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The role of the interventionalist in peripheral vascular interventions
Published in Ever D. Grech, Practical Interventional Cardiology, 2017
Alfred Hurley, Jayant Khitha, Tanvir Bajwa
Chronic total occlusion remains a challenging area despite advances in endovascular techniques and devices. Specialised re-entry devices such as the Outback (Cordis, Fremont, California) and Pioneer (Volcano Corp., San Diego, California) catheters have shown procedural success rates of 70%–90%. In addition, the Frontrunner catheter (LuMend, Inc., Redwood City, California) offers a different technique, creating a channel through the plaque in order to subsequently perform angioplasty or stenting.
Procedural and technical complications
Published in George D Dangas, Roxana Mehran, Jeffrey W Moses, Handbook of Chronic Total Occlusions, 2007
Masashi Kimura, Antonio Colombo, Eugenia Nikolsky, Etsuo Tsuchikane, George D Dangas
Chronic total occlusion is the last frontier in the field of interventional cardiology. Despite the development of new devices and techniques, certain complications still persist. One of the most common, serious complications during CTO procedures is coronary perforation. The angiographic spectrum of coronary perforation ranges from small-size extravasations with no hemodynamic consequences, to life-threatening events, such as cardiac tamponade, myocardial infarction, and emergent cardiac surgery, and death. Treatment of coronary perforation depends largely on the angiographic type of perforation. Types I and II perforations may be effectively treated with the reversal of anticoagulation and prolonged balloon inflations. Type III perforations should be treated with PTFE-covered stent grafts, demonstrated to be an alternative to surgery. Given the delayed development of cardiac tamponade, a high index of suspicion for tamponade should be maintained for patients with unexplained hypotension after PCI. Once complications occur, careful management and adequate treatment are indispensable. A complete understanding of appropriate decision-making and skills for managing this life-threatening complication should be mandatory for all interventional cardiologists. The most important point is not troubleshooting but avoiding the complication by performing a gentle and careful procedure.
Chronic Total Occlusions: New Therapeutic Approaches
Published in Richard R Heuser, Giancarlo Biamino, Peripheral Vascular Stenting, 1999
Raghunandan Kamineni, Richard R. Heuser
Acute or subacute total occlusions are usually treated with conventional methods of angioplasty and/or stenting with adjunctive thrombolysis or fibrinolysis. However, such conventional methods are usually not successful in treating chronic total occlusions. The major limitation of conventional recanalization techniques is the inability to cross total occlusions with a length of more than 5 cm in up to 50% of the cases. Hydrophilic wires (e.g. Terumo) have considerable success in crossing chronic total occlusion but run the risk of distal perforation. A variety of new techniques designed to treat chronic total occlusion have been developed and are described in the subsequent sections.
Early and long-term prognosis in patients with remaining chronic total occlusions after revascularization attempt. A cohort study from the SKEJ-CTO registry
Published in Scandinavian Cardiovascular Journal, 2023
Naja Stausholm Winther, Emil Nielsen Holck, Lone Juul Hune Mogensen, Salma Raghad Karim, Ashkan Eftekhari, Evald Høj Christiansen
Coronary artery disease (CAD) is a leading cause of mortality and morbidity in the world [1]. Twenty percent of CAD patients have a chronic total occlusion (CTO), which is associated with higher mortality compared to non-CTO CAD [2,3]. Only 15% of CTO patients are treated with percutaneous coronary intervention (PCI), although previous research has shown that PCI improves patients’ quality of life and relieves symptoms [4,5]. Observational studies also suggest a beneficial effect of successful recanalization on mortality and other clinical endpoints [6,7]. However, the prospective randomized trial DECISION-CTO found no such effect. Despite being powered for clinical endpoints, a high crossover rate and a premature stop of inclusion limited the interpretation of the results [8]. CTO PCI is currently considered indicated in patients with significant reversible ischemia and/or refractory symptoms despite optimal medical treatment [9,10].
The prognostic role of intra-aortic pulse pressure measured before percutaneous coronary intervention in patients with chronic coronary syndrome: a single-center, retrospective, observational cohort study
Published in Clinical and Experimental Hypertension, 2022
The main strength of our study is that, apart from previous studies, lower IAPP values were significantly associated with MACE in patients with CCS similar to ACS. A possible explanation for this result might be that the high-grade stenosis (>90%) of the coronary arteries in the vast majority (84.9%) of the patients included in the study. Also, similar results were found in patients with chronic total occlusion (26). As the degree of coronary artery lesion increases, the predictive effect of low IAPP on MACE may increase. The previously demonstrated J- or U-shaped relationship between MACE and IAPP would have been possible if IAPP had been incrementally evaluated in this study. Another possible explanation is that the nitrate could not be given before PCI due to lower SBP values in the low IAPP group, therefore the true vessel diameter could not be accurately evaluated and the implanted stents might be undersized.
Percutaneous coronary intervention for chronic total occlusion in patients aged <75 years versus ≥75 years: a systematic review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Noman Lateef, Muhammad Junaid Ahsan, Hafiz Muhammad Fazeel, Abdul Haseeb, Azka Latif, Omar Kousa, Mohsin Mirza, Mark Holmberg
Chronic total occlusion (CTO) of coronary arteries is defined as complete obstruction of a native coronary artery for the duration of ≥3 months based on estimation from clinical symptoms [1]. The gravity of occlusion is defined by thrombolysis in myocardial infarction (TIMI) grade using angiography as true (TIMI flow grade 0) or functional (TIMI flow grade 1) [2]. Large clinical registries have reported a CTO prevalence of 16–18% in patients with CAD [3,4]. The traditional treatment for CTO has been optimal medical therapy while revascularization therapies, namely, coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) were utilized in a lesser proportion of patients (CABG, 22–26% and PCI, 10–22%) [4]. This was due to the uncertainty regarding the post-operative prognosis after revascularization, difficulty in performing CTO-PCI, and the morbidity related to CABG surgery.