retrograde approach
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Author(s):  
Cynthia B. Zevallos ◽  
Mudassir Farooqui ◽  
Darko Quispe‐Orozco ◽  
Alan Mendez‐Ruiz ◽  
Andres Dajles ◽  
...  

Background Despite thrombectomy having become the standard of care for large‐vessel occlusion strokes, acute endovascular management in tandem occlusions, especially of the cervical internal carotid artery lesion, remains uncertain. We aimed to compare efficacy and safety of acute carotid artery stenting to balloon angioplasty alone on treating the cervical lesion in tandem occlusions. Similarly, we aimed to explore those outcomes’ associations with technique approaches and use of thrombolysis. Methods and Results We performed a systematic review and meta‐analysis to compare functional outcomes (modified Rankin Scale), reperfusion, and symptomatic intracranial hemorrhage and 3‐month mortality. We explored the association of first approach (anterograde/retrograde) and use of thrombolysis with those outcomes as well. Two independent reviewers performed the screening, data extraction, and quality assessment. A random‐effects model was used for analysis. Thirty‐four studies were included in our systematic review and 9 in the meta‐analysis. Acute carotid artery stenting was associated with higher odds of modified Rankin Scale score ≤2 (odds ratio [OR], 1.95 [95% CI, 1.24–3.05]) and successful reperfusion (OR, 1.89 [95% CI, 1.26–2.83]), with no differences in mortality or symptomatic intracranial hemorrhage rates. Moreover, a retrograde approach was significantly associated with modified Rankin Scale score ≤2 (OR, 1.72 [95% CI, 1.05–2.83]), and no differences were found on thrombolysis status. Conclusions Carotid artery stenting and a retrograde approach had higher odds of successful reperfusion and good functional outcomes at 3 months than balloon angioplasty and an anterograde approach, respectively, in patients with tandem occlusions. A randomized controlled trial comparing these techniques with structured antithrombotic regimens and safety outcomes will offer definitive guidance in the optimal management of this complex disease.


2022 ◽  
Vol 12 ◽  
Author(s):  
Xiaoli Min ◽  
Jianhua Du ◽  
Xuesong Bai ◽  
Tao Wei ◽  
Adam A. Dmytriw ◽  
...  

Background: Acute ischemic stroke (AIS) caused by tandem intracranial and extracranial occlusions is not rare. However, optimal strategy between antegrade (extracranial first) or retrograde (intracranial first) approaches still remains elusive. This systematic review and meta-analysis aim to compare the two approaches to provide updated clinical evidence of strategy selection.Methods: PubMed, Ovid, Web of Science, and the Cochrane Library were searched for literature comparing antegrade and retrograde approaches for patients with AIS with concomitant tandem occlusions. Outcomes including successful reperfusion [Throbolysis in Cerebral Infarction (TICI) 2b−3] and 90-day favorable outcome [modified Rankin Scale (mRS) 0–2], any intracerebral hemorrhage, symptomatic intracerebral hemorrhage, procedural complications, and mortality were evaluated. The risk of bias was assessed using the Newcastle–Ottawa Scale and illustrated in the Funnel plot. Heterogeneity was assessed by I2 statistic. Subgroup and sensitivity analyses were also performed.Results: A total of 11 studies accounting 1,517 patients were included. 831 (55%) patients were treated with an antegrade approach and 686 (45%) patients were treated with the retrograde approach. A higher successful reperfusion rate was achieved in retrograde group than that of antegrade group [83.8 vs. 78.0%; odds ratio (OR): 0.63, 95% CI: 0.40–0.99, p = 0.04]. 90-day favorable outcome (mRS 0–2 at 90 days) also showed significantly higher in retrograde group compared with antegrade group (47.3 vs. 40.2%; OR: 0.72, 95% CI: 0.58–0.89, p = 0.002). The incidence of any intracranial hemorrhage (ICH), symptomatic intracranial hemorrhage, 90-day mortality, and other complications did not differ between two groups.Conclusion: In AIS with tandem occlusions, the retrograde approach might achieve a higher successful reperfusion rate and better functional outcome with a comparable safety profile when compared with an antegrade approach. Further prospective controlled studies with more meticulous design and a higher level of evidence are needed to confirm these results.Systematic Review Registration: “PROSPERO” database (CRD 42020199093), https://www.crd.york.ac.uk/PROSPERO/.


Vascular ◽  
2022 ◽  
pp. 170853812110673
Author(s):  
Yusuke Sato ◽  
Kazushi Urasawa ◽  
Michinao Tan ◽  
Taichi Hayashi ◽  
Takashi Miwa

Objectives This study aims to report the efficacy and safety of new atherectomy methods using the Crosser system for calcified lesions in the common femoral and popliteal artery: the Crosser system supported by bended 0.014 wire (Crossbow) technique and retrograde approach of sheathless Crosser system supported by bended 0.014 wire (Rambow) technique. Materials and Methods This report describes a single-center, retrospective study. A total of 23 patients (mean ± SD age, 73 ± 10 years; 19 men) with symptomatic peripheral artery disease received the Crossbow technique and Rambow technique for treatment of calcified common femoral and popliteal disease; these patients were enrolled between October 2013 and October 2015. The primary efficacy outcome was acute technical success, defined as achievement of residual stenosis < 30% for stenting and < 50% for angioplasty or atherectomy. The primary safety outcome was assessed on the basis of angiographic complications. Results The Crossbow and Rambow techniques were undertaken in 100% and 17% of the patients, respectively. Acute technical success was achieved in 96% of the patients. There were two embolic events. Conclusion Crossbow and Rambow techniques could be effective atherectomy methods of calcified common femoral and popliteal disease. Regarding safety, embolic protection devices may be needed for our atherectomy methods.


2021 ◽  
Author(s):  
◽  
Artis Kalniņš ◽  

One of the methods for coronary heart disease (CHD) treatment is percutaneous coronary intervention (PCI). After the first successful percutaneous coronary angioplasty, done in 1977, PCI many years were performed only for patients with stable CHD. Since the early 1980s, PCI has also been used for acute myocardial infarction (MI) treatment. The benefits of invasive treatment over thrombolysis in acute MI had became clear already after the first studies (Keeley et al., 2003). Primary percutaneous coronary intervention is now undoubtedly the treatment of choice for the treatment of acute myocardial infarction (Ibanez et al., 2018). The usefulness and effectiveness of PCI in the treatment of chronic coronary heart disease, on the other hand, is constantly being discussed. Several studies have been performed trying to attempt to question the efficacy of PCI in the treatment of stable CHD (COURAGE, ORBITA). However, these studies have had a relatively short follow-up time and have not led to a limitation of PCI as a treatment method for stable CHD. A large proportion of CTO patients are asymptomatic and it is therefore even more difficult to demonstrate the benefits and advantages of invasive treatment for this group of patients. There are very few long-term follow-up studies that would prove efficacy or ineffectiveness of CTO invasive treatment, so the dissertation summarizes data and angioplasty results for 551 patients who underwent CTO PCI over 10 years.The aim of the study is to compare the long-term results of invasive treatment methods for patients with coronary heart disease and chronic total coronary artery occlusions. The dissertation compared the overall survival after successful and unsuccessful CTO PCI procedures, compared the long-term results of antegrade and retrograde percutaneous coronary intervention techniques, evaluated the multifactor effect of chronic total coronary artery occlusion complexity on the outcome of percutaneous coronary intervention and survival. Study also analyses PCI results for different groups of patients: with and without diabetes, before and after the age of 65, men and women, patients with and without a history of coronary artery bypass graft surgery.Comparing the long-term results after successful and unsuccessful CTO PCI procedures, a better survival was found after successful CTO PCI. Also has been found that the use of the retrograde approach improves the results of procedures and does not worsen the prognosis. It is concluded that in cases where successful antegrade CTO PCI is unlikely, the retrograde approach should be used as the primary strategy. It has been confirmed that the complexity of CTO, calculated by the J-CTO, PROGRESS CTO, CL and CASTLE scores, is directly correlated with the outcome of the procedure. The complexity of CTO, assessed by the PROGRESS CTO and CASTLE scales, can affect patient survival due to the complexity criteria included in these scales – quality of collaterals available for retrograde approach, age, and previous CABG.Analyses of different groups of patients have shown that CTO revascularization provides better survival in men than in women, the presence or absence of diabetes does not affect the long-term results of CTO PCI, for patients under and up to 65 years of age long term outcome after CTO PCI is not related to the patients age, but to the success of the procedure, patients with CTO and previous coronary artery bypass grafting should be considered as patients with increased complexity of CTO PCI.The obtained results provide recommendations for the CTO patients assesement and for CTO PCI procedure planning and performance.


Author(s):  
Kyusup Lee ◽  
Pil Hyung Lee ◽  
Seung‐Whan Lee ◽  
Osung Kwon ◽  
Yong‐Hoon Yoon ◽  
...  

2021 ◽  
Vol 78 (19) ◽  
pp. B30-B31
Author(s):  
Spyridon Kostantinis ◽  
Khaldoon Alaswad ◽  
Dimitri Karmpaliotis ◽  
Farouc Amin Jaffer ◽  
Wissam Jaber ◽  
...  

2021 ◽  
Vol 17 (8) ◽  
pp. e647-e655
Author(s):  
Yongzhen Fan ◽  
Akiko Maehara ◽  
Myong Hwa Yamamoto ◽  
Emad U. Hakemi ◽  
Khady N. Fall ◽  
...  

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Oksnes ◽  
M McEntegart

Abstract Background Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with procedural myocardial injury (PMI), and adverse long-term clinical outcomes [1–4].CTO lesion complexity is quantified using established scores [5–8], with high complexity known to determine the need for dissection and re-entry techniques and the retrograde approach, which are then associated with a higher incidence of procedural complications [9,10]. If CTO recanalization is unsuccessful, a modification procedure can be performed, with the intention to improve subsequent procedural success [11–14]. There are limited data on the association between PMI, CTO complexity and treatment strategy. Purpose To report the incidence of myocardial injury following CTO PCI, and assess whether this is associated with lesion complexity, crossing strategy, or the use of a modification procedure. Methods This is a retrospective analysis of consecutive elective CTO PCI procedures performed at a single centre in Norway between January 2020 and March 2021. High-sensitivity troponin T (hsTnT) was measured pre and 12–18 hours post-procedure. Myocardial injury defined as a post-procedure elevation of hsTnT &gt;5x 99th percentile URL with a normal baseline value or a rise &gt;20% with elevated pre-procedure hsTnT. CTO complexity was described using the J-CTO, PROGRESS, RECHARGE and EuroCASTLE scores [5–8]. Procedures were classified as technical successful or unsuccessful according to CTO academic research consortium (CTO-ARC)criteria [15], and further categorised according to final crossing strategy [antegrade wiring (AW), antegrade dissection re-entry (ADR), retrograde wiring (RW) or retrograde dissection re-entry (RDR)]. If unsuccessful they were further categorised as “failure” or “unplanned modification procedure”. A “planned modification procedure” defined as intentional antegrade modification of the occlusive segment with no attempt to complete CTO crossing. Results We analysed 122 CTO PCI procedures. Mean J-CTO, PROGRESS, RECHARGE, EuroCASTLE scores were 2.7, 1.2, 3.0 and 3.1 respectively. Technical success during the index procedure was 75%. An unplanned or planned modification procedure was performed in 16% and 2% of cases, respectively. Technical failure occurred in 7% of cases. Myocardial injury occurred in 65% of all procedures (78% of failed procedures, 64% of successful procedures, 63% of unplanned and none of 3 planned CTO modification procedures). The mean hs-TnT according to treatment strategy and outcomes are reported in Table 1. The relationship between the CTO complexity scores and hs-TnT are illustrated in Figure 1. Conclusions Myocardial injury is common during CTO PCI, particularly with more complex anatomy, requiring the retrograde approach or an unplanned modification procedure. A prospective analysis of whether myocardial injury can be avoided using a planned investment procedure in high complexity cases is currently being conducted. FUNDunding Acknowledgement Type of funding sources: None.


2021 ◽  
Vol 24 (10) ◽  
pp. 1424-1425
Author(s):  
Walter A. Sosa ◽  
Nora Mendoza ◽  
Angelica Claros-Hulbert ◽  
Carlos Eduardo Restrepo-Garces
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