Novel predictors of late lumen enlargement in distal reference segments after successful recanalization of coronary chronic total occlusion

Okuya, Yoshiyuki; Saito, Yuichi; Takahashi, Takefumi; Kishi, Koichi; Hiasa, Yoshikazu

doi:10.1002/ccd.28143

Cited by 10 publications

(10 citation statements)

References 32 publications

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“…This is probably the most difficult, often subjective, decision during CTO recanalisation and IVUS definitely helps, distinguishing a distal small hypoperfused vessel without significant plaque burden from a severely diseased vessel needing treatment. Predictors of lumen area enlargement after CTO recanalisation have been described: occlusion duration >3 months, poor collateral flow, statin use, LAD occlusion and the absence of moderate/severe calcification, and one of these, the presence of a perimedial high echoic band, can be identified on IVUS before stenting 174,[178][179][180] . There is also no agreement on vessel preparation before stenting.…”

Section: Ivus For Stent Implantation and Optimisationmentioning

confidence: 99%

Recanalisation of coronary chronic total occlusions

Mario¹,

Mashayekhi²,

Garbo³

et al. 2022

EuroIntervention

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Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators in this demanding, rapidly evolving field of interventional cardiology.

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Section: Ivus For Stent Implantation and Optimisationmentioning

confidence: 99%

Recanalisation of coronary chronic total occlusions

Mario¹,

Mashayekhi²,

Garbo³

et al. 2022

EuroIntervention

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“…iFR measurements post‐CTO PCI should not be seen as an alternative to intravascular imaging, from which the added value is well recognized 1 . Intravascular ultrasound is often indispensable in complex CTO PCI and may also help in predicting late lumen enlargement 24 . However, our findings indicate that a post‐CTO PCI iFR and pullback may be a better way to assess the result than angiography alone.…”

Section: Discussionmentioning

confidence: 78%

“…Once antegrade flow is restored, several changes take place over time. Mostly, distal lumen and vessel enlarge progressively, especially if the distal vessel appears small in diameter immediately post‐PCI, if the CTO is in the left anterior descending artery, and if moderate or severe calcification is absent 24 . Microvascular dysfunction, if present, often recovers after recanalization 14‐17 .…”

Section: Discussionmentioning

confidence: 99%

iFR uncovers profound but mostly reversible ischemia in CTOs and helps to optimize PCI results

Kayaert

Coeman

Drieghe

et al. 2020

Cathet Cardio Intervent

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Objectives The study aimed to demonstrate through instant wave‐free ratio (iFR) measurements that myocardium distal to a chronic total occlusion (CTO) is ischemic, that ischemia is reversible by PCI, and that iFR assessment after PCI can be used to optimize PCI results. Background The greatest benefit of revascularization is found in patients with low fractional flow reserve. In patients with CTOs, iFR measurement may be more appropriate to evaluate ischemia as it does not require maximal microvascular vasodilation, which may be hampered by microvascular dysfunction. Methods The iFR was measured in 81 CTO patients, both pre‐ and post‐PCI in 63 patients, and only post‐PCI in the following 18 patients. A pressure wire pullback was performed post‐PCI if iFR ≤0.89. Results The first 63 patients all had significant ischemia distal to the CTO with a median iFR of 0.33 [0.22; 0.44], improving significantly post‐PCI to a median iFR of 0.93 [0.89;0.96] (p < .001). In the complete cohort, the median iFR post‐PCI was 0.93 [0.86;0.96] but still ≤0.89 in 23 patients (30%). 12 of these patients had further PCI optimization because of a residual focal pressure gradient on pullback, after which only two had a final iFR ≤0.89. Conclusions In CTO patients with an indication for PCI, iFR consistently demonstrated profound myocardial ischemia. Successful PCI immediately relieved ischemia in 70% of patients. In the remaining 30% of cases, a manual iFR pullback proved helpful in guiding further optimization of the PCI result.

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“…Coronary artery disease is widely regarded as the most common disease endangering human health worldwide. With economic development, the incidence of coronary heart disease is rising each year, and CTO accounts for approximately 30% of cases, according to coronary angiography [1,2]. Patients with CTO often have atrial fibrillation, arrhythmia, angina pectoris, and heart dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic coronary total occlusions (CTOs) are generally defined as complete interruptions of antegrade blood flow, as detected with angiography, within a period of >3 months [1]. CTO, which occurs in as many as 30% of patients with coronary diseases, is the end stage of coronary artery atherosclerosis [2]. Percutaneous coronary intervention (PCI) is a treatment method for CTO that is relatively simple, safe, and nonpainful; thus, it is widely used in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Effects of Tirofiban and Nicorandil on Effective Reperfusion and the Levels of IL-4 and sICAM-1 After PCI for Chronic Coronary Total Occlusion

2022

CVIA

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Aim: The effects of tirofiban combined with nicorandil on effective reperfusion, and the levels of interleukin-4 (IL-4)and soluble intercellular adhesion molecule-1 (sICAM-1) after percutaneous coronary intervention (PCI) for chronic coronary total occlusion (CTO) were investigated.Method: From January 1, 2017, to June 31, 2019, a total of 40 patients with CTO receiving PCI in Shandong QianfoshanHospital were randomly divided into a control group (treated with single tirofiban) and a cocktail group (treated with nicorandil combined with tirofiban). Effective reperfusion was compared between groups. In addition, differences in coronary serum IL-4 and sICAM-1 levels before and 10 min after the operation were compared between groups, and the incidence rates of adverse reactions were observed. Finally, patient follow-up occurred at 1 month and 6 months, and the total incidence rates of adverse cardiac events in both groups were assessed.Results: The levels of IL-4 and sICAM-1 in the cocktail group significantly decreased after the operation (P < 0.05).In addition, after the operation, significantly greater decreases in the IL-4 and sICAM-1 levels were observed in thecocktail group than the control group (P < 0.05). The Seattle Angina Scale (SAQ) score of the cocktail group, comparedwith the control group, showed a significant improvement after vessel opening in the patients with CTO. At the 1-month follow-up, the SAQ score of the cocktail group, compared with the control group, indicated further improvements in terms of angina attack frequency. No significant differences were observed in the incidence rates of adverse reactions between groups (P > 0.05).Conclusion: The treatment of patients with CTO undergoing PCI with nicorandil and tirofiban alleviated the inflammatoryresponse, improved the SAQ scores, and decreased the occurrence of angina pectoris in patients. Moreover, this treatment is safe and reliable, and has important clinical significance.

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Novel predictors of late lumen enlargement in distal reference segments after successful recanalization of coronary chronic total occlusion

Cited by 10 publications

References 32 publications

Recanalisation of coronary chronic total occlusions

Recanalisation of coronary chronic total occlusions

iFR uncovers profound but mostly reversible ischemia in CTOs and helps to optimize PCI results

Effects of Tirofiban and Nicorandil on Effective Reperfusion and the Levels of IL-4 and sICAM-1 After PCI for Chronic Coronary Total Occlusion

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