Traditional antegrade approach versus combined antegrade and retrograde approach in the percutaneous treatment of coronary chronic total occlusions

Hsu, Jen Te; Tamai, Hideo; Kyo, Eisho; Tsuji, Takafumi; Watanabe, Satoshi

doi:10.1002/ccd.22035

Cited by 40 publications

(21 citation statements)

References 16 publications

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“…Although the sheathless guiding catheters appear to provide better backup support, we should keep in mind again that the larger size of a guiding catheter might be more common with aortic dissection or donor vessel dissection. Major in-hospital events, including emergent bypass surgery or PCI, recurrent MI, stroke, cardiac tamponade and cardiac death, were similar to previous reports in CTO studies [18], [19], [20], [26], [27].…”

Section: Discussionsupporting

confidence: 87%

Transradial percutaneous coronary intervention for chronic total occlusion of coronary artery disease using sheathless standard guiding catheters

Chen

Lee

Hsueh

et al. 2015

IJC Heart & Vasculature

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ObjectivesOur aim was to evaluate the feasibility and safety of routine transradial approach (TRA) percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions using the sheathless technique with standard guiding catheters.BackgroundTransradial approach PCI was applied for CTO lesions. A major limitation of TRA CTO PCI is the inability to use large guiding catheters because of the relatively small size of the radial artery. Therefore, the sheathless technique for TRA PCI has been recently developed. However, reports on TRA CTO PCI using the sheathless technique are still lacking.MethodsSixty-eight patients with CTO lesions were enrolled for TRA PCI using the sheathless technique with standard guiding catheters. The baseline characteristics, coronary angiographic characteristics and major procedure or access site related complications were compared between procedure success and procedure failure group to determine the predictors of success in sheathless CTO PCI. In-hospital and 30-day clinical outcomes were also evaluated in this study. Routine assessments of radial artery occlusion via Doppler ultrasound and pulse oximeter were recorded during one-year clinical follow-up.ResultsThe mean duration of CTO by history was 31.8 ± 42.3 months. The 7 Fr standard guiding catheter was used with the sheathless technique in 91.2%, and bilateral sheathless approach in 42.6% of the study patients. The procedure-related complications included coronary perforation needing covered stent deployment (2.9%), cardiac tamponade (2.9%), collateral perforation needing coil deployment (4.4%), and contrast induced nephropathy (2.9%). Only 2 patients (2.9%) experienced forearm ecchymosis at the radial artery access sites. In-hospital mortality and 30-day all-cause mortality were 2.9%, and 30-day MACEs were 1.5%. The rate of radial artery occlusion during one-year clinical follow-up was only 3.0%.ConclusionsIt is feasible and safe to routinely use the sheathless technique with standard guiding catheters for TRA CTO PCI, with a low incidence of procedure-related complications and long-term radial artery occlusion.

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Section: Discussionsupporting

confidence: 87%

Transradial percutaneous coronary intervention for chronic total occlusion of coronary artery disease using sheathless standard guiding catheters

Chen

Lee

Hsueh

et al. 2015

IJC Heart & Vasculature

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“…However, computed tomography (CT) coronary angiography can reveal the calcification plaque as well as highlight the course of the coronary artery [7][8][9]. It has also been reported that severe calcifications are associated with more complications, low success rate, inadequate stent expansion, and high restenosis rate [9][10][11]. This study aimed to investigate the association between heavy calcification detected by CT coronary angiography and the result of intervention by 1 experienced operator.…”

Section: Introductionmentioning

confidence: 98%

Impact of calcification length ratio on the intervention for chronic total occlusions

Hsu¹,

Kyo²,

Chu³

et al. 2011

International Journal of Cardiology

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“…To the best of our knowledge, a technique involving a bilateral ulnar approach has never been reported. We safely performed the PCI procedure with a radiation time quite comparable to the bilateral radial and femoral approaches described in the study of Hsu, et al 6) In the presented case report, both ulnar arteries were selected for access due to a smaller radial artery from pre-PCI physical examination, which was confirmed by peripheral hand injection through the arterial sheath. In our center, we predominately use "the arm approach"; 91.6% underwent PCI using a transradial approach, 3.5% through a brachial approach, 0.9% a transulnar approach, while the rest underwent a femoral approach.…”

Section: Discussionmentioning

confidence: 89%

Bilateral Percutaneous Ulnar Artery Approach for Retrograde Chronic Total Occlusion Intervention

Hussein¹,

Gan

Fang

et al. 2010

Int. Heart J.

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SummaryThe transradial approach for coronary diagnostic and therapeutic interventions is a well-established, safe, and effective technique that has shown a success rate comparable to that of the transfemoral approach for chronic total occlusion (CTO) with less access site complications. Recently, the transulnar approach was also found to be a safe and feasible alternative for diagnostic and percutaneous coronary intervention (PCI). There is limited data on the efficacy and safety of the transulnar approach for CTO PCI. Here, we report the case of a patient who underwent coronary intervention for CTO via the bilateral ulnar approach. (Int Heart J 2010; 51: 137-140) Key words: Ulnar, Chronic total occlusion, Retrograde intervention T ransradial coronary intervention (TRI) has become a worldwide popular approach, with increasing data showing its safety and efficacy are comparable to those of standard transfemoral intervention (TFI). The advantages of TRI include relatively lower access site complications, early mobilization, and hence shortening of hospital stay.1) With the advancement of miniaturized percutaneous coronary intervention (PCI) devices, forearm vascular access, and operator experience, TRI is also now being used for more complex lesions.Chronic total occlusion (CTO) occurs in approximately 30-50% of all patients with significant coronary stenosis who have undergone coronary angiography.2) In a recent study, TRI was found to be comparable to TFI with respect to in-hospital major adverse cardiac events (MACE).3) However, radial artery (RA) access still has certain limitations such as the relatively smaller vessel size, higher incidence of vasospasm, and presence of some anatomical variations of RA (eg, radial loop, RA access originating from high brachial or axillary arteries). In such patients, the transulnar (TU) approach may provide a reasonable alternative, but TU had not received that much attention until it was reported in 2001.4) The TU approach was then compared to the transradial (TR) approach, which was found to be a safe and effective alternative with a high success rate and low access site complications. 5) In our literature search, we could not find any reports on TU for CTO intervention. Here, we report the case of a patient who underwent the bilateral TU retrograde approach for long CTO at the distal right coronary artery (RCA). Case ReportA 71-year-old man with a history of diabetes, hypertension, and hyperlipidemia presented with stable angina on regular medication. He was admitted for elective PCI for a totally occluded RCA. History of PCI included Taxus Liberte stenting (Taxus

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Traditional antegrade approach versus combined antegrade and retrograde approach in the percutaneous treatment of coronary chronic total occlusions

Abstract: These results suggest that all CTO lesions should first be managed with an antegrade approach. When there is difficulty crossing the lesion, switching to a bilateral approach is an option for lesions with well-developed collaterals.

Cited by 40 publications

References 16 publications

Transradial percutaneous coronary intervention for chronic total occlusion of coronary artery disease using sheathless standard guiding catheters

Transradial percutaneous coronary intervention for chronic total occlusion of coronary artery disease using sheathless standard guiding catheters

Impact of calcification length ratio on the intervention for chronic total occlusions

Bilateral Percutaneous Ulnar Artery Approach for Retrograde Chronic Total Occlusion Intervention

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