Bypass Angioplasty Revascularization Investigation: Patient Screening, Selection, and Recruitment

Bourassa, Martial G.; Roubin, Gary S.; Detre, Katherine M.; Sopko, George; Krone, Ronald J.; Attabuto, Michael J.; Bjerregaad, Preben; Boiling, Steven F.; Herman, Michael V.; Frye, Robert L.

doi:10.1016/s0002-9149(99)80389-0

Cited by 96 publications

(34 citation statements)

References 5 publications

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“…In a study by Werner et al, 88 paclitaxel-eluting TAXUS stents were implanted in 48 CTOs, and the outcomes were compared with a historical bare metal stent control group. Use of the paclitaxel-eluting stent was associated with reductions in angiographic restenosis at 6 months by 84% (8 thrombosis occurring in only 1 patient. 89 Thus, emerging data suggest that drug-eluting stents may enhance long-term patency rates and freedom from restenosis and repeated revascularization compared with bare metal stents in patients with CTOs, although appropriately powered randomized trials are required to definitively prove the safety and efficacy of this new technology for this application.…”

Section: Late Patency and Restenosis After Successful Cto Angioplastymentioning

confidence: 93%

Percutaneous Recanalization of Chronically Occluded Coronary Arteries

et al. 2005

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In Part I of this article, the definitions, prevalence, and clinical presentation of chronic total occlusions (CTOs) were reviewed, the histopathology of CTOs was examined, efforts to replicate human CTOs with experimental models were appraised, and the clinical relevance and rationale for CTO revascularization were evaluated. 1 In Part II, we summarize the technical approach to and outcomes after percutaneous coronary intervention (PCI) of occluded coronary arteries, describe the novel devices and drugs approved and undergoing investigation for CTO recanalization, and conclude with practical perspectives on managing the patient with 1 or more chronic coronary occlusions.

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Section: Late Patency and Restenosis After Successful Cto Angioplastymentioning

confidence: 93%

Percutaneous Recanalization of Chronically Occluded Coronary Arteries

et al. 2005

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“…Generalizability of trial results has also been questioned, because a minority of screened patients are generally eligible, only some of whom ultimately consent and are enrolled into trials. 25 Larger, definitive trials comparing current medical, interventional, and surgical therapies, particularly in patients at moderate to high risk of events, are urgently needed.…”

Section: Methodological Limitations Of Available Datamentioning

confidence: 99%

Indications for Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention in Chronic Stable Angina

et al. 2003

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“…53 Similarly, in the Bypass Angioplasty Revascularization Investigation (BARI) trial, of 12 530 patients who were clinically eligible for randomization to angioplasty versus bypass graft surgery, 8000 patients were deemed angiographically ineligible, with the most common reason being the presence of 1 or more CTOs (68% of patients). 54 The disparity between the frequency of CTO and percutaneous treatment underscores not only the technical and procedural complexities of this lesion subtype but also the clinical uncertainties with regard to which patients benefit from CTO revascularization.…”

Section: Clinical Relevance and Rationale For Cto Revascularizationmentioning

confidence: 99%

Percutaneous Recanalization of Chronically Occluded Coronary Arteries

et al. 2005

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R emarkable progress in the percutaneous management of coronary artery disease has been achieved over the last decade. The scaffolding properties of coronary stents have resulted in percutaneous coronary intervention (PCI) becoming a predictable procedure, with reduced rates of acute closure and late restenosis compared with balloon angioplasty alone. 1,2 More recently, the site-specific delivery of antiproliferative agents from drug-eluting stents has been demonstrated to markedly attenuate vascular responses leading to neointimal hyperplasia, further reducing the occurrence of clinical and angiographic restenosis to Ͻ10% in most patients. 3,4 PCI in patients with acute coronary syndromes and acute myocardial infarction (AMI) has also been proven to save lives, reduce rates of myocardial infarction (MI), and enhance quality of life compared with alternative treatment modalities. [5][6][7] With these advances in perspective, it is often stated that successful recanalization of chronic total occlusions (CTOs) of native coronary arteries represents the "last frontier" of PCI. This statement is made in deference to the fact that CTOs represent the most technically challenging lesion subset that interventional cardiologists face, with procedural success rates considerably lower than those achieved in nonoccluded coronary vessels or acutely occluded arteries. Moreover, no consensus exists with regard to the definition of CTO, the factors related to procedural failure and/or complications, and the optimal technical approach. Indeed, until recently, the clinical benefits of PCI in CTOs had not been demonstrated.An international panel of 47 physicians from 9 countries was therefore convened in New York City for 2 days in January 2004, the purpose of which was to reach consensus on the current state of the art of CTO angioplasty (see Appendix in the online-only Data Supplement for a complete participant list). This goal was approached through a series of didactic lectures, roundtable discussions, breakout focus groups, and the performance of 14 live case demonstrations of CTO angioplasty by many of the world's most skilled operators in this subspecialty. The present report represents a synthesis of the findings from this meeting and also incorporates a literature review from the field of CTO intervention. Topics covered in Part I of this review include definitions, prevalence, and clinical presentation of CTOs; the anatomy and histopathology of coronary occlusions; experimental CTO models; and the clinical relevance and rationale for CTO revascularization. Part II will review the technical approach to and clinical outcomes after percutaneous intervention of CTOs and describe the novel devices and drugs approved and undergoing investigation for CTO recanalization.

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Bypass Angioplasty Revascularization Investigation: Patient Screening, Selection, and Recruitment

Cited by 96 publications

References 5 publications

Percutaneous Recanalization of Chronically Occluded Coronary Arteries

Percutaneous Recanalization of Chronically Occluded Coronary Arteries

Indications for Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention in Chronic Stable Angina

Percutaneous Recanalization of Chronically Occluded Coronary Arteries

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