Recanalization Of Chronic Total Occlusion Research Articles

Antegrade and retrograde in‐stent tibial artery chronic total occlusion recanalization with double kiss crush (DK crush) stenting of previous stent

Below the knee (BTK) peripheral arterial disease often presents with critical limb ischemia (CLI) clinically with involvement of more than one tibial vessels. Drug eluting stent (DES) technology for treatment of BTK disease has shown promising long-term durable results; however, currently only coronary DESs are available for application in the United States. Although coronary bifurcation stenting techniques are backed by extensive data in literature, there is a scarcity of data for the treatment of tibial bifurcation disease. Bifurcation angles in the tibials are similar to those in the coronaries and therefore the same two stent bifurcation technique can be applied in BTK disease. Double Kiss crush (DK crush) stenting has superior outcomes when compared to provisional or culotte stenting in randomized coronary trials (based on Medina classification). We present a case of BTK CLI with tibial bifurcation chronic total occlusion treated with two stent DK crush technique using coronary DES.

Primary retrograde transpedal approach for revascularization of chronic total occlusions of the superficial femoral artery and re-route technique using percutaneous puncture for re-entry.

We aimed to demonstrate the safety and feasibility of revascularization of chronic total occlusion of the superficial femoral artery (SFA) using the transpedal approach and describe a new technique called "re-route". The study included all consecutive patients who had chronic total occlusions at the level of SFA and underwent retrograde treatment through a pedal artery intervention between September 2017 and October 2019. Balloon angioplasty was applied as the first treatment option. After angioplasty, bailout stenting was performed when necessary in patients with indications. If the common femoral artery lumen could not be reached from the SFA ostium, the re-route technique was used. Technical success was defined as revascularization with residual stenosis of less than 30%. Twenty-five SFAs were revascularized in 23 patients (17 males; mean age, 66±7.3 years) by angioplasty in 5 SFAs and angioplasty and stents in 20 SFAs. While the transpedal approach was applied after the failure of antegrade recanalization in three patients, it was used as the first treatment route in the remaining cases. The re-route technique was applied in 7 patients, with a 100% technical success rate. The mean follow-up was 15.3 months (range, 12-18 months). The primary patency rate was 78% at one year. The retrograde transpedal approach is a safe and successful technique for chronic total occlusion recanalization and carries a low risk of complications. In order to increase technical success, the re-route technique can be used as an alternative re-entry method.

A sex-stratified long-term clinical outcome analysis in coronary chronic total occlusion patients

BackgroundDifferences in outcomes for women and men after percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) patients remain controversial. Herein, we compared the clinical outcomes by sex in CTO patients undergoing PCI.MethodsA total of 563 consecutive patients (19% women) who were diagnosed with CTO at a single center in China from June 2017 to December 2019 were included in this study. Three hundred patients were revascularized by PCI, and 263 were not revascularized. The clinical outcomes of these patients stratified by sex were examined. The primary endpoints included the risk of major adverse cardiovascular and cerebrovascular events (MACCE); the secondary endpoint was cardiac death; hazard ratios were generated using multivariable Cox regression.ResultsWomen represented 19% of the cohort (107/563 patients). Women have lower mean body mass index (BMI) and abdominal circumference compared with men; however, the proportion of hypertension, diabetes, and previous coronary heart disease is higher in female patients. At 2-year follow-up, there were no differences between men and women for MACCE (15.8% vs 20.6%, p = 0.234) and cardiac death (3.1% vs 5.6%, p = 0.202). Predictors of CTO recanalization revealed that age < 65 years, absence of prior CABG, no history of DM, and non-triple vessel were predictors of CTO recanalization. Sex did not predict recanalization in this regression model. Successful CTO PCI was associated with reduced MACCE.ConclusionOur study suggests an equal benefit of CTO recanalization with a marked reduction in MACCE in women and men alike. Further dedicated studies are needed to confirm these findings.

Central Venoplasty in Patients with Cardiac Implantable Electronic Devices

AbstractObjective The aim of this study was to assess the safety and effectiveness of the central venous angioplasty in patients with central venous occlusion and cardiac implantable electronic device (CIED) without lead extraction.Materials and Methods A retrospective study was used to evaluate the effectiveness of 37 central venous angioplasty procedure for 15 patients with CIED without lead extraction.Results Technical success was achieved in 97% (n = 36/37) and clinical success was achieved in 89% (33/37) of the procedures. One procedure failed recanalization of chronic total occlusion of the left subclavian vein, and the patient required fistula embolization due to severe arm swelling. Another procedure failed initially to recanalize long-segment occlusion involving the right subclavian vein/brachiocephalic vein and superior vena cava in a patient with a history of Hickman line and left-sided CIED. This was successfully recanalized and angioplastied on a subsequent session. No lead fracture or dislodgment was documented in any procedure. No procedure-related complication was documented within 2 weeks after the angioplasty. Six-month primary patency was achieved in 62% (23/37) of the procedures. Ten patients (66%) required an average of 1.4 reinterventions (range: 1–4 interventions) during the follow-up time with mean time to reintervention of 318 days (5–1,380 days). Two patients required early reinterventions within 10 days due to catheter dysfunction.Conclusion Findings of this study support the existing evidence on the safety and effectiveness of balloon angioplasty without lead extraction.

Conquering Retrograde Coronary Chronic Total Occlusion Intervention: Review of recent Developments

Chronic total occlusion recanalization still represents the final frontier in percutaneous coronary intervention. Retrograde recanalization is one of the greatest amendments of this technique. At present, it has become an integral complement to the traditional antegrade approach. Despite being most frequently used in complex patients; it has the highest success rate with the lowest incidence of complications. Since its inception, significant iterations have occurred that made this technique safer, faster, and even more successful. In this article, we describe various tips and tricks which can help in increasing the success rate of retrograde CTO PCI. Various complications, their preventions, and treatments, if they occur, have been described.

Tips and Tricks for PCI of Chronic Total Occlusions – A Review

Chronic total occlusion recanalization still represents the final frontier in percutaneous coronary intervention. Retrograde recanalization is one of the greatest amendments of this technique. At present, it has become an integral complement to the traditional antegrade approach. Despite being most frequently used in complex patients, it has the highest success rate with the lowest incidence of complications. Since its inception, significant iterations have occurred that made this technique safer, faster, and even more successful.

Assessment of the Impact of Percutaneous Coronary Intervention to Chronic Total Occlusion on the Ventricular Performance Using Different Echo-Doppler Modalities

Background: Chronic total occlusion (CTO) of coronary arteries represents one of the most challenging targets of lesion recanalization with percutaneous coronary intervention (PCI). The rationale for recanalization of CTO is the possible improvement of ventricular function. Different echo-Doppler modalities can be used for the assessment of ventricular performance with reported superiority of the newer modalities. Aim: To assess the impact of successful percutaneous coronary intervention for chronic totally occluded vessel on the ventricular performance using different echo-Doppler modalities. Methods: This study enrolled 30 patients with CTO for whom PCI was performed. Patients were subjected to thorough clinical assessment, Echo-Doppler evaluation of LV and RV functions before, within 48-hrs after successful PCI and one-month later, Echo-Doppler parameters included LV dimension, LV volumes, biplane and 3D-LV ejection fraction (LVEF), mitral Doppler-flow velocities (E, A & E/A), mitral valve early deceleration time (MV-EDT), mitral tissue Doppler systolic & diastolic annular velocities (Sa, Ea and Aa), LV global longitudinal strain (GLS). Results: There was no significant improvement of parameters reflecting LV function comparing the pre and 48-hrs post PCI. On the other hand, significant improvement was detected comparing the echo-Doppler measures of either the pre or 48-hours after PCI with those of one-month later. There was significant increase of biplane-LVEF (p

The atherogenic index of plasma and its impact on recanalization of chronic total occlusion.

The plasma-derived atherogenic index (AIP) is associated with an increasing risk for cardiovascular diseases. Whether an increased AIP may predict the complexity of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO), according to available research, has never been investigated before. Three hundred seventeen patients were included prospectively and treated with PCI for at least one CTO between 2012 and 2017. High-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) plasma levels were measured 24 h before PCI. All patients were stratified into tertiles of AIP (defined as 0.11, 0.11-0.21, > 0.21) based on their TG/HDL-C (AIP) levels. Mean AIP of all patients undergoing CTO-PCI was 0.53 ± 0.29. The majority of patients were male (82.6%), and mean age was 61 ± 10.4 years. Increased AIP > 0.21 was associated with longer occlusion length (statistical trend p = 0.082) and stent routes (p = 0.022) and with a higher number of implanted stents (n > 4) (statistical trend p = 0.072). Success rates were similar in all AIP categories (p = 0.461). In-hospital PCI-related complications were rare and not statistically different (p = 0.852). This study demonstrates for the first time that an increased AIP may predict the complexity of CTO-PCI and additionally may help to improve planning and quality of CTO-PCI.

The Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent in Patients with Chronic Total Occlusion Evaluated by Clinical Outcome and Optical Coherence Tomography Imaging Analysis.

We sought to determine the effects of the use of a Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent (Combo® DTS) in patients with chronic total occlusion (CTO) by evaluating clinical outcomes and by performing an optical coherence tomography (OCT) analysis. We retrospectively analyzed data from 39 patients who had successfully undergone OCT-guided revascularization of a CTO being treated with a Combo® DTS. Clinical assessment, angiography (with quantitative coronary angiography analysis) and OCT examination were performed at baseline and at follow-up. The median follow-up period was 189 days, ranging from 157 to 615 days. At follow-up, revascularization was required due to angiographic restenosis in 40% (14 of 35) of patients. OCT analysis detected neointima proliferation in 23 (76.6%) patients. Neointima formation was often associated with microvessels in 18 patients (60%). Neoatheroslcerosis was observed in 2 (6.6%) patients. Malapposition was found in 4 patients (13.3%), and stent fractures were found in 11 patients (36.6%). Rate of strut coverage was 96.3% at follow-up. In conclusion, the implantation of a Combo® DTS after successful CTO recanalization was associated with a restenosis rate of 40% despite good stent implantation at baseline, proven by OCT. Neointima formation was found as a main contributor to restenosis. Nevertheless, we observed a low rate of major cardiovascular events in our follow-up.

The retrograde technique for recanalization of chronically occluded coronary arteries: Case series report

Introduction. Chronic total occlusion (CTO) of the coronary artery still represents one of the most challenging lesion subsets in the field of interventional cardiology. Considering the complexity and increased risk posed by the retrograde approach, it is most often performed after a failed antegrade approach. Case report. We present a series of cases describing the retrograde approach as a special technique for treating CTO of the coronary artery. All cases had some special characteristics that are part of a dedicated portfolio in every catheterization lab today. In our series of cases, all three percutaneous coronary interventions (PCI) with a different strategies of the retrograde approach and supported with rotational atherectomy or intravascular ultrasound finished with successful recanalization of CTO. Conclusion. In cases where there is the presence of ?interventional? collaterals, as well as when the antegrade approach is very difficult, the retrograde approach can increase the success rate of procedures. The retrograde approach requires a long learning curve as well as very skilled and experienced operators who are able to per-form the procedure independently.

The retrograde approach for recanalisation of chronic total occlusions - a risk worth taking?

The retrograde approach for recanalisation of chronic total occlusions - a risk worth taking?

Abstract 17312: Incidence of Periprocedural Complications in Patients With Percutaneous Coronary Intervention of Chronic Total Occlusions and Impact of Mortality

Background: Percutaneous recanalization of coronary chronic total occlusions (CTO) remains one of the biggest challenges in interventional cardiology and is known to be associated with higher complication rate compared to regular coronary angioplasty. The aim of the current study is to explore the frequency and clinical outcomes of patients with procedural complications. Methods: All patients with CTOs were included in prospective registry. CTO was defined as a total obstruction of a coronary artery with thrombolysis in myocardial infarction (TIMI) grade flow of 0 and duration of more than three months. Frequency of periprocedural complications were analyzed and all patients were followed-up for vital status. Results: For the purpose of current analysis we included 595 patients (66±10 years, 78% males) who underwent a total of 661 PCIs of chronic total occlusions. 623 procedures (94.3%) were successful with TIMI 3 final flow. In 10.9% (n=72) of the procedures there was a periprocedural complication defined as: coronary perforation (type I-III) 3.02% (n=20), puncture site haematoma 1.7%(n=11), coronary intramural haematoma 1.5%(n=10), coronary dissection n=5(0.8%). In 4 people (0.6%) there was perforation with formation of haemopericardium (type IV coronary perforation). On logistic regression analysis factors found to be significantly predictive for occurrence of complication were carotid artery disease (OR=4.794, CI: 1.718-13.374, p = 0.038) and renal failure (OR=1.774, CI: 1.060-2.967, p=0.016). At a median follow-up of 31 months (IQR 13-49) the overall death rate was 20.7% (n=123) and was significantly lower in noncomplicated vs complicated group (104/525, 19.8% vs 19/69, 27.5%, log-rank p=0.042). On Cox-regression analysis procedural complication was independent predictor of death (OR= 1.650, CI 1.011- 2.692, p= 0.042). Conclusion: In patients undergoing PCI for CTO the presence of periprocedural complication was independent predictors of mortality and these subjects had higher mortality rate at a median follow-up of 31 months.

Impact of chronic total occlusion recanalisation on the quality of life in patients with stable coronary artery disease

Background. Coronary chronic total occlusion (CTO) is a common finding during routine coronary angiography. Despite significant progress in the technical success rate of CTO percutaneous coronary intervention over the last decade, indications for an invasive strategy are still controversial. To date, there is limited data on the role of invasive strategy in patients with CTO in improving the quality of life (QoL).Aim. To compare the QoL changes in patients with coronary artery disease with a single-vessel coronary CTO randomised to invasive or medical strategies.Methods. The study included 140 symptomatic patients with single-vessel CTO, who were randomised to either invasive or medical strategies. The QoL was then analysed using the Seattle Quality of Life Questionnaire (SAQ-7), EQ-5D-5L and the Rose Dyspnea Scale at baseline, after 3 and 12 months.Results. In total, 140 clinical, demographic, instrumental variables were analysed. There were no statistically significant differences between groups. At baseline, the summary score of the SAQ-7 in the medical group was 63.3 ± 15.7 and in the invasive group was −66.5 ± 13.1 (p = 0.13). The severity of dyspnoea according to the Rose questionnaire in the medical and invasive groups were 1.8 ± 1.1 and 1.9 ± 1.2, respectively, (p = 0.60). By 3 months, the summary score in the invasive group was 89.02 ± 9.2 and was statistically significantly higher than in the medical group (72.3 ± 12.4, p = 0.0001). The subscales of SAQ-7 at 3 months were also statistically significantly higher in the invasive group (p = 0.0001). This statistically and clinically significant difference between the groups persisted up to 12 months. The rate of adverse cardiovascular events was comparable in the study groups to 12 months of follow-up: 12.8% (9/70) and 7.1% (5/70) in the medical and invasive strategies, respectively. The crossover rate (from the medical to the invasive group) was 11.4% (8/70).Conclusion. Our study showed that an invasive strategy should be considered as effective and safe in improving the QoL in symptomatic patients with single-vessel CTO. Received 13 May 2020. Revised 29 May 2020. Accepted 1 June 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributions Conception and design: A.G. Badoian, O.V. Krestyaninov Data collection and analysis: A.G. Badoian, D.A. Khelimskii, O.V. Krestyaninov Statistical analysis: A.G. Badoian, D.A. Khelimskii, R.A. Naydenov Drafting the article: A.G. Badoian, R.U. Ibragimov, D.A. Khelimskii Critical revision of the article: R.U. Ibragimov, O.V. Krestyaninov, R.A. Naydenov Final approval of the version to be published: A.G. Badoian, D.A. Khelimskii, O.V. Krestyaninov, R.U. Ibragimov, R.A. Naydenov

Time-dependent improvement in coronary flow reserve in collateral donor artery following successful recanalization of the Coronary Chronic Total Occlusion

Abstract Background Coronary chronic total occlusion (CTO) is characterized by the presence of collateral blood vessels which can provide additional blood supply to CTO-artery dependent myocardium. Successful CTO recanalization is followed by significant decrease in collateral donor artery blood flow and collateral derecruitment. Purpose Study aim was to assess time-dependent changes in coronary flow reserve (CFR) in collateral donor artery after CTO recanalization and identify factors that influence these changes. Methods Our study enrolled 31 patients with CTO scheduled for percutaneous coronary intervention (PCI). Non-invasive CFR was measured before PCI in collateral donor artery, and 24h and 6 months post-PCI in CTO and collateral donor artery. Gated SPECT MIBI was performed before PCI, while quality of life was assessed by Seattle angina questionnaire (SAQ) pre-PCI, and 6 months after PCI. Results Collateral donor artery showed significant increase in CFR 24h after CTO recanalization compared to pre-PCI values (2.30±0.49 vs. 2.71±0.45, p=0.005), which remained unchanged after 6 months (2.68±0.24). Maximum baseline blood flow velocity of the collateral donor artery showed significant decrease measured 24h post-PCI compared to pre-PCI values (0.28±0.06 vs. 0.24±0.04m/s), and remained similar after 6-months. There was no significant difference in maximum hyperemic blood flow velocity pre-PCI, 24h and 6 months post-PCI. CFR change of the collateral donor artery 24h post-PCI compared to pre-PCI values showed inverse correlation with left ventricle ejection fraction (LVEF) measured on SPECT. CFR changes showed no correlation with the changes in quality of life assessed by SAQ post-PCI compared to pre-PCI. Conclusions Significant increase in CFR of the collateral donor artery was observed within 24h after successful recanalization of CTO artery, which maintained constant after the 6 months follow-up. This increase was largely driven by the significant reduction in the maximum baseline blood flow velocity within 24h after CTO recanalization compared to pre-PCI values. Our results suggest that possible benefit of CTO recanalization could be the improvement in physiology of the collateral donor artery. Funding Acknowledgement Type of funding source: None

Comparison of different access sites (radial, brachial and femoral) for subclavian artery intervention

Abstract Introduction The primary purpose of this multicenter prospective register was to evaluate the success and complication rate of different access sites for subclavian artery intervention. Secondary purpose was to investigate the safety of the distal radial artery access for subclavian artery intervention. Methods The clinical and angiographic data of 223 consecutive patients with symptomatic subclavian and anonym artery stenosis treated via transradial (TR), transbrachial (TB) and transfemoral (TF) access between 2015 and 2019 were evaluated in a multicenter registry. The exclusion criteria of the intervention was the acute proximal subclavian artery thrombosis. Primary endpoint: angiographic outcome of the subclavian and anonym artery intervention, rate of major and minor access site complications. Secondary endpoints: procedural complications, consumption of the angioplasty equipment, cross over rate to another puncture site and hospitalization in days. Results The procedure was successful in 182/184 in TR, in 5/5 in TB and in 32/32 patients in TF group. The cross over rate in the TR, TB and TF group was 0%. Chronic total occlusion recanalization was successful in 75/77 cases in TR, and 15/15 cases in the TF group. Contrast consumption was 152±106 ml in TR, 99±22.5 ml in TB and 152±95 in TF group, respectively (p=ns). Cummulativ dose was 602±1205 mGray in RA, 455±210 mGray in BA and 1089±1674 mGray in FA group (p&amp;lt;0.05). Procedural complications occurred in 1/184 (0.5%) case in RA group, in 0 case (0%) in BA group and in 4/32 cases (12.5%) in the FA group (p&amp;lt;0.05). Major access site complication were detected in 3 patients (1.6%) in RA, in 1 patient in BA (20%) and in 1 patient in FA group (3.1%) (p&amp;lt;0.05). Minor access site complication were encountered in 9 patients in the RA (4.8%), in 1 patient in the BA (20%) and in 8 patients in the FA group (25%) (p&amp;lt;0.05). Distal radial access was used in 29 cases and proximal radial access in 155 patients. The rate of radial artery occlusion in proximal and distal radial group was 5.1% and 0% (p&amp;lt;0.05). Conclusions Subclavian artery intervention can be safely and effectively performed using radial access with acceptable morbidity and high technical success. Femoral and brachial access is associated with more access site complications than radial artery access. Distal radial access is associated with less radial artery occlusion than proximal radial artery access. Funding Acknowledgement Type of funding source: None

Determinants and prognostic implication of periprocedural myocardial injury after successful recanalization of coronary chronic total occlusion.

Periprocedural myocardial injury (PMI) has been generally associated with major adverse cardiac events (MACE), however, limited studies addressed its clinical implications following chronic total occlusion (CTO) percutaneous coronary intervention (PCI). To evaluate the determinants and prognostic implication of PMI following CTO-PCI. Retrospective single-centre study of 125 consecutive patients undergoing CTO-PCI was attempted between December 2013 and December 2017. Angiographic success was achieved in 115 patients (92.0%) and cTn-I values were obtained 12-24h following PCI. PMI was defined as an elevation of cTn-I above 5 times the 99th-percentile upper reference limit. Baseline demographic, clinical, angiographic and procedural characteristics were compared. Multivariate analysis was performed to determine the predictors of PMI and the correlates of PMI and 1-year MACE, a composite of all-cause death, non-fatal myocardial infarction, and target lesion revascularization. Overall, mean age was 67 ± 17years; 25 patients (21.7%) were female; and PMI occurred in 41 patients (35.7%). Multivessel coronary artery disease (MVD) (odds ratio [OR], 3.41; 95% confidence interval [CI], 1.09-10.67; p = 0.04) and procedural complications (a composite of iatrogenic coronary artery dissection/haematoma or perforation) (OR, 19.08; 95% CI, 3.77-96.65; p < 0.01) predicted PMI. Significant collateralization (Rentrop 3) (hazard ratio, [HR], 0.19; 95% CI, 0.06-0.64; p < 0.01) and procedural complications (HR, 8.86; 95% CI, 2.66-29.46; p < 0.01) were independently associated with 1-year MACE, while PMI was not (p = 0.26). In this contemporary cohort, PMI following successful CTO-PCI was a common finding and was predicted by MVD and procedural complications. PMI was not independently associated with 1-year MACE.

A contemporary definition of periprocedural myocardial injury after percutaneous coronary intervention of chronic total occlusions

Abstract Background Coronary chronic total occlusion (CTO) recanalization represents the most technically challenging percutaneous coronary interventions (PCI). The complexity harbours a significant increased risk risk for complications with CTO PCI as compared to non-CTO PCI. However there are evidenced biomarker cut-off levels that help to identify those patients at risk for an unfavorable clinical outcome. Objective This study aimed to assess the prognostic impact of postprocedural troponin T increase and mortality in patients undergoing CTO-PCI in order to define the threshold, where procedural related myocardial injury drives mortality. Methods We enrolled a total of 3712 consecutive patients undergoing PCI for at least one CTO lesion and performed comprehensive troponin Tmeasurements 6, 8, and 24 hours after the procedure. All-cause mortality was defined as the primary study endpoint. Results Using spline curve analysis, we observed that a more than 18-fold increase of troponin above the upper reference limit (URL) is significantly associated with mortality. In the Cox regression analysis we observed a crude hazard ratio (HR) of 2.32 (95% CI 1.83–2.93, P&amp;lt;0.001) for a ≥18fold increase compared to patients with post-procedural troponin increase &amp;lt;18-fold of the URL.Results remained virtually unchanged after bootstrap- or clinical confounder-based adjustment. Conclusion This large-scale outcome study demonstrates for the first time the prognostic value of post-procedural troponin T elevation after PCI in CTO patients. We could define a threshold for procedure related myocardial injury in CTO patients that differ non- CTO patients and may help guide the postprocedural clinical care in this high risk patient population. Figure 1 Funding Acknowledgement Type of funding source: None

Fate of lumen size in distal coronary segment following successful chronic total occlusion recanalization

BackgroundRestoration of anterograde blood flow leads to alterations in vascular wall stress that may influence lumen size distal to chronic total occlusion (CTO) lesions. We sought to assess changes in lumen diameter of segments distal to the stent segment of successfully recanalized CTO. MethodsWe analyzed 507 consecutive CTO cases with stent implantation that underwent follow-up angiography at a single high-volume center (mean follow-up of 13.5 months). Segments ≤40 mm distal to the stent edge were analyzed using quantitative coronary angiography. ResultsAt follow-up, lumen diameters significantly increased; diameter changes of 0.26 ± 0.47 (percent diameter change of 18.2%) at 5 mm distal, mean lumen diameter changes of 0.23 ± 0.35 (14.3%) and minimal lumen diameter changes of 0.22 ± 0.80 (24.7%) (all p < 0.001). Lumen enlargement was similar between visually shrunken and stenosed vessels (degree of stenosis ≥20% with luminal irregularities) distal to stents; 5 mm distal (0.32 ± 0.48 vs. 0.30 ± 0.48, p = 0.76), mean lumen diameter changes (0.26 ± 0.37mm vs. 0.26±0.33 mm, p = 0.94), minimal lumen diameter changes (0.28 ± 0.43 mm vs. 0.22 ± 1.30 mm, p = 0.48). There was no association between degree of in-stent narrowing and changes in distal lumen diameter (Spearman r = −0.02, p = 0.59). Multivariate logistic regression for the predictors of greater lumen enlargement indicated that patients with left ventricle dysfunction (ejection fraction ≤45%) had greater enlargement [odds ratio (OR): 2.53, 95% confidence interval (CI): 1.23–5.23, p = 0.01]. Conversely, a low hematocrit (male <40%, and female <35%) was associated with attenuated lumen enlargement (OR: 0.68 95% CI: 0.47–0.98; p = 0.04). ConclusionsLumen diameter distal to CTO lesions significantly increased following successful revascularization, regardless of diseased status of the distal bed or degree of in-stent narrowing. These findings implicate appropriate determination of stent size, stent coverage length, as well as management strategies of distal vessels.

Do Myocardial Blush Grade Following Chronic Total Occlusion Recanalization Improve Clinical Outcome of Chronic Coronary Syndromes Patients?

Background : Myocardial blush grade (MBG) is an angiographic parameter to describe the adequacy of myocardial reperfusion. The correlation between myocardial blush and the clinical outcome following chronic total occlusion (CTO) recanalization is still unclear. Our study aimed to investigate the impact of myocardial blush after CTO recanalization on the clinical outcome of CCS patients. Design : A retrospective cohort study was conducted. Patients who underwent CTO recanalization were divided into two groups based on the myocardial blush. Patients were classified as having good myocardial blush (MBG category 2 to 3 or QUBE 0 to 10.2) and poor myocardial blush (MBG category 0 to 1 or QUBE 10.2 to 36.4). The outcome measured was the improvement of angina measured using the Seattle Angina Questionnaire (SAQ) and the reduction of antianginal drug regimens. Results : The follow-up period was ranging from 2 to 24 months following the CTO recanalization procedure. The SAQ for physical limitation (83.86 ± 16.11 vs. 77.92 ± 3.44; p = 0.247), angina frequency (85.27 ± 17.44 vs. 74.76 ± 22.05; p = 0.105), and quality of life (73.24 ± 3.41 vs. 72.82 ± 3.56; p = 0.932) between the two groups was not significantly different. Good myocardial blush was not correlated with the reduction of antianginal drug regimens (10 (52.6) vs. 8 (40); p = 0.639). Conclusion : Myocardial blush post-CTO recanalization was not associated with the improvement of angina symptoms and the reduction of antianginal drug regimens among patients with CCS.

Long-term follow-up of therapeutic efficacy of everolimus-eluting bioresorbable vascular scaffold in comparison to everolimus-eluting stent in treatment of chronic total occlusion guided by intracoronary imaging

BackgroundWe hypothesized that 1st generation everolimus-eluting bioresorbable vascular scaffold (BVS) stent associated with less complication and less restenosis rate than everolimus-eluting stent (EES) in chronic total occlusion (CTO) recanalization guided by intracoronary imaging. Therefore, we aimed to assess the safety and performance of BVS stent in CTO revascularization in comparison to EES guided by intracoronary imaging.Our prospective comparative cross-sectional study was conducted on 60 CTO patients divided into two groups according to type of stent revascularization: group I (EES group): 40 (66.7%) patients and group II (BVS group): 20 (33.3%) patients. All patients were subjected to history taking, electrocardiogram (ECG), echocardiography, laboratory investigation, stress thallium study to assess viability before revascularization. Revascularization of viable CTO lesion guided by intracoronary imaging using optical coherence tomography (OCT). Then, long-term follow-up over 1 year clinically and by multi-slice CT coronary angiography (MSCT). Our clinical and angiographic endpoints were to detect any clinical or angiographic complications during the follow-up period.ResultsAt 6 months angiographic follow-up, BVS group had not inferior angiographic parameters but without statistically significant difference (p = 0.566). At 12 months follow-up, there was no difference at end points between the two groups (p = 0.476).No differences were found at angiographic or clinical follow-up between BVS and EES.ConclusionThis study shows that 1st generation everolimus-eluting BVS is non-inferior to EES for CTO revascularization. Further studies are needed to clearly state which new smaller footprint BVS, faster reabsorption, magnesium-based less thrombogenicity, and advanced mechanical properties is under development. We cannot dismiss the efficacy and safety of new BVS technology.Trial registrationZU-IRB#2498/3-12-2016 Registered 3 December 2016, email: IRB_123@medicine.zu.edu.eg