Subadventitial stenting around occluded stents: A bailout technique to recanalize in‐stent chronic total occlusions

Azzalini, Lorenzo; Karatasakis, Aris; Spratt, James C.; Tajti, Péter; Riley, Robert F.; Ybarra, Luiz F.; Schumacher, Stefan; Benincasa, Susanna; Bellini, Barbara; Mitomo, Satoru; Henriksen, Peter; Hidalgo, Francisco; Timmers, Leo; Kraaijeveld, Adriaan O.; Agostoni, Pierfrancesco; Roy, James; Ramsay, David; Weaver, James; Knaapen, Paul; Starčević, Boris; Ojeda, Soledad; Pan, Manuel; Alaswad, Khaldoon; Lombardi, William; Carlino, Mauro; Brilakis, Emmanouil S.; Colombo, Antonio; Rinfret, Stéphane; Mashayekhi, Kambis

doi:10.1002/ccd.27472

Cited by 15 publications

(6 citation statements)

References 19 publications

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“…This may be partially explained by lower availability of dedicated ADR equipment and hence lower number of trained operators in Latin America. It is important to state that the few ADR cases in the IS‐CTO group are unlikely to represent a subadventitial stent‐crush technique, but rather the use of this strategy to re‐enter into the true lumen after exiting the occluded stent in subadventitial fashion 11 …”

Section: Discussionmentioning

confidence: 99%

In‐stent chronic total occlusion angioplasty in the LATAM‐CTO registry

Lamelas

Padilla

Abud

et al. 2020

Cathet Cardio Intervent

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Objectives: To inform about contemporary PCI practice of in-stent (IS) chronic total occlusions (CTO) from a large international registry in Latin America. Background: IS-CTO represent a distinctive challenge for PCI, but literature is limited and restricted to high-resource regions of the world. Methods: Patients undergoing CTO PCI enrolled in the LATAM CTO registry from 42 centers in eight countries were included. We analyzed demographics, angiographic, procedure technique, success and postprocedural outcomes between IS-CTO and non-IS-CTO PCI. Results: From 1,565 patients IS-CTO was present in 181 patients (11.5%). IS-CTO patients had higher prevalence of diabetes and hypertension than patients without IS-CTO. IS-CTOs had less calcification (32.5 vs. 46.7%, p < .001), lower prevalence of a proximal branch (36.3 vs. 50.1%, p < .001), more likely to be ostial (24.4 vs. 18.1%, p = .042), were longer (28.5 vs. 25.2 mm, p = .062), and had less interventional collaterals (49.1 vs. 57.3%, p = .038) compared with non-IS-CTO. CTO complexity scores were similar between both groups. There was no statistically significant difference in the initial or successful strategy between IS-CTO and non-IS-CTO PCI. Technical success rates remained high in IS-CTO (86.7%) and non-IS-CTO (83.1%, p = .230). There was no independent association between IS-CTO and technical success in multivariable analysis. There were no differences between IS-CTO and non-IS-CTO groups for in-hospital clinical outcomes. Conclusion: In a contemporary, multicenter, and international registry from Latin America, IS-CTO PCI is frequent and has comparable technical success and safety profile compared to non-IS-CTO PCI.

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Section: Discussionmentioning

confidence: 99%

In‐stent chronic total occlusion angioplasty in the LATAM‐CTO registry

Lamelas

Padilla

Abud

et al. 2020

Cathet Cardio Intervent

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“…Supplementary Appendix 5 is dedicated to CTO PCI in the following particular settings: CTO associated with bifurcation lesions [76][77][78] , in-stent CTO [79][80][81][82][83] and CTO patients with low left ventricular ejection fraction (LVEF) 27,[84][85][86] .…”

Section: Cto In Particular Settingsmentioning

confidence: 99%

Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club

Galassi

Werner²,

Boukhris³

et al. 2019

EuroIntervention

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143

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Since its inception in December 2006, the EuroCTO Club has strived to provide the framework for stateof-the-art chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in Europe and nearby regions. Among its initiatives, the EuroCTO Club has published a set of recommendations regarding the technical aspects of CTO PCI, whose last edition dates to 2012. The EuroCTO Club consensus document discusses CTO PCI clinical indications, techniques and equipment use, as well as the qualifications of operators/centres. Given the considerable amount of progress made by this subspecialty in recent years, there is a need for an updated document that includes data from recent clinical trials and registries, information on novel devices and techniques, and an up-to-date revision on the training requirements to approach CTO PCI. The current updated consensus document of the EuroCTO Club reflects the expertise of European operators to promote the widespread application of state-of-the-art CTO PCI, not only in Europe but also across neighbouring communities.

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“…Follow‐up with angiography was performed in 10 patients, showing patent stents in six, mild neointimal hyperplasia in one, and severe restenosis at the subadvential stenting site in three patients. The 24‐month incidence of target vessel failure was 13.8% …”

Section: Discussionmentioning

confidence: 99%

Staged revascularization in patients with acute coronary syndromes due to saphenous vein graft failure and chronic total occlusion of the native vessel: A novel concept

Xenogiannis

Tajti

Burke

et al. 2018

Cathet Cardio Intervent

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Percutaneous coronary intervention of saphenous vein graft (SVG) lesions can be challenging due to high risk for acute and long‐term complications. Treating the corresponding native coronary artery lesion(s) is preferable, but may not be feasible in the acute setting, due to high technical difficulty, especially when the native coronary lesion is a chronic total occlusion (CTO). We describe a novel concept of “staged revascularization” in patients presenting with an acute coronary syndrome due to SVG failure, whose native coronary artery supplied by the SVG has a CTO. In the first stage, the culprit SVG lesion is treated restoring flow to the supplied myocardium and minimizing the extent of myocardial injury. During the second stage (typically few weeks later), revascularization of the corresponding native coronary artery lesion(s) is performed, often using the initially treated SVG for retrograde crossing of the native coronary artery CTO. We describe two cases of non‐ST segment elevation acute myocardial infarction due to SVG failure that were treated with “staged revascularization”: the culprit SVG was initially treated followed by staged revascularization of the corresponding native coronary artery CTO. Staged revascularization of SVG lesions causing acute coronary syndromes may allow optimization of both acute and long‐term outcomes.

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Subadventitial stenting around occluded stents: A bailout technique to recanalize in‐stent chronic total occlusions

Abstract: SS is rarely performed, usually as last resort, to recanalize complex IS-CTOs. It is associated with favorable acute and mid-term outcomes, but given the small sample size of our study additional research is warranted.

Cited by 15 publications

References 19 publications

In‐stent chronic total occlusion angioplasty in the LATAM‐CTO registry

In‐stent chronic total occlusion angioplasty in the LATAM‐CTO registry

Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club

Staged revascularization in patients with acute coronary syndromes due to saphenous vein graft failure and chronic total occlusion of the native vessel: A novel concept

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