Current Perspectives on Coronary Chronic Total Occlusions

Fefer, Paul; Knudtson, Merril L.; Cheema, Asim N.; Galbraith, P. Diane; Osherov, Azriel B.; Yalonetsky, Sergey; Gannot, Sharon; Samuel, Michelle; Weisbrod, Max; Bierstone, Daniel; Sparkes, John D.; Wright, Graham A.; Strauss, Bradley H.

doi:10.1016/j.jacc.2011.12.007

Cited by 692 publications

(264 citation statements)

References 20 publications

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“…The number is expected to rise as a result of improved survival of patients with acute coronary syndrome, due to rapid advances in medical and interventional therapy for patients with coronary artery disease. Despite the complete interruption of antegrade blood flow caused by heavy atherosclerotic plaque burden or arterial thrombosis, the frequency of myocardial infarction in areas subtended by chronic total occlusion varies considerably (Fefer et al, 2012), and the degree of myocardial injury downstream of epicardial chronic total occlusion is inversely correlated with the degree of angiographic coronary collateral circulation (Choi et al, 2013). Well-developed coronary collaterals have the potential to alleviate myocardial ischemia, preserve residual contractility, reduce cardiovascular events (Regieli et al, 2009;Meier et al, 2012), and even save lives in patients with severe coronary artery occlusion (Meier, 2011).…”

Section: Introductionmentioning

confidence: 99%

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Sun

Shen

Lü

et al. 2013

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Coronary collateral circulation is an alternative source of blood supply to myocardium in the presence of advanced coronary artery disease. We sought to determine which clinical and angiographic variables are associated with collateral development in patients with stable angina and chronic total coronary occlusion. Methods: Demographic variables, biochemical measurements, and angiographic findings were collected from 478 patients with stable angina and chronic total coronary occlusion. The presence and extent of collaterals supplying the distal aspect of a total coronary occlusion from the contra-lateral vessel were graded from 0 to 3 according to the Rentrop scoring system. Results: Low (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralizations were detected in 186 and 292 patients, respectively. Despite similar age, cigarette smoking, and medical treatment, patients with low collateralization were female in a higher proportion and less hypertensive, and had higher rates of type 2 diabetes and dyslipidemia than those with high collateralization (for all comparisons, P<0.05). In addition, patients with low collateralization exhibited more single-vessel disease, less right coronary artery occlusion, more impaired renal function, and higher serum levels of high-sensitivity C-reactive protein (hsCRP) compared with those with high collateralization. Multivariate analysis revealed that age of ≥65 years, female gender, diabetes, no history of hypertension, dyslipidemia, moderate to severe renal dysfunction, single-vessel disease, and elevated hsCRP levels were independently associated with low coronary collateralization. Conclusions: Coronary collateralization was reduced in almost 40% of stable angina patients with chronic total occlusion, which was related to clinical and angiographic factors. The impact of coronary collateralization on outcomes after revascularization needs further investigation.

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Section: Introductionmentioning

confidence: 99%

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Sun

Shen

Lü

et al. 2013

J. Zhejiang Univ. Sci. B

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“…CTOs are a common finding during routine coronary angiography and the prevalence varies from 18% to 52% [2]. CTOs typically have collateralization of the distal vessel on coronary angiography, but these collaterals may not provide sufficient blood flow to the myocardial bed, resulting in ischemia and anginal symptoms.…”

Section: Introductionmentioning

confidence: 99%

Delayed spontaneous recanalization of chronic total occlusion of left anterior descending artery after attempted but failed revascularization during percutaneous coronary intervention

Guragai

Rampal

Vasudev

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Chronic total occlusion (CTO) of coronary artery remains the Achilles heel of the interventional cardiologist and is present in a significant proportion of referrals for coronary artery bypass graft surgery (CABG); however, with the development and standardization of modern CTO recanalization techniques, it has been able to achieve excellent success while coping with lesions of increasing complexity. Nevertheless, failure to recanalize despite the development of new techniques still remains one of the challenges in the field of interventional cardiology. Spontaneous recanalization has been described in nonocclusive coronary artery dissections in detail; none has addressed the possibility of spontaneous recanalization after failed percutaneous coronary intervention (PCI). We report a case of spontaneous but delayed recanalization of CTO of left anterior descending artery 3 years after attempted but failed revascularization during PCI.

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“…The reported prevalence of CTOs in patients with clinically significant coronary artery disease (CAD) varies widely, from 16% to 50%, but is generally about 20% in large registries [2]. In a report from the Canadian multicentre CTO registry, a CTO was observed in 14.7% of patients without previous coronary artery bypass surgery (CABG) undergoing coronary angiography, and in 18.4% of patients with clinically significant CAD [3]. In this registry, the majority of patients were treated medically (64%) or were referred for CABG surgery (26%) -only 10% were referred for percutaneous coronary intervention (PCI) of the occluded vessel.…”

Section: Introductionmentioning

confidence: 99%

What do Polish interventional cardiologists know about indications and qualification for recanalisation of chronic total coronary artery occlusions?

et al. 2015

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A b s t r a c tBackground: Chronic total occlusions (CTO) are diagnosed in about 20% of patients with significant coronary artery disease. A disproportion between the high prevalence of CTOs and low rate of invasive treatment still exists. Technical difficulties, clinical uncertainties whether patients benefit from recanalisation, and a lack of knowledge of CTO may be responsible for this fact. Aim:To assess the knowledge of coronary arteries CTO among Polish interventional cardiologists. Methods:A self-designed questionnaire was used during two major Polish invasive cardiology workshops held in 2014. Results:The study included 113 physicians, mostly cardiologists certified as independent operators. Average self-declared efficacy of CTO recanalisation was 63.5%. Most of the respondents agreed that the operator involved in the CTO recanalisation program should perform at least 30-50 procedures per year. Only 67% stated that before CTO revascularisation the evaluation of myocardial viability should be performed with dobutamine stress echocardiography as a preferred test. One third of the physicians agreed that CTO percutaneous coronary intervention (PCI) should not be performed directly after diagnostic angiography, and 51.5% believed that in patients with multi-vessel coronary artery disease PCI of CTO should be performed first. Multi-slice spiral computed tomography during the qualification and planning of the CTO revascularisation, in the opinion of 91% of the responders, should not be used before each procedure but could be useful in selected cases. Conclusions:Polish interventional cardiologists remains in compliance with current opinions about recanalisation of chronic coronary artery occlusions and the consensus of the EuroCTO Club, but there is still an unceasing need for further education and promotion of knowledge about CTOs.

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Current Perspectives on Coronary Chronic Total Occlusions

Abstract: Chronic total occlusions are common in contemporary catheterization laboratory practice. Prospective studies are needed to ascertain the benefits of treatment strategies of these complex patients.

Cited by 692 publications

References 20 publications

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Delayed spontaneous recanalization of chronic total occlusion of left anterior descending artery after attempted but failed revascularization during percutaneous coronary intervention

What do Polish interventional cardiologists know about indications and qualification for recanalisation of chronic total coronary artery occlusions?

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