Trends in Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions

Prasad, Abhiram; Rihal, Charanjit S.; Lennon, Ryan J.; Wiste, Heather J.; Singh, Mandeep; Holmes, David R.

doi:10.1016/j.jacc.2006.12.040

Cited by 301 publications

(190 citation statements)

References 28 publications

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“…Despite advantages in interventional cardiology during last decade, chronic total occlusions (CTO) still remains one of the biggest problem in percutaneous coronary interventions (PCI) (10,14). CTO prevalence is high, but only less than 10% of percutaneous revascularizations are CTO interventions (17).…”

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confidence: 99%

Chronic Total Coronary Artery Occlusion Recanalization with Percutaneous Coronary Intervention Using Anterograde and Retrograde Approach – Riga East Clinical University Hospital Experience

Kalniņš¹,

Lukstins²,

Kurcalte³

et al. 2013

Acta Chirurgica Latviensis

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17Summary Introduction. Despite advantages in interventional cardiology during last decade, chronic total occlusions (CTO) still remains one of the biggest problem in percutaneous coronary interventions (PCI) (10,14). CTO prevalence is high, but only less than 10% of percutaneous revascularizations are CTO interventions (17). There are no prospective randomized trials, properly powered for hard clinical endpoints, comparing modern optimal medical therapy with contemporary state of the art CTO recanalization (6). Aim of the study. The aim of our study was to compare CTO PCI procedural parameters and treatment results using anterograde and/or retrograde approach. Materials and methods. The study included all patients undergoing PCI for CTO at single tertiary PCI center between January 2007 and December 2012. 5568 PCI procedures were done in this period in our institution. 486 (8,64%) of them were CTO PCI. Retrograde approach was used in 138 (28,7% of all CTO PCI) cases. Patients were grouped according PCI year performing, approach (anterograde or retrograde) and PCI results (successful or unsuccessful). Demographic and procedural data were collected at the time of intervention. Results. A total of 405 patients undergoing CTO PCI were included. The median age was 64yrs(38-88) and 79,2% was male. Retrograde approach (RA) was used in 138(28,7%) cases. RA usage has increase from 15.9% in 2007 till 46,8% of cases in 2012(p=0,0000218). The overall patient and procedure success rates were 77,8% (315/90) and 69,9%(340/146) respectively. Overall success rate has increase from 61,4% in 2007 till 87,1% in 2012 (p<0,001). Overall survival was found better in patients group after successful procedure (Long-rank test p=0,019). Conclusions. Retrograde approach usage significantly increase CTO PCI success rate, but doesn't increase risk of complications. Long-term outcome and survival after CTO PCI is not depending on approach (anterograde or retrograde), but on procedural success.

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confidence: 99%

Chronic Total Coronary Artery Occlusion Recanalization with Percutaneous Coronary Intervention Using Anterograde and Retrograde Approach – Riga East Clinical University Hospital Experience

Kalniņš¹,

Lukstins²,

Kurcalte³

et al. 2013

Acta Chirurgica Latviensis

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“…Myocardium inthe perfusionterritory of a CTO can be functional, dysfunctional but viable, or dysfunctional and nonviable [14][15][16]. The targeted area of heart tissues in CTO patients comprise hibernating myocardium [17].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of left ventricular function after percutaneous recanalization of chronic coronary occlusions

Wang

Liu

Ren

2018

Herz

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Evaluation of left ventricular function after percutaneous recanalization of chronic coronary occlusionsThe role of two-dimensional speckle tracking echocardiography Chronic total occlusion (CTO) is defined as an occluded coronary artery presenting as thrombolysis in myocardial infarction (TIMI) with grade 0 or 1 flow in a recent myocardial infarction (MI) [1,2]. The myocardium in the perfusion territory of a CTO can be functional, dysfunctional but viable, or dysfunctional and nonviable [3,4]. Dysfunctional but viable myocardium in CTO may have restored function after percutaneous coronary intervention (PCI) [5][6][7][8][9]. However, the earliest time that the recovery of dysfunctional but viable myocardium can be detected remains unknown. Conventional echocardiography enables us to identify significant left ventricular (LV) dysfunction but not subclinical dysfunction [10]. Two-dimensional speckle tracking echocardiography (2D-STE) allows for an angle-independent evaluation of myocardial strain, and provides comprehensive information on LV myocardial contractility. Thus, 2D-STE is superior in detecting subtle deteriorations of contractility [11][12][13]. These advantages of 2D-STE are useful for the detection of subclinical recovery of dysfunctional but viable myocardium after CTO-PCI.In this study, the LV systolic function of CTO patients with dysfunctional myocardium was evaluated at 1 day as well as 3 and 6 months after percutaneous revascularization using 2D-STE. It was found that 2D-STE was superior in detecting subclinical LV systolic dysfunction in CTO patients after percutaneous revascularization. Patients and methods SubjectsA single-center prospective observational study was performed from July 2012 to March 2016. Patients with CTO with an estimated duration of less than 3 months or an MI during the previous 30 days were excluded, but no other predefined clinical inclusion or exclusion criteria were applied. The indication for PCI was determined by individual investigators at the participating center. In all, 43 patients (mean age: 66.09 ± 10.99 years) scheduled to undergo PCI for CTO in a native coronary artery were eligible for enrollment. Among them, there were 40 males and three females. The CTO of ten patients was located in the left anterior descending artery in ten patients, in the right coronary artery in 25 patients, and in the circumflex artery in eight patients. A follow-up visit or telephone interview was scheduled at 1 day as well as 3 and 6 months after percutaneous revascularization. Prior written and informed consent was obtained from every patient. This study was approved by the Ethics Review Board of Capital Medical University. Percutaneous revascularizationPercutaneous revascularization was performed by operators highly experienced in the treatment of CTO according to their standard practices with the femoral or brachial approach. The operation was considered successful when the residual stenosis was ≤30% of the intraluminal diameter, with TIMI grade 3 flow and no inhospital complic...

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“…Despite developments in interventional cardiology during the last decade, chronic total occlusions (CTO) still remain as one of the unresolved problems in percutaneous coronary interventions (PCI) (Prasad et al, 2007). CTO prevalence is high; approximately one-third of patients with significant coronary artery disease on angiography has at least 1 CTO, but only less than 10% of percutaneous revascularisations are CTO interventions (Werner et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Chronic Total Coronary Artery Occlusion Recanalisation with Percutaneous Coronary Intervention — Single Centre 10-Year Experience

Kalniņš

Strēle

Kurcalte

et al. 2018

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Trends in Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions

Cited by 301 publications

References 28 publications

Chronic Total Coronary Artery Occlusion Recanalization with Percutaneous Coronary Intervention Using Anterograde and Retrograde Approach – Riga East Clinical University Hospital Experience

Chronic Total Coronary Artery Occlusion Recanalization with Percutaneous Coronary Intervention Using Anterograde and Retrograde Approach – Riga East Clinical University Hospital Experience

Evaluation of left ventricular function after percutaneous recanalization of chronic coronary occlusions

Chronic Total Coronary Artery Occlusion Recanalisation with Percutaneous Coronary Intervention — Single Centre 10-Year Experience

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