Percutaneous Coronary Intervention in Chronic Total Occlusion

Ybarra, Luiz F.; Cantarelli, Marcelo J. C.; Lemke, Viviana de Mello Guzzo; Quadros, Alexandre Schaan de

doi:10.5935/abc.20180077

Cited by 9 publications

(14 citation statements)

References 65 publications

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“…The present analysis is relevant because equipment and resources are generally more limited in Latin America, mainly due to financial restraints and fragmented regulatory issues 25 . Registry data from very experienced CTO centers report success rates of approximately 90%, higher than found in our report.…”

Section: Discussionmentioning

confidence: 51%

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Chronic total occlusion percutaneous coronary intervention in Latin America

Quadros

Belli

Paula³

et al. 2020

Cathet Cardio Intervent

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Objectives To report clinical, angiographic characteristics, outcomes, and predictors of unsuccessful procedures in patients who underwent chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in Latin America. Background CTO PCI has been increasingly performed worldwide, but there is a lack of information in this region. Methods An international multicenter registry was developed to collect data on CTO PCI performed in centers in Latin America. Patient, angiographic, procedural and outcome data were evaluated. Predictors of unsuccessful procedures were assessed by multivariable analysis. Results We have included data related to 1,040 CTO PCIs performed in seven countries in Latin America (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, and Puerto Rico). The mean age was 64 ± 10 years, and CTO PCI was performed mainly for angina control (81%) or treatment of a large ischemic area (30%). Overall technical success rate was 82.5%, and it was achieved with antegrade wire escalation in 81%, antegrade dissection/re‐entry in 8% and with retrograde techniques in 11% of the successful procedures. Multivariable analysis identified moderate/severe calcification, a blunt proximal cap and a previous attempt as independent predictors of unsuccessful procedures. In‐hospital major adverse cardiovascular events (MACE) occurred in 3.1% of the cases, death in 1% and cardiac tamponade in 0.9% Conclusions CTO PCI in Latin America has been performed mainly for ischemia relief. Procedures were associated with a success rate above 80% and low incidence of MACE. Predictors of unsuccessful procedures were similar to those previously reported in the literature.

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Section: Discussionmentioning

confidence: 51%

“…As mentioned above, our lower success rates could be related to more limited resources and because many centers and operators are in different phases of the learning curve for CTO PCI 25 . This is exemplified by the variability of success rates and number of patients included amongst participating centers and countries in this report.…”

Section: Discussionmentioning

confidence: 84%

Chronic total occlusion percutaneous coronary intervention in Latin America

Quadros

Belli

Paula³

et al. 2020

Cathet Cardio Intervent

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“…Planning of the recanalization procedure requires the use of angiographic scores to estimate the probable success rate and the type of approach. 8 The J-CTO score is the most widespread and oldest one.15 Higher J-CTO score significantly indicates lower success rates, greater use of contrast, more frequent use of retrograde approach and longer procedures. 13,14 In the present study, we aimed to investigate the association of J score with percutaneous revascularization success in chronic coronary total occlusion patients.…”

Section: Discussionmentioning

confidence: 99%

“…Occlusions with the minimal passage of contrast without opacification of the distal vessel are considered "functional CTO." 8 CTOs occur in 18-52% of individuals submitted to coronary angiography and who have coronary heart disease. 9 Recent reviews showed a prevalence between 16 and 20%.…”

Section: Introductionmentioning

confidence: 99%

Correlation of angiographic scoring system with percutaneous revascularization success in chronic coronary total occlusion patients

Balghaith¹,

Alharbi²,

Mahmud³

et al. 2020

JCCR

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Background:The percutaneous coronary intervention of chronic total occlusions (CTOs) is considered the most challenging technical procedure in the current interventional cardiology. Japanese Multicenter CTO Registry (J-CTO Score) was established to predict the probability of successful guidewire crossing through a half-hour.Aim: To assess the correlation of J score with percutaneous revascularization success in chronic coronary total occlusion patients.Method: This is a retrospective study that was included CTO patients who underwent coronary angiography at Cardiac Catheterization Laboratory at King Abdul-Aziz Cardiac Center between January 2010 -December 2017 will be extracted from an electronic database (Apollo Lx, Best Care, Xcelera, Muse). Data collected from patients included demographics, cardiovascular risk factors, co-morbidities, angiographic parameters, Haemodynamic Measurements, and laboratory tests. SPSS was used to analyze data.Results: There were 173 patients included in the study, the mean±SD of CTOs number was1.4±0.8, the mean±SD of J-CTO score was1.8±0.9, the mean ±SD of fluro time was 29.3±14. There was no significant association between J-CTO score and outcome of patients (P=0.6), the amount of contrast used also had no significant association with patients'outcome (P=0.4), whereas the mean of fluro time was significantly associated with outcome of patients (P=0.01). Conclusion:J score showed no association with the success rate, however lower fluro time was a predictor of success.

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“…With the rapid development of CTO-PCI technology and the wide application of coronary stents, the problem of in-stent restenosis is gradually exposed. The in-stent restenosis after CTO-PCI with bare mental stents was as high as 50%, which undoubtedly hindered its application in this situation (7). The first-generation drug-eluting stent (DES) was introduced to solve in-stent restenosis in 2002, and its anti-proliferative drugs can inhibit the proliferation of vascular endothelial cells and eliminate neointimal hyperplasia, the incidence of instent restenosis after CTO-PCI was reduced to 7-8.2% (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Clinical Outcomes Between Second-and First-Generation Drug-Eluting Stents in Patients With Chronic Total Occlusion Lesion: A Meta-Analysis

Qiao

Zhang

Guo

et al. 2021

Front. Cardiovasc. Med.

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Background and Objectives: The second-generation drug-eluting stents have been used to treat chronic total occlusion lesion. However, there is limited evidence of the clinical outcomes that whether the second-generation drug-eluting stents is superior to first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The study aimed to compare the differences in clinical outcomes between the two generations drug-eluting stents in patients with those by a meta-analysis.Methods: PubMed, Embase, the Cochrane library and Web of science databases were systemically searched before March, 2021. Randomized controlled trials and observational studies were included to compare the second-generation drug-eluting stents with the first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The clinical outcomes were major adverse cardiac events (MACE), target vessel revascularization, myocardial infarction, all-cause death. Fixed effects models were used to calculate the odds ratio (OR) and 95% confidence interval (CI) of each clinical outcome. Sensitivity analysis was performed to detect potential sources of heterogeneity. Subgroup analyses were used to assess the differential effects.Results: The meta-analysis included eight studies involving 4,583 patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. Pooled analysis showed that the incidence of MACE (OR = 0.68, 95%CI 0.54–0.85, P = 0.0008), target vessel revascularization (OR = 0.70, 95%CI 0.54–0.91, P = 0.007), and myocardial infarction (OR = 0.58, 95%CI 0.37–0.93, P = 0.02) were lower in the second-generation drug-eluting stents compared with the first-generation ones. However, there was not difference in all-cause deaths between two drug-eluting stents (OR = 0.67, 95%CI 0.45–1.01, P = 0.05).Conclusions: The second-generation drug-eluting stents are associated with lower MACE, target vessel revascularization, and myocardial infarction compared with the first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The results of this study can provide a reference for the selection of stents in patients with chronic total occlusion lesion. Further randomized controlled trials are needed to verify that the second-generation drug-eluting stents is superior to the first-generation ones in patients with chronic total occlusion (Registered by PROSPERO, CRD42020158406).

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Percutaneous Coronary Intervention in Chronic Total Occlusion

Cited by 9 publications

References 65 publications

Chronic total occlusion percutaneous coronary intervention in Latin America

Chronic total occlusion percutaneous coronary intervention in Latin America

Correlation of angiographic scoring system with percutaneous revascularization success in chronic coronary total occlusion patients

Comparison of Clinical Outcomes Between Second-and First-Generation Drug-Eluting Stents in Patients With Chronic Total Occlusion Lesion: A Meta-Analysis

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