula ◽  
The Right

Traumatic vessel perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI). A rare consequence of this complication is a coronary-cameral fistula. The management of this condition is not well elucidated. Herein, we present such a case of symptomatic left anterior descending to the right ventricle (LAD-RV) fistula which was treated with coil embolization.

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