Angioplasty Of Chronic Coronary Occlusions Research Articles

What are the non-procedural factors predicting the success of angioplasty for chronic coronary occlusion in a hospital center in France?

The expansion of the angioplasty technique (ATL) of chronic coronary occlusion (CTO) in France, led us to initiate this work. To determine the associations between procedural factors and the success rate of chronic coronary occlusion angioplasty. Our study was retrospective, cross-sectional and analytical on all CTO angioplasties performed from October 2018 to April 2019. There were 172 procedures. We watched all the movies, calculated the JCTO score, entered and analyzed the data on SPSS21. Success meant establishment of an active stent. The associations between procedural factors and the success rate of chronic coronary occlusion angioplasty. There was no significant link between the success of the PTA of the CTO and the history of infractus (P = 0.25), the history of angioplasty (P = 0.19), and the amount of iodine (P = 0.23) (Table 1). The J – CTO score, the time of fluoroscopy and the site of the treated lesion were procedural factors for the failure of angioplasty for chronic coronary occlusion.

What are the non-procedural factors predicting the success of angioplasty for chronic coronary occlusion in a hospital center in France?

What are the non-procedural factors predicting the success of angioplasty for chronic coronary occlusion in a hospital center in France?

Predictors for restenosis after angioplasty of chronic coronary occlusions

Background: The Stenting In Chronic Coronary Occlusion (SICCO) study assessed the effects of additional intracoronary stenting (Palmaz–Schatz) after successful percutaneous transluminal coronary angioplasty (PTCA) of chronic coronary occlusions and showed a significant reduction of restenosis in stented patients. Methods: Univariate and logistic regression analyses were used to assess clinical, angiographic and procedure related predictors for restenosis (>50% diameter stenosis at follow-up) and Major Adverse Clinical Events (MACE=cardiac death, lesion-related acute myocardial infarction, repeat lesion-related angioplasty, bypass surgery involving the treated segment or angiographic documentation of reocclusion in non-revascularized patients) in the 114 SICCO patients with an angiographic end-point and 300 days clinical follow-up. Results: By 6 months the restenosis rate was 53%, and after 300 days MACE had occurred in 39%. Both the rates of restenosis and MACE was significantly reduced by stenting. The restenosis rate was improved by stenting also in patients with a `stentlike' result after the initial PTCA. In the multivariate model the risk of restenosis was increased by a history of unstable angina, a long lesion and a non-tapering occlusion stump. LAD location was associated with a threefold increased risk of MACE. Conclusion: Stent implantation should always be considered in successfully opened chronic occlusions.

Improvement in left ventricular ejection fraction and wall motion after successful recanalization of chronic coronary occlusions.

This study assessed changes in left ventricular ejection fraction and regional radial shortening after successful angioplasty of chronic coronary occlusions. We studied 95 patients with angina pectoris or exercise-induced ischaemia with a successfully recanalized chronic (median duration 4.3 months) coronary occlusion. Intracoronary stents were implanted in 71%. Left ventriculograms were obtained at baseline and after 6.7 +/- 1.4 months. Left ventricular ejection fraction and regional radial shortening were determined by a computer-assisted method. Left ventricular ejection fraction increased from 0.62 +/- 0.13 at baseline to 0.67 +/- 0.11 at follow-up (P < 0.001). The change in left ventricular ejection fraction in patients with a patent artery and in patients with reocclusion (n = 8) was 0.05 +/- 0.06 and 0.01 +/- 0.04, respectively (P = 0.04). Regional radial shortening in the territory of the recanalized artery increased by 16% (from 0.28 +/- 0.11 to 0.32 +/- 0.11, P < 0.001) in patients with a patent artery at follow-up, but was unchanged in patients with reocclusion. Long-term patency after recanalization of old, chronic coronary occlusions in patients with angina pectoris is associated with improvement in global and regional left ventricular function. This may be a result of recovery of hibernating myocardium and supports the strategy of recanalizing chronic coronary occlusions.

3.P.332 Predictors of restenosis after successful balloon angioplasty of chronic coronary occlusions

3.P.332 Predictors of restenosis after successful balloon angioplasty of chronic coronary occlusions

Morphology of chronic coronary occlusions and response to interventional therapy--a study by intracoronary ultrasound.

Balloon angioplasty of chronic coronary occlusions has a low procedural success and a high recurrence rate. Better tomographic insights into the lesion morphology may improve the interventional strategy and results. Intracoronary ultrasound was used during the recanalizaton procedure of 45 chronic coronary occlusions (2 weeks to 14 months; average 3.4 months) to determine the lesion morphology and to assess the angioplasty result. The luminal area and the plaque burden were measured proximal and distal to the occlusion, and within the occlusion. The ultrasonographic characteristics of the occlusive lesions were compared to 45 nonocclusive lesions of age-matched patients with stable angina pectoris. Occlusive lesions were more often echodense as compared to nonocclusive lesions (35% vs. 20%; p = 0.10). In chronic occlusions a multi-layered plaque morphology was observed in 22%, and this morphology was not found in nonocclusive lesions. Angiographic characteristics were not related to the ultrasonographic morphology of the lesion. Despite similar vessel areas in occlusive and nonocclusive lesions, the balloon size selected according to the angiographic image was underestimated in occlusive lesions. Based on the quantitative ultrasound measurement the balloon size was increased from 2.6 +/- 0.3 mm to 3.3 +/- 0.5 mm in 53% of the lesions. This resulted in an increase of the luminal area from 3.51 +/- 0.92 to 5.08 +/- 1.43 mm2 (p < 0.001). The acute recoil after balloon angioplasty was similar (34 +/- 18%) in hypodense and echodense plaques, but was significantly higher in lesions with a multi-layered plaque morphology (49 +/- 22%; p < 0.05). In 19 patients with severe dissections or extreme acute recoil (residual stenosis > 50%) the use of a stent increased the luminal area from 3.94 +/- 0.81 to 7.51 +/- 1.71 mm2 (p < 0.001). Intracoronary ultrasound demonstrated a multi-layered plaque morphology in one fourth of the chronic occlusions. This type of plaque was associated with a significant acute recoil. The presence of diffuse atherosclerosis in neighbouring segments of chronic coronary occlusions leads to underestimation of the balloon size. Quantitative assessment by intracoronary ultrasound helped to optimize the balloon size leading to a significant luminal area gain. The detection of excessive acute recoil should be considered an indication for stent deployment.