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Chronic Total Occlusion (chronic + total_occlusion)
Selected AbstractsCT Coronary Angiography Predicts the Outcome of Percutaneous Coronary Intervention of Chronic Total OcclusionJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2007F.R.A.C.P., KEAN H. SOON M.B.B.S. Background: The success rate of percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is relatively low. Further evaluation of CTO lesion with CT coronary angiography (CT-CA) may help to better select patients that would benefit from percutaneous revascularization. We aimed to test the possible association between failed PCI and transluminal calcification of CTO as assessed by CT-CA. Methods: Patients with CTO awaiting PCI were scanned with a 16-slice CT. A cardiologist and a radiologist assessed transluminal calcification of CTO lesions on CT images while an interventional cardiologist at a core laboratory assessed conventional variables of invasive fluoroscopic coronary angiography (FCA) associated with failed PCI of CTO. The significance of CT and FCA variables in association with failed PCI were analyzed. Results: In a cohort of 39 patients with 43 CTO lesions, 24 lesions were successfully revascularized. Transluminal calcification ,50% as assessed on CT-CA was strongly associated with failed PCI (odds ratio [OR] of PCI success = 0.10, 95% confidence interval [CI]: 0.02,0.47, P = 0.003). Blunt stump as seen on FCA was also associated with failed PCI (OR of PCI success = 0.24, 95% CI: 0.07,0.86, P = 0.029). There was no significant evidence to support that the duration of CTO, presence of side branch and bridging collaterals, and the absence of microchannels as assessed with FCA were associated with failed PCI. On multivariate analysis, transluminal calcification ,50% on CT-CA was the only significant predictor of failed PCI. Conclusions: Heavy transluminal calcification as assessed with CT-CA is an independent predictor of failed PCI of CTO. CT-CA may have a role in the work-up of CTO patients prior to PCI. [source] Treatment of chronic total occlusion by retrograde passage of stents through an epicardial collateral vessel,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2008Darpan Bansal MD Abstract Chronic total occlusion (CTO) may occur in as many as 30,40% of patients with coronary artery disease. Retrograde revascularization through a collateral channel has been described earlier. We report the first case of retrograde passage of a stent through an epicardial collateral to revascularize a right coronary artery CTO. © 2008 Wiley-Liss, Inc. [source] Editorial: At the Bifurcation of the Last FrontiersJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2010THACH NGUYEN M.D. The concept of coronary angioplasty percutaneous coronary intervention (PCI) was pioneered by Andreas Gruntzig. Since then, several modifications, innovative devices, techniques, and advances have revolutionized the practice of interventional cardiology. Coronary bifurcation and chronic total occlusion are the last two frontiers that continue to challenge the skills of the interventional cardiologists. Proceedings of the second Bifurcation Summit held from November 26 to 28, 2009 in Nanjing, China are published in this symposium. In a general review, the state of the art in management of bifurcation lesion is summarized in the statement of the "Bifurcation Club in KOKURA." A new-presented concept was the "extension distance" between the main vessel and the sidebranch ostia and its association with restenosis. The results of two studies on shear stress (SS) after PCI showed that contradictory lower SS after stenting was associated with lower in-stent restenosis. There was better fractional flow reserve after double kissing crush technique than provisional one-stent technique. There was also lower rate of stent thrombosis after bifurcation stenting with excellent final angiographic results. In a negative note, the SYNTAX score had no predictive values on trifurcated left main stenting. In summary, different aspects of percutaneous management for bifurcated lesion are described seen from different perspectives and evidenced by novel techniques and strategies. (J Interven Cardiol 2010;23:293,294) [source] The Challenges of Chronic Total Coronary Occlusions: An Old Problem in a New PerspectiveJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2004DAVID E. KANDZARI M.D. In spite of the remarkable technological innovation and improved outcomes with percutaneous coronary revascularization, chronic coronary artery total occlusions remain a familiar source of procedural frustration and clinical uncertainty. However, considering the recent development of catheter-based technologies specific for chronic total occlusion (CTO) recanalization and the potential for drug-eluting stents to reduce restenosis and reocclusion, this challenging lesion subset is now recognized as the last formidable barrier to percutaneous revascularization success. Further, consistent observations from more recent clinical trials support successful CTO revascularization to avoid subsequent adverse cardiac events and improve long-term overall survival. This review of total coronary occlusions provides an overview of CTO pathophysiology, describes the procedural and clinical outcomes associated with CTO revascularization, and presents future directions for clinical investigation. [source] Immediate and Long-Term Outcome of Recanalization of Chronic Total Coronary OcclusionsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2002FEDERICO PISCIONE M.D. Eighty-three consecutive patients with 85 coronary total occlusions undergoing coronary angioplasty were retrospectively studied. Patients were divided into two groups according to the occlusion age that was<30 days (subacute total occlusion [STO]: 25 patients; range 1,30 days) or>30 days (chronic total occlusion [CTO]: 58 patients; range 3,144 months). All procedures were carried out using a hydrophilic guidewire. Clinical success, consisting of crossing the lesion, balloon dilatation, stent deployment without complication, was 96% in STO and 81% in CTO. Multiple stepwise logistic regression analysis identified a family history of coronary artery disease (CAD), left anterior descending and right coronary artery occlusions as independent predictors of a successful procedure. No major events occurred during or immediately after the angioplasty. After a mean follow-up of 24 ± 2 months, no difference was found in survival or freedom from myocardial infarction or target vessel revascularization among the STO and CTO patients. Successful recanalization by using a hydrophilic guidewire was achieved in a high percentage of chronic total occlusions with a low incidence of complications and a satisfactory late clinical outcome. Family history of CAD and occlusion of left anterior descending or right coronary arteries are independent predictors of procedural success. [source] Inferolateral ST Elevation as a First Sign of Left Anterior Descending Artery OcclusionANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2010Po-Chao Hsu M.D. Combined anterior and inferior ST elevation due to occlusion of wrapped left anterior descending artery (LAD) is well reported in the literature. However, there is rare literature mentioned about inferolateral ST elevation in this patient group. Herein, we report a case of acute proximal wrapped LAD occlusion with initial electrocardiographic sign of inferolateral ST elevation. The most likely mechanism of this electrocardiographic finding might be related to old anteroseptal myocardial infarction, combination with other coronary abnormality, such as chronic total occlusion of left circumflex artery that caused larger injury current in inferolateral than anteroseptal myocardium, and made anteroseptal leads reveal isoelectric pattern. Ann Noninvasive Electrocardiol 2010;15(1):90,93 [source] Native chronic total occlusion recanalization after lower limb bypass graft occlusion: A series of nine cases,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2010FSCAI, Osami Kawarada MD Abstract Objective: The aim of the study was to report the clinical utility of native chronic total occlusion (CTO) recanalization as an endovascular strategy in lower limb bypass graft occlusion. Background: There is no consensus on the best approach for threatened limbs in patients with graft occlusion. Methods: The subjects were nine consecutive patients with limb-threatening ischemia after bypass graft occlusion. Native CTO recanalization was attempted endovascularly using conventional intraluminal and subintimal angioplasty techniques supported by stents. Results: The mean age of the bypass grafts was 6.7 ± 7.3 (range: 1,24) months and the mean number of previous lower limb bypass surgeries was 1.4 ± 0.5 (range: 1,2). Native CTO recanalization was performed in the iliofemoral (n = 2), iliac (n = 2), superficial femoral (n = 3), popliteal (n = 1), and popliteal-tibial (n = 1) arteries. Technical success was achieved in 89% (8/9) of cases without complications or major adverse cardiovascular events. The ankle-brachial index and skin perfusion pressure of the foot significantly increased after revascularization, with marked improvement of clinical symptoms (Rutherford class: 4.5 ± 1.1,0.9 ± 1.4, P < 0.001). Limb salvage was achieved in all successful recanalization cases during the mean follow-up time of 25 ± 20 months (range: 9,60). Conclusions: In this preliminary study, endovascular recanalization of native CTO showed satisfactory outcomes in patients with bypass graft occlusion. © 2010 Wiley-Liss, Inc. [source] Peripheral chronic total occlusion in patients with critical limb ischemia,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2010Hernan A. Bazan MD No abstract is available for this article. [source] Five-year clinical outcomes after coronary stenting of chronic total occlusion using sirolimus-eluting stents: Insights from the rapamycin-eluting stent evaluated at Rotterdam Cardiology Hospital,(Research) Registry,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2009Zhu Jun Shen MD Abstract Background: The use of drug eluting stents (DES) in patients with a successfully recanalized chronic total occlusion (CTO) has been associated with a significant decrease in the need for repeat revascularization, and a favorable short-term clinical outcome when compared with the use of bare metal stents (BMS). Our group, however, has previously reported similar rates of target lesion revascularisation (TLR) and major adverse cardiovascular events (MACE) at 3 years follow-up in patients with a successfully opened CTO who were treated with either a sirolimus eluting stent (SES) or a BMS. The objective of this report was to evaluate the outcomes of these patients at 5-years clinical follow-up. Methods and Results: A total of 140 (BMS 64, SES 76) patients with successfully opened CTOs were included. Seven patients died in the BMS group whilst nine patients died in the SES group (P = 0.90). Noncardiac death was the major component of all-cause mortality (11 noncardiac deaths vs. 5 cardiac). There were two and three myocardial infarctions (MI) in the BMS and SES group, respectively (P = 1.0). The composite of death and MI occurred in seven (10.9%) and eleven (14.5%) patients in the BMS and SES group, respectively (P = 0.53). Clinically driven TLR was performed in eight patients (12.5%) in the BMS group, and five (6.6%) in the SES group (P = 0.26). Non-TLR target vessel revascularization was performed in one patient in the BMS group, and four in the SES group (P = 0.37). The 5-year device-oriented cumulative MACE rate was 15.6% and 11.8% in the BMS and SES group, respectively (P = 0.56). Conclusion: In patients with a successfully treated CTO, clinical outcome after 5 years was similar between SES and BMS, however, clinically driven TLR was slightly higher in the BMS group. © 2009 Wiley-Liss, Inc. [source] Percutaneous intervention for chronic total occlusion of the internal iliac artery for unrelenting buttock claudication,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2009Satjit Adlakha DO Abstract Internal iliac artery stenosis or occlusion has been documented to cause hip pain, erectile dysfunction, and buttock claudication. Endovascular repair for patients with significant stenosis has been well documented, but chronic total occlusion revascularizations have not been reported in the literature. The reluctance to attempt percutaneous intervention may be in part due to the extensive collateralization that forms to this vessel, or fear of complications such as wire perforation in a vessel that has a tortuous route with multiple bifurcations. This report describes two cases of patients with unrelenting buttock claudication that completely resolved after percutaneous intervention of unilateral chronic total occlusions of the internal iliac artery. © 2008 Wiley-Liss, Inc. [source] Treatment of chronic total occlusion by retrograde passage of stents through an epicardial collateral vessel,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2008Darpan Bansal MD Abstract Chronic total occlusion (CTO) may occur in as many as 30,40% of patients with coronary artery disease. Retrograde revascularization through a collateral channel has been described earlier. We report the first case of retrograde passage of a stent through an epicardial collateral to revascularize a right coronary artery CTO. © 2008 Wiley-Liss, Inc. [source] Impact of 16-slice computed tomography in percutaneous coronary intervention of chronic total occlusionsCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2006Naoyuki Yokoyama MD Abstract The main reason for failure of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is because the calcified plaque prevents the guide wire crossing the occlusion. We aimed to identify the route, and characterize plaque components within CTO, using 16-slice computed tomography (MSCT). Twenty three angiographic CTO in 22 patients (mean age 69 ±± 5 years, 17 males) were included. All patients had undergone MSCT prior to PCI. Images were analyzed for lesion visibility and plaque characteristics of CTO. The presence and location of calcified plaque within the CTO were systematically assessed. Each lesion was classified as a noncalcified, moderately calcified, or exclusively calcified plaque. Procedural failure was defined as the inability to cross a guide wire through the occlusion. All coronary routes of CTO segment were visualized. MSCT revealed three markedly bent CTO segments (13.0%), which could not be identified by coronary angiography only. Calcified plaques were detected in 30 lesions of 19 CTO segments (82.6%), but were not detected in the other four. The majority of calcified plaque was located in the proximal lesion, or both proximal and distal lesions. Fifteen out of 30 calcified lesions (50.0%) were exclusively calcified plaques. Overall procedural success was obtained in 21 CTOs (91.3%). MSCT can accurately identify the route of the CTO segment and evaluate both distribution and amount of the calcified plaque within it. Even with the complicated and/or calcified lesions, PCI success rate was excellent under MSCT guidance. MSCT should become a useful tool in PCI of CTO. © 2006 Wiley-Liss, Inc. [source] Novel double catheter technique in complex percutaneous coronary interventionsCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2006Imad A. Alhaddad MD Abstract We present a novel double catheter technique for successful complex intervention of a very old proximal left circumflex chronic total occlusion (>10 years old). Prior attempts of guide wire passage using bare wire alone, over-the wire balloon or microcatheter support techniques were unsuccessful. © 2006 Wiley-Liss, Inc. [source] CT Coronary Angiography Predicts the Outcome of Percutaneous Coronary Intervention of Chronic Total OcclusionJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2007F.R.A.C.P., KEAN H. SOON M.B.B.S. Background: The success rate of percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is relatively low. Further evaluation of CTO lesion with CT coronary angiography (CT-CA) may help to better select patients that would benefit from percutaneous revascularization. We aimed to test the possible association between failed PCI and transluminal calcification of CTO as assessed by CT-CA. Methods: Patients with CTO awaiting PCI were scanned with a 16-slice CT. A cardiologist and a radiologist assessed transluminal calcification of CTO lesions on CT images while an interventional cardiologist at a core laboratory assessed conventional variables of invasive fluoroscopic coronary angiography (FCA) associated with failed PCI of CTO. The significance of CT and FCA variables in association with failed PCI were analyzed. Results: In a cohort of 39 patients with 43 CTO lesions, 24 lesions were successfully revascularized. Transluminal calcification ,50% as assessed on CT-CA was strongly associated with failed PCI (odds ratio [OR] of PCI success = 0.10, 95% confidence interval [CI]: 0.02,0.47, P = 0.003). Blunt stump as seen on FCA was also associated with failed PCI (OR of PCI success = 0.24, 95% CI: 0.07,0.86, P = 0.029). There was no significant evidence to support that the duration of CTO, presence of side branch and bridging collaterals, and the absence of microchannels as assessed with FCA were associated with failed PCI. On multivariate analysis, transluminal calcification ,50% on CT-CA was the only significant predictor of failed PCI. Conclusions: Heavy transluminal calcification as assessed with CT-CA is an independent predictor of failed PCI of CTO. CT-CA may have a role in the work-up of CTO patients prior to PCI. [source] Immediate and Long-Term Outcome of Recanalization of Chronic Total Coronary OcclusionsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2002FEDERICO PISCIONE M.D. Eighty-three consecutive patients with 85 coronary total occlusions undergoing coronary angioplasty were retrospectively studied. Patients were divided into two groups according to the occlusion age that was<30 days (subacute total occlusion [STO]: 25 patients; range 1,30 days) or>30 days (chronic total occlusion [CTO]: 58 patients; range 3,144 months). All procedures were carried out using a hydrophilic guidewire. Clinical success, consisting of crossing the lesion, balloon dilatation, stent deployment without complication, was 96% in STO and 81% in CTO. Multiple stepwise logistic regression analysis identified a family history of coronary artery disease (CAD), left anterior descending and right coronary artery occlusions as independent predictors of a successful procedure. No major events occurred during or immediately after the angioplasty. After a mean follow-up of 24 ± 2 months, no difference was found in survival or freedom from myocardial infarction or target vessel revascularization among the STO and CTO patients. Successful recanalization by using a hydrophilic guidewire was achieved in a high percentage of chronic total occlusions with a low incidence of complications and a satisfactory late clinical outcome. Family history of CAD and occlusion of left anterior descending or right coronary arteries are independent predictors of procedural success. [source] Percutaneous coronary intervention using a virtual 3-Fr guiding catheter,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2010Shingo Mizuno MD Abstract Background: We have recently reported a novel percutaneous coronary intervention (PCI) system using a hydrophilic-coated sheathless guiding catheter (Virtual 3-Fr, Medikit, Tokyo, Japan), which provides us with less invasive angioplasty and a puncture site injury equivalent to a conventional 3-Fr introducer sheath. Here, we report the initial results of PCI using this novel system. Methods: A total of 36 coronary artery lesions of 27 patients were treated by using a virtual 3-Fr PCI system. Procedural outcomes of virtual 3-Fr PCI were retrospectively evaluated. Results: The mean age was 73.0 ± 8.7 years (range, 46,84 years), and 15 were men (56%). Access sites included the radial artery in 18 patients (67%), the brachial artery in eight patients (30%), and the femoral artery in 1 patients (4%). Among 36 lesions, seven were chronic total occlusions, and a virtual 3-Fr PCI was successful in 33 lesions (92%). Among the successfully treated 33 lesions, coronary stents were deployed in 32 (97%), and intravascular ultrasound examination was performed in 19 (58%). Hemostasis was achieved immediately after PCIs in all cases. No access-site related complications including radial artery occlusion were observed. Conclusions: The performance of a virtual 3-Fr PCI system appears to be comparable to one using a regular 5-Fr guiding catheter while the puncture-site damage remains equivalent to that of a 3-Fr introducer sheath. Virtual 3-Fr PCI may have a potential to serve as a minimally invasive strategy for the treatment of coronary artery diseases. © 2010 Wiley-Liss, Inc. [source] Percutaneous intervention for chronic total occlusion of the internal iliac artery for unrelenting buttock claudication,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2009Satjit Adlakha DO Abstract Internal iliac artery stenosis or occlusion has been documented to cause hip pain, erectile dysfunction, and buttock claudication. Endovascular repair for patients with significant stenosis has been well documented, but chronic total occlusion revascularizations have not been reported in the literature. The reluctance to attempt percutaneous intervention may be in part due to the extensive collateralization that forms to this vessel, or fear of complications such as wire perforation in a vessel that has a tortuous route with multiple bifurcations. This report describes two cases of patients with unrelenting buttock claudication that completely resolved after percutaneous intervention of unilateral chronic total occlusions of the internal iliac artery. © 2008 Wiley-Liss, Inc. [source] High-frequency vibration for the recanalization of guidewire refractory chronic total coronary occlusions,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2008Klaus Tiroch MD Abstract Background: Recanalization of coronary chronic total occlusions (CTOs) remains a clinical challenge, particularly when standard guidewire attempts fail. Objectives: We sought to determine the safety and efficacy of a novel method that used high-frequency (20 kHz) vibration to fragment occlusive fibrous tissue and facilitate guidewire crossing into the distal vessel. Methods: A total of 125 patients with CTO, who failed at attempts of conventional guidewire recanalization after more than 5 min of fluoroscopy time, were enrolled in the study. The primary efficacy endpoint was the advancement of the CROSSERÔ catheter through the occlusion and attainment of coronary guidewire positioning in the distal coronary lumen. The primary safety endpoint was the occurrence of death, myocardial infarction, clinical perforation, or target vessel revascularization within the first 30 days. Results: The average fluoroscopy time while delivering the CROSSER catheter was 12.4 min. CROSSER-assisted guidewire recanalization was achieved in 76 (60.8%) procedures and a final diameter stenosis <50% was obtained in 68 (54.4%) of cases. Major adverse events occurred in 11 (8.8%) patients, lower than the predefined objective performance criteria. Angina frequency and quality of life were improved in patients with successful guidewire recanalization. Conclusions: We conclude that high-frequency vibration using the CROSSER catheter is a safe and effective therapy for patients with CTO, which are refractory to standard guidewire recanalization. © 2008 Wiley-Liss, Inc. [source] Through the back door,Retrograde stenting in chronic total occlusions,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2008Christoph Hehrlein MD No abstract is available for this article. [source] Impact of 16-slice computed tomography in percutaneous coronary intervention of chronic total occlusionsCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2006Naoyuki Yokoyama MD Abstract The main reason for failure of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is because the calcified plaque prevents the guide wire crossing the occlusion. We aimed to identify the route, and characterize plaque components within CTO, using 16-slice computed tomography (MSCT). Twenty three angiographic CTO in 22 patients (mean age 69 ±± 5 years, 17 males) were included. All patients had undergone MSCT prior to PCI. Images were analyzed for lesion visibility and plaque characteristics of CTO. The presence and location of calcified plaque within the CTO were systematically assessed. Each lesion was classified as a noncalcified, moderately calcified, or exclusively calcified plaque. Procedural failure was defined as the inability to cross a guide wire through the occlusion. All coronary routes of CTO segment were visualized. MSCT revealed three markedly bent CTO segments (13.0%), which could not be identified by coronary angiography only. Calcified plaques were detected in 30 lesions of 19 CTO segments (82.6%), but were not detected in the other four. The majority of calcified plaque was located in the proximal lesion, or both proximal and distal lesions. Fifteen out of 30 calcified lesions (50.0%) were exclusively calcified plaques. Overall procedural success was obtained in 21 CTOs (91.3%). MSCT can accurately identify the route of the CTO segment and evaluate both distribution and amount of the calcified plaque within it. Even with the complicated and/or calcified lesions, PCI success rate was excellent under MSCT guidance. MSCT should become a useful tool in PCI of CTO. © 2006 Wiley-Liss, Inc. [source] Current status of rotational atherectomyCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2004Erdal Cavusoglu MD Abstract Despite the increasing use of percutaneous transluminal coronary angioplasty and intracoronary stent placement for the treatment of obstructive coronary artery disease, a large subset of coronary lesions cannot be adequately treated with balloon angioplasty and/or intracoronary stenting alone. Such lesions are often heavily calcified or fibrotic and undilatable with the present balloon technology and attempts to treat them with balloon angioplasty or intracoronary stent placement often lead to vessel dissection or incomplete stent deployment with resultant adverse outcomes. Rotational atherectomy remains a useful niche device for the percutaneous treatment of such complex lesions, usually as an adjunct to subsequent balloon angioplasty and/or intracoronary stent placement. In contrast to balloon angioplasty or stent placement that widen the coronary lumen by displacing atherosclerotic plaque, rotational atherectomy removes plaque by ablating the atherosclerotic material, which is dispersed into the distal coronary circulation. Other lesion subtypes amenable to treatment with this modality include ostial and branch-ostial lesions, chronic total occlusions, and in-stent restenosis. This review discusses the technique and principles of rotational atherectomy, the various treatment strategies for its use (including adjunctive pharmacotherapy), the lesion-specific applications for this device, and the complications unique to this modality. Recommendations are also made for its use in the current interventional era. Catheter Cardiovasc Interv 2004;62:485,498. © 2004 Wiley-Liss, Inc. [source] | ||||||||||