Dedicated devices and techniques – a cornerstone in recanalisation of chronic total occlusions of coronary arteries

Bryniarski, Leszek; Kusak, Piotr; Surowiec, Sławomir; Dudek, Dariusz; Czarnecka, Danuta

doi:10.5114/pwki.2014.45153

Cited by 5 publications

(9 citation statements)

References 6 publications

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“…The progress in percutaneous revascularisation of the CTO is parallel to technological developments in interventional cardiology [1,7]. Apart from the technical feasibility, correct assessment of indications for the procedure and possible clinical benefits remain a key issue [7].…”

Section: Discussionmentioning

confidence: 99%

“…Apart from the technical feasibility, correct assessment of indications for the procedure and possible clinical benefits remain a key issue [7].…”

Section: Discussionmentioning

confidence: 99%

“…Although dedicated randomised clinical trials in patients with CTO are ongoing, extrapolation of data from the literature on patients with stable coronary artery disease suggests that revascularisation is warranted in those with at least moderate ischaemia [8]. Most of the studies in that area used single photon emission computed tomography (SPECT) [4,7,9,10]. The number of studies with the use of cardiovascular magnetic resonance (CMR) allowing comprehensive assessment of myocardial function, viability, and ischaemia in these patients is far smaller [5].…”

Section: Introductionmentioning

confidence: 99%

“…Technical feasibility of the CTO revascularisation relies on the angiographic picture of the occluded artery and often on the collateral flow to the artery segments distally to the site of occlusion [1,7]. Many studies focused on the relation between the angiographic status of the CTO territory and the feasibility of the procedure by means of dedicated tools and various approaches (antegrade, retrograde, or combined) [1].…”

Section: Introductionmentioning

confidence: 99%

“…Clinical studies have consistently demonstrated that revascularisation of the CTO leads to an improvement of the myocardial systolic function and a reduction of ischaemic burden, and may even improve prognosis [2][3][4][5][6]. Qualification for the procedure is based on clinical symptoms, and the assessment of ischaemia and viability of the myocardial area supplied by the occluded artery [7]. Although dedicated randomised clinical trials in patients with CTO are ongoing, extrapolation of data from the literature on patients with stable coronary artery disease suggests that revascularisation is warranted in those with at least moderate ischaemia [8].…”

Section: Introductionmentioning

confidence: 99%

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Combined analysis of myocardial function, viability, and stress perfusion in patients with chronic total occlusion in relation to collateral flow

et al. 2015

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A b s t r a c tBackground: Indications for revascularisation in chronic total occlusion (CTO) of the coronary artery depend on the interplay between myocardial function, viability, and ischaemia. The technical feasibility of the procedure often relies on the collateral flow to the occluded artery. Aim:To assess the relation between the degree of collateral flow and characteristics of the myocardium supplied by the occluded artery. Methods:The study included 54 patients (mean age 62 years, 85% males) with CTO referred for cardiovascular magnetic resonance (CMR) to assess indications for revascularisation. The presence of well-developed collateral flow was defined as a collateral connection grade = 2 and Rentrop score = 3. Results:The presence of well-developed collaterals (n = 24, 44%) was less likely to be related to systolic dysfunction of the segments supplied by the occluded artery (mean wall motion score index 1.31 ± 0.44 vs. 1.64 ± 0.67, p = 0.04) in comparison to a lack of well-developed collaterals. Patients with well-developed collaterals had a lower frequency of previous myocardial infarction of the CTO territory (38% vs. 67%, p = 0.03) with similar frequency of transmural infarctions (21% vs. 23%, p = 0.83). They less frequently presented perfusion deficits of the CTO area during hyperaemia (42% vs. 70%, p = 0.03) and the size of deficits was smaller (median 0.0% [interquartile range 0-12%] vs. 7.5% [0-15%], p = 0.04). Conclusions:Myocardial segments supplied by CTO with well-developed collaterals are less prone to inducible ischaemia, have better systolic function, and are less likely to undergo myocardial infarction, in comparison to those supplied by CTO with poor collateral circulation. CMR is a non-invasive method that can be used for a comprehensive workup of patients being considered for CTO revascularisation.

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Section: Discussionmentioning

confidence: 99%

“…Apart from the technical feasibility, correct assessment of indications for the procedure and possible clinical benefits remain a key issue [7].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Combined analysis of myocardial function, viability, and stress perfusion in patients with chronic total occlusion in relation to collateral flow

et al. 2015

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Clinical and angiographic predictors of successful percutaneous coronary intervention in chronic total coronary occlusions

Mansour¹,

Atia²,

Tabl³

et al. 2018

Benha Journal of Applied Sciences

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Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is considered one of the most challenging procedures I interventional cardiology & may lead to multiple complications. Multiple factors may adversely influence the success rate of the procedure however the benefits of the revascularization usually outweigh the risks of the procedure. Is to assess the clinical and angiographic predictors of successful PCI in CTO of native coronary artery. 100 patients who have referred to Damanhur teaching hospital for elective PCI of CTO, mean age was 53.9 ± 8.49, were assessed clinically & angiographically with reporting the procedure outcome among them. The overall success rate was 83% mostly in LAD (82%) leas in the LCX (75%), there was no significant affection of the clinical & demographic factors on the success rate of the PCI however angiographic characteristics including stump shape, calcifications, presence of bridging collaterals, side branch at occlusion point, vessel tortuosity, site of the lesion, length of the lesion and vessel diameter were strong predictors for success in the study. The duration of occlusion, length of the lesion, vessel diameter, stump shape, presence of bridging collaterals, side branch at occlusion point, calcifications, vessel tortuosity and lesion location were independent predictors of successful CTO revascularization, whereas patient's characteristics and clinical risk factors are not.

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Clinical and angiographic predictors of successful percutaneous coronary intervention in chronic total coronary occlusions

Mashhour

Tabl

Traigy

et al. 2019

Benha Journal of Applied Sciences

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Dedicated devices and techniques – a cornerstone in recanalisation of chronic total occlusions of coronary arteries

Cited by 5 publications

References 6 publications

Combined analysis of myocardial function, viability, and stress perfusion in patients with chronic total occlusion in relation to collateral flow

Combined analysis of myocardial function, viability, and stress perfusion in patients with chronic total occlusion in relation to collateral flow

Clinical and angiographic predictors of successful percutaneous coronary intervention in chronic total coronary occlusions

Clinical and angiographic predictors of successful percutaneous coronary intervention in chronic total coronary occlusions

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