Coronary angioplasty for chronic total occlusion reduces the need for subsequent coronary bypass surgery

Warren, Roderic; Black, Alexander; Valentine, P. A.; Manolas, Emmanuel; Hunt, David

doi:10.1016/0002-8703(90)90069-a

Cited by 96 publications

(52 citation statements)

References 16 publications

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“…Successful recanalization of a CTO can alleviate angina, reduce the need for coronary artery bypass surgery [1] and increase long-term survival [2,3]. Improving results from the historically quoted success rates of 50% to the levels now routinely quoted by some operators (80-90%), requires not only skill and experience but also a thorough understanding of the wide array of materials and techniques now available in this area.…”

Section: Introductionmentioning

confidence: 99%

Crossing CTOs—The tips, tricks, and specialist Kit that can mean the difference between success and failure

Godino

Sharp

Carlino

et al. 2009

Cathet Cardio Intervent

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Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remains one of the major challenges in interventional cardiology. The appropriate use of the rapidly increasing range of tools available to interventional cardiologists is bringing more and more CTOs into the 'treatable' category. The bar has now been raised to 80% success rates by some expert operators around the world, which, in our view, cannot be achieved without a thorough understanding of technique and technical know-how. CTO procedures are increasingly becoming a sub-specialist field within interventional cardiology and we would encourage centers to consider appointing 'super-specialists' who are able to concentrate experience and expertise in this area. In this paper we detail the principal characteristics of the over the wire balloons, microcatheters and guidewires at present available, the most popular and recent of which are listed in Table 1 and 2. The knowledge and the specific choice of these materials and the criteria for selection of your guidewire or microcatheter can mean the difference between success and failure. Moreover, we discuss on the most important and groundbreaking techniques to approach a CTO. Finally, considering the greater risk of coronary perforation related to a CTO procedure compared to routine PCI, we describe which are best strategy and devices for treating coronary perforations and other major complications.

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Section: Introductionmentioning

confidence: 99%

Crossing CTOs—The tips, tricks, and specialist Kit that can mean the difference between success and failure

Godino

Sharp

Carlino

et al. 2009

Cathet Cardio Intervent

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“…It constitutes approximately one third of patients undergoing coronary angiography and is a common reason for referral for surgical revascularization [16]. Alternatively, when a CTO-PCI is successfully engaged, it decreases the need for future bypass surgery [17].…”

Section: Discussionmentioning

confidence: 99%

Total aorto‐ostial chronic occlusion of the right coronary artery successfully recanalized via retrograde approach

Londoño

Singh

O’Neill

2011

Cathet Cardio Intervent

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Chronic total occlusions remain a technical challenge for interventional cardiologists. This group of lesions carries a decreased rate of success and continues to be an important reason for surgical revascularization. Recently, retrograde percutaneous coronary intervention of total occlusions via epicardial and septal perforators was introduced as an alternative approach when a previous antegrade attempt has failed. We describe a unique case where retrograde approach was used as the initial recanalization technique in the absence of a right coronary ostium.

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“…In a meta-analysis of six observational studies [27][28][29][30][31][32] that evaluated angina post-CTO PCI, patients undergoing successful PCI experienced a significant reduction in recurrent angina during a six-year follow-up compared with patients undergoing unsuccessful PCI (odds ratio, 0.45; 95 % confidence interval, 0.30 to 0.67). 33 …”

Section: Anginamentioning

confidence: 99%

Percutaneous Treatment of Coronary Chronic Total Occlusions Part 1: Rationale and Outcomes

Galassi

Grantham

Kandzari

et al. 2014

Interventional Cardiology Review

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A chronic total occlusion (CTO) is defined as a completely occluded coronary artery with no antegrade flow (thrombolysis in myocardial infarction [TIMI] 0 flow) for at least three months.1 CTOs are present in 15-30 % of patients undergoing coronary angiography.2-5 In a Canadian prospective registry of 14,439 patients undergoing coronary angiography a CTO was present in 18.4 % of all patients with significant coronary artery disease (CAD).2 Approximately 1/3-1/2 6,7 of patients undergoing CTO percutaneous coronary intervention (PCI) have had a prior acute myocardial infarction (MI). This suggests acute onset of the occlusion, whereas in the remaining patients gradual development of CTO from high-grade lesions likely occurred.The basic histopathologic feature of a CTO is a proximal cap of the occlusion. This is often fibrotic or calcified and may provide considerable resistance to wire advancement during CTO PCI. Distal to the proximal cap and along the occlusion length follows a segment of loose fibrous tissue or organised thrombus, with various extent of calcification. 8,9 In several of these lesions, residual channels may be observed that are not visible under angiography. In addition, microchannels may appear during the CTO's consolidation process, however these are mostly located in the adventitia with extremely tortuous courses and do not generally traverse the entire occluded segment.10 A recent autopsy study of 95 CTO lesions from 82 patients reported frequent negative remodelling of the CTO body (more frequent with longer duration of the occlusion), very rare presence of microchannels and more frequent tapering of the distal cap as compared with the proximal cap (79 % vs. 50 %, P<0.0001). Successful CTO percutaneous coronary intervention (PCI) can significantly improve angina and improve left ventricular function. Although currently unproven, successful CTO PCI might also reduce the risk for arrhythmic events in patients with ischaemic cardiomyopathy, provide better tolerance of future acute coronary syndrome, and possibly improve survival. Evaluation by a heart team comprised of both interventional and non-interventional cardiologists and cardiac surgeons is important for determining the optimal revascularisation strategy in patients with coronary artery disease and CTOs. Ad hoc CTO PCI is generally not recommended, so as to allow sufficient time for (a) discussion with the patient about the indications, goals, risks, and alternatives to PCI; (b) careful procedural planning; and (c) contrast and radiation exposure minimisation. Use of drug-eluting stents is recommended for CTO PCI, given the lower rates of angiographic restenosis compared to bare metal stents.

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Coronary angioplasty for chronic total occlusion reduces the need for subsequent coronary bypass surgery

Cited by 96 publications

References 16 publications

Crossing CTOs—The tips, tricks, and specialist Kit that can mean the difference between success and failure

Crossing CTOs—The tips, tricks, and specialist Kit that can mean the difference between success and failure

Total aorto‐ostial chronic occlusion of the right coronary artery successfully recanalized via retrograde approach

Percutaneous Treatment of Coronary Chronic Total Occlusions Part 1: Rationale and Outcomes

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