scholarly journals Retrograde Balloon Dilation outside the Main Branch Stent to Restore the Occlusion of Side Branch in Chronic Total Occlusion Bifurcation Lesions

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Gao Hao-kao ◽  
Li Cheng-xiang
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Balloon Dilation ◽  
Coronary Intervention ◽  
Side Branch ◽  
Total Occlusion ◽  
Bifurcation Lesion ◽  
Percutaneous Coronary ◽  
Bifurcation Lesions

Percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) can be challenging when a bifurcation is present at the distal cap. We described a case of retrograde balloon outside the main branch stent to restore the occlusion of side branch in CTO bifurcation lesion through the jailed wire.

scholarly journals Prediction Score of Antegrade Chronic Total Occlusion Percutaneous Coronary Intervention Success in Dr. Kariadi Central General Hospital Semarang

2020 ◽  
Vol 7 (2) ◽  
pp. 415-421
Author(s):  
Anggit Pudjiastuti ◽  
Sodiqur Rifqi ◽  
Sefri Noventi Sofia
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Side Branch ◽  
Prediction Score ◽  
Total Occlusion ◽  
Antegrade Approach ◽  
Percutaneous Coronary ◽  
Score Model ◽  
Point Total

Background: Lesion characteristics of chronic total occlusion (CTO) are predictors of percutaneous coronary intervention (PCI) success. A prediction score consist of these predictors can help CTO-PCI operators. Various prediction score had been established but none had been established in Indonesian population. Methods: This observational cohort study was performed in patients underwent native vessel CTO-PCI in Dr.Kariadi Hospital during 2018. Target vessels, ostial lesion, blunt stump, calcification, long lesion, bending, side branch, bridging collateral, and retrograde collateral were angiographic variables proposed to be predictors of CTO-PCI success. All of the variables were quantitatively assessed by two observers. Bivariate and multivariate analysis used to identify independent predictors of CTO-PCI success and to establish a scoring model. Results: A total 200 patients underwent CTO-PCI procedures were included to this study. All of the procedures used antegrade approach. The prediction score established as follows: bending (1 point), calcification (2 point), blunt stump (3 point), long lesion (1 point), and poor retrograde collateral filling (2 point). Total score ranged from 0 to 9 with decreased probability of success from 92.3% to 0.5%. Score value ? 3 categorized as difficult lesion with higher risk to failure compared to score value <3 (OR 15.4; p<0.001). The score model had good calibration and discrimination in predict CTO-PCI success (AUC 0.88; p<0.001). Conclusion: Bending, calcification, blunt stump, long lesion, and poor retrograde collateral were predictors of CTO-PCI success. The score consist of these variables could predict antegrade CTO-PCI success. Keywords: chronic total occlusion; percutaneous coronary intervention; success; prediction score.

Abstract 2236: Usefulness of 64-Slice Computed Tomography in Patients Undergoing Percutaneous Coronary Intervention of Chronic Total Occlusion

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Alice Ohanessian ◽  
Thierry Lefévre ◽  
Sanjay Sastry ◽  
Yves Louvard ◽  
Pierre Dumas ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Side Branch ◽  
Beta Blockade ◽  
Conventional Coronary Angiography ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Procedural Strategy ◽  
Procedural Success

Background. Despite constant technical advances, percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) remains a challenge with procedural success ranging from 65 to 85% in high volume center. MSCT provides information which cannot be obtained with conventional coronary angiography such as: plaque constitution, calcifications and distribution, route and distal run off. A better knowledge of these parameters may influence the approach to such complex PCI, optimize procedural strategy and success. The aim of our study was to evaluate the usefulness of cardiac CT before PCI of CTO. Methods . All patients with CTO underwent 64-slice CT before the scheduled PCI. We used a scan protocol with 64±0.625mm slice collimation (pitch 0.2), 350 ms (General Electric Lihgtspeed VCT) and 420 ms (Philips Brillance) rotation time and simultaneous (ECG) gating. Patients with heart rates above 65 bpm received intravenous beta-blockade. All CT examinations were performed with retrospective electrocardiogram gating. Exclusion criteria were atrial fibrillation and creatinemia >140 μmol/l. Results . Sixty patients were included in the study. Mean age was 63.58.5 yrs, 90% were male. On MSCT, the occlusion length was 25.5mm16.5 (33.119.8 on angiography). Calcifications were evaluated as minimal in 42% (26% angio), moderate in 42% (54%) and severe in 1% (12%) of the cases. No calcification was found in 15% (8%). A possible coronary route was identified in 68% (18% on angio), the lumen was relatively visible in 77%, acceptable in 23% and eccentric in 98%. One side branch was observed in 62 %, two in 8% and none in 30% of the CTO. Procedural difficulty was assessed by angio using a scale of 1 (very easy) to 5 (extremely difficult) with a mean rate of 3.540.92 falling to 2.620.81 after reading the MSCT data. MSCT was deemed as extremely useful in 80%, useful in 18% and non useful in 2%. Overall procedural success was achieved in 79% of the CTOs. Conclusion . MSCT appears to be a new tool for optimising procedural strategy and increasing success rate in CTO angioplasty.

Precision Percutaneous Coronary Intervention of a Complex Lesion

2020 ◽  
Vol 15 ◽  
Author(s):  
Nooraldaem Yousif ◽  
Fawaz Bardooli ◽  
Tajammul Hussain ◽  
Husam A. Noor
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coil Embolization ◽  
Chronic Total Occlusion ◽  
Balloon Dilation ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Timely Manner ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
High Calcium

Background: Balloon dilation and atherectomy have limitations in the treatment of heavily calcific coronary lesions. Introduction: Intravascular lithotripsy (IVL) is a state-of-the-art system that modifies severe calcific coronary plaques efficiently. In this paper, we report our experience with IVL in the context of a calcific in-stent chronic total occlusion. Case summary: A 75-year-old gentleman whose status was post percutaneous coronary intervention, with the deployment of two overlapping bare-metal stents in the mid-left anterior descending artery (LAD) 20 years ago, was admitted to our cardiac center for the elective intervention of in-stent chronic total occlusion (CTO) of LAD, which was performed using an antegrade wire escalation (AWE) technique. After recanalization of the CTO body, optical coherence tomography pullback confirmed a very high calcium score. Balloon dilatation attempts failed, so we proceeded with shockwave lithotripsy with successful full expansion of the 3.5-mm IVL balloon followed by a straightforward stent delivery. The procedure was complicated by distal wire perforation, which was handled in a timely manner with coil embolization. The patient’s postoperative course was uneventful. Conclusion: This case illustrates the feasibility and effectiveness of IVL that powerfully cracks coronary calcium while minimizing vessel wall trauma in the context of heavily calcific in-stent CTO. In our case, coronary perforation occurred in a small-caliber side branch, which was identified in a timely manner before hemodynamic compromise and treated successfully straight away with coil embolization.

Percutaneous Coronary Intervention for Complex Bifurcation Lesions

2010 ◽  
Vol 5 (1) ◽  
pp. 58
Author(s):  
Yves Louvard ◽  
Morice Marie-Claude ◽  
Thomas Hovasse ◽  
Thierry Lefèvre ◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Side Branch ◽  
Drug Eluting Stents ◽  
Open Angle ◽  
Balloon Inflation ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Bifurcation Lesions ◽  
Stent Diameter

Coronary bifurcations are prone to the development of atherosclerosis. They pose technical difficulties for angioplasty treatment and are a predictor of stent thrombosis and restenosis. Treatment of coronary bifurcations is still subject to debate, especially when the side branch (SB) is large, not easily accessible and narrowed by a long lesion. There is currently no indexed treatment for this type of lesion (Medina classification), as the strategy of provisional SB stenting with drug-eluting stents (DES) has proved to be equally efficient as the dualstent technique. Complex techniques are associated with poor outcome in certain lesion types, such as T-stenting when the angle between the two distal branches is small or the crush and culotte technique in the presence of an open angle. Provisional SB stenting may be used when primary dual stenting is required, with a low risk of failure provided that the following guidelines are implemented: stenting of the main branch through the protected SB with a stent diameter adapted to the distal main branch, immediate optimisation of the proximal stent segment (Finet’s law), guidewire exchange, kissing balloon inflation with non-compliant balloons selected according to the diameter of the distal branches and T-stenting of the SB before final kissing inflation.

scholarly journals Late survival benefit of percutaneous coronary intervention compared with medical therapy in patients with coronary chronic total occlusion: a 10-year follow-up study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.K Park ◽  
S.H Choi ◽  
J.M Lee ◽  
J.H Yang ◽  
Y.B Song ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Treatment Strategy ◽  
Initial Treatment ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary

Abstract Background As an initial treatment strategy, percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) did not show mid-term survival benefits compared with optimal medical therapy (OMT). Purpose To compare 10-year clinical outcomes between OMT and PCI in CTO patients. Methods Between March 2003 and February 2012, 2,024 patients with CTO were enrolled in a single center registry and followed for about 10 years. We excluded CTO patients who underwent coronary artery bypass grafting, and classified patients into the OMT group (n=664) or PCI group (n=883) according to initial treatment strategy. Propensity-score matching was performed to minimize potential selection bias. The primary outcome was cardiac death. Results In the PCI group, 699 patients (79.2%) underwent successful revascularization. Clinical and angiographic characteristics revealed more comorbidities and more complex lesions in the OMT group than in the PCI group. At 10 years, the PCI group had lower risks of cardiac death (10.4% versus 22.3%; HR 0.43; 95% CI 0.32 to 0.57; p&lt;0.001) than the OMT group. After the propensity-score matching analyses, the PCI group had lower risks of cardiac death (13.6% versus 20.8%; HR 0.62; 95% CI 0.44 to 0.88; p=0.007), acute myocardial infarction (6.3% versus 11.2%; HR 0.55; 95% CI 0.34 to 0.91; p=0.02), any revascularization (23.9% versus 32.2%; HR 0.67; 95% CI 0.51 to 0.88; p=0.004) than the OMT group. The beneficial effects of CTO PCI were consistent across various subgroups (all p-values for interaction: non-significant). Conclusions As an initial treatment strategy, PCI reduced late cardiac death compared with OMT in CTO patients. Cardiac death in matched population Funding Acknowledgement Type of funding source: None

scholarly journals Antegrade Approach of Percutaneous Coronary Intervention for Chronic Total Occlusion

2021 ◽  
Author(s):  
C. Raghu ◽  
Rahul K. Ghogre ◽  
Alekhya Mandepudi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Chronic Total Occlusion ◽  
Bypass Surgery ◽  
Coronary Intervention ◽  
Technical Expertise ◽  
Total Occlusion ◽  
Antegrade Approach ◽  
Percutaneous Coronary ◽  
Coronary Lesions

AbstractChronic total occlusion (CTO) is a common challenge accounting for 10% of coronary lesions found on coronary angiography. Patients are frequently referred for bypass surgery because percutaneous coronary intervention is challenging in this subset. Recent advances in the hardware as well as the technical expertise and an algorithm approach have improved the success to more than 90%.Antegrade approach is the cornerstone for managing CTO and has two distinct strategies: antegrade wire escalation, and antegrade dissection and reentry strategy. Step-wise approach to perform these procedures and the use of adjunct imaging are discussed.

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