Percutaneous revascularization of coronary chronic total occlusion: Toward a reappraisal of the available evidence

Abstract

Chronic total occlusion (CTO) is a challenging subset of coronary artery disease that is commonly encountered in real-world practice; it is associated with worse long-term prognosis. Observational studies suggest that percutaneous coronary intervention (PCI) for CTO is associated with reduction in myocardial ischemia and improvement in quality of life and left ventricular function. Some observational studies suggested that CTO-PCI is associated with improvement of the 'hard' clinical endpoints; others did not. Nearly all these studies compared the clinical outcome of successful versus failed PCI, rather than comparing the outcome of a whole CTO-PCI cohort versus a 'true' control group. Interestingly, in observational studies that compared the outcome of CTO-PCI versus optimal medical treatment, long-term mortality was comparable between the two strategies. In patients with multi-vessel disease and CTO, complete revascularization is more often achieved by coronary artery bypass grafting than by PCI; the SYNTAX score of these patients often favors surgical revascularization according to the current guidelines. The current guidelines reflect the divergence of opinion on the usefulness/benefit of CTO-PCI, mainly due to the lack of randomized trials. Evidence is awaited from three ongoing randomized controlled trials comparing PCI versus optimal medical treatment in the setting of CTO.

Effect of combination of non-slip element balloon and drug-coating balloon for in-stent restenosis lesions (ELEGANT study)

“…In-stent restenosis (ISR) remains a problematic issue in the second-generation drug-eluting stent (DES) era [1,2]. Drug-coating balloons (DCB) generally provide excellent angiographic and clinical outcomes in patients with ISR lesions [3].…”

Recent treatment modalities for cardiovascular diseases with a focus on stem cells, aptamers, exosomes and nanomedicine

“…Although current treatments in ischemic events are continually improving, the main factor that determines the level of disability sustained by a cardiac event, and even whether the patient survives, is usually time. The faster an individual receives percutaneous coronary intervention (PCI), the better his or her outcome upon discharge [3,4]. Current strategies are designed to speed up the time from cardiac event onset to receiving the appropriate medical intervention.…”

Determination of predictors of successful recanalization of the chronic occlusions of coronary arteries by means of CT-coronarography method

“…Данные крупных регистров подтверждают тот факт, что успешная реканализация ХОКА улучшает долгосрочный прогноз, по сравнению с безуспешной коронарной ангиопластикой хронических окклюзий. После успешной реканализации не рецидивируют приступы стенокардии, улучшается фракция выброса (ФВ) левого желудочка (ЛЖ) и снижается необходимость в выполнении операции аортокоронарного шунтирования (АКШ) [1,3,6,[8][9][10][11]. Однако уровень успешности вмешательств при ХОКА ниже (55-80%), чем при неокклюзирующем поражении коронарных артерий (90%) [3].…”