Coronary Chronic Total Occlusion Research Articles

Clinical Outcomes of Drug-Coated Balloon Treatment After Successful Revascularization of de novo Chronic Total Occlusions.

BackgroundThe safety and efficacy of drug-coated balloon (DCB) treatment for de novo coronary chronic total occlusion (CTO) remain uncertain. The aim of this study was to evaluate the outcomes of DCB only treatment for de novo CTO.MethodsIn this retrospective study, 101 vessels with de novo CTO lesions dilated by balloon angioplasty with thrombolysis in myocardial infarction flow grade 3 were included. Among them, 93 vessels successfully treated with DCB only treatment were analyzed. The study endpoint was major adverse cardiac events (MACE) at 2 years, a composite of cardiac death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR), and target vessel thrombosis. The secondary endpoint was late lumen loss (LLL) on follow-up coronary angiography.ResultsAll 84 patients were followed up clinically, and 67 vessels underwent scheduled coronary angiography after 6 months. There were no procedural complications, and three vessels required bailout-stenting. The median follow-up was 720 days (interquartile range [IQR]; 406–1,268 days). MACE occurred in 8.3% of the patients after 1 year, including cardiac death (1.2%), TVR (7.1%), and no non-fatal MI and target vessel thrombosis. Two years after treatment, MACE occurred in 16.7% of the patients, including cardiac death (2.4%), non-fatal MI (3.6%), TVR (13.1%), and no target vessel thrombosis. The mean LLL was 0.03 ± 0.53 mm. Binary restenosis occurred in 14.9% of the treated vessels, and 3.0% of the vessels had late re-occlusion on follow-up coronary angiography.ConclusionsIf the result of revascularization using balloon angioplasty is good, the clinical outcomes of DCB only treatment of de novo CTOs at the 2-year follow-up are encouraging, with a low rate of hard endpoints and acceptable MACE rates (Clinical Trial Registration Information; Impact of Drug-coated Balloon Treatment in de novo Coronary Lesion; NCT04619277).

Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Graft: Current Evidence and Future Perspectives.

Coronary chronic total occlusion (CTO), which occurs in 18. 4–52% of all patients referred for coronary angiography, represents one of the last barriers in coronary intervention. Approximately half of all patients with prior coronary artery bypass graft (CABG), who undergo coronary angiography, are diagnosed with coronary CTO. In fact, these patients often develop recurrent symptoms and events, necessitating revascularization. Currently, there is neither a consensus nor developed guidelines for the treatment of CTO patients with prior CABG, and the prognosis of these patients remains unknown. In this review, we discuss current evidence and future perspectives on CTO revascularization in patients with prior CABG, with special emphasis on clinical and lesion characteristics, procedural success rates, periprocedural complications, and long-term outcomes.

Crossing Total Occlusions Using a Hydraulic Pressure Wave: Development of the Wave Catheter.

With the ongoing miniaturization of surgical instruments, the ability to apply large forces on tissues for resection becomes challenging and the risk of buckling becomes more real. In an effort to allow for high force application in slender instruments, in this study, we have investigated using a hydraulic pressure wave (COMSOL model) and developed an innovative 5F cardiac catheter (L = 1,000 mm) that allows for applying high forces up to 9.0 ± 0.2 N on target tissues without buckling. The catheter uses high-speed pressure waves to transfer high-force impulses through a slender flexible shaft consisted of a flat wire coil, a double braid, and a nylon outer coating. The handle allows for single-handed operation of the catheter with easy adjusting of the input impulse characteristic, including frequency (1–10 Hz), time and number of strokes using a solenoid actuator, and easy connection of an off-the-shelf inflator for catheter filling. In a proof-of-principle experiment, we illustrated that the Wave catheter was able to penetrate a phantom model of a coronary Chronic Total Occlusion (CTO) manufactured out of hydroxyapatite and gelatin. It was found that the time until puncture decreased from 80 ± 5.4 s to 7.8 ± 0.4 s, for a stroke frequency of 1–10 Hz, respectively. The number of strikes until puncture was approximately constant at 80 ± 5.4, 76.7 ± 2.6, and 77.7 ± 3.9 for the different stroke frequencies. With the development of the Wave catheter, first steps have been made toward high force application through slender shafts.

TCTAP C-117 Wire Perforation in Posterior Lateral Artery Treated With Coil During Right Coronary Artery Chronic Total Occlusion Intervention

TCTAP C-117 Wire Perforation in Posterior Lateral Artery Treated With Coil During Right Coronary Artery Chronic Total Occlusion Intervention

TCTAP C-053 A Challenging Right Coronary Artery Chronic Total Occlusion Required Hybrid Approach and Multiple Troubleshooting to Achieve Success

TCTAP C-053 A Challenging Right Coronary Artery Chronic Total Occlusion Required Hybrid Approach and Multiple Troubleshooting to Achieve Success

TCTAP C-060 Rock-Hard Right Coronary Artery Chronic Total Occlusion Intervention and Thrilling Complication

TCTAP C-060 Rock-Hard Right Coronary Artery Chronic Total Occlusion Intervention and Thrilling Complication

TCTAP C-087 Revascularization in Patient With Left Main Coronary Artery Chronic Total Occlusion and Left Ventricular Dysfunction

TCTAP C-087 Revascularization in Patient With Left Main Coronary Artery Chronic Total Occlusion and Left Ventricular Dysfunction

Femoral or Radial Approach in Treatment of Coronary Chronic Total Occlusion: A Randomized Clinical Trial.

The aim of this study was to compare transradial access (TRA) with transfemoral access (TFA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). TRA reduces the risk for vascular access complications but may make complex PCI, such as CTO PCI, more challenging. FORT CTO (Femoral or Radial Approach in the Treatment of Coronary Chronic Total Occlusion) (NCT03265769) was a prospective, noninferiority, randomized controlled study of TRA vs TFA for CTO PCI. The primary study endpoint was procedural success, defined as technical success without any in-hospital major adverse cardiovascular events. The secondary study endpoint was major access-site complications. Between 2017 and 2021, 610 of 800 patients referred for CTO PCI at 4 centers were randomized to TRA (n=305) or TFA (n=305). Mean J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 0.1 vs 2.2 ± 0.1; P=0.279), PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) (1.3 ± 0.9 vs 1.1± 1.0; P=0.058) and PROGRESS CTO complication (2.4 ± 1.8 vs 2.3 ± 1.8; P=0.561) scores and use of the retrograde approach (11% vs 14%; P=0.342) were similar in the TRA and TFA groups. TRA was noninferior to TFAfor procedural success (84% vs 86%; P=0.563) but had fewer access-site complications (2.0% vs 5.6%; P=0.019). There was no difference between TFA and TRA in procedural duration, contrast volume, or radiation dose. TRA was noninferior to TFA for CTO PCI but had fewer access-site complications.

Factors associated with all-cause mortality in patients with coronary artery chronic total occlusions undergoing revascularization (percutaneous coronary intervention or surgery) or medical treatment.

Aim Chronic total occlusion of a coronary artery (CTO) is a predictor of early and late cardiovascular mortality and poor cardiovascular outcomes in patients with coronary artery disease. The purpose of this study was to identify predictors of all-cause mortality in CTO patients that underwent invasive treatment.Material and methods Patients between 2012 and 2018 with CTO in at least one vessel, as demonstrated by coronary angiography, were included retrospectively in the study. The patients were divided into two groups, an intervention group (percutaneous and surgical revascularization) and a medical group.Results A total of 543 patients were studied, 152 females (28%) and 391 males (72%). The median follow-up period was 49 (26-72) mos. A total of 186 (34.2%) patients in the medical group and 357 (65.8%) patients in the invasive therapy group were followed. The 5-yr death rate was observed in 50 (26.9%) patients in the medical group and 53 (14.8%) patients in the intervention group, and it was found to be statistically higher in the medical group (p=0.001). In multivariable analysis, heart failure (odds ratio (OR): 1.92, 95% CI: 1.18-3.14; p=0.01), higher glucose levels (OR: 1.05, 95% CI: 1,02-1.08; p=0.04), lower albumin levels (OR: 0.49, 95% Cl: 0.32-0.72; p=0.001), SYNTAX score (OR: 1.03, 95% CI: 1.01-1.05; p=0.001), and CTO (≥2 occluded artery) (OR: 0.42, 95% CI: 0.22-0.72; p=0.01) were independent factors for all-cause mortality.Conclusion In comparison to the revascularized group, there was an increase in mortality among CTO patients treated medically. Heart failure, SYNTAX score, albumin, glucose, and CTO (≥2 occluded arteries) were independent risk factors for all-cause mortality.

The Feasibility and Long-Term Outcomes of the Crossboss/Stingray for Treating Coronary Chronic Total Occlusions Lesions with Distal Diffuse Disease Landing Zone

The feasibility and long-term outcomes of the CrossBoss/Stingray for treating coronary chronic total occlusions (CTO) with distal diffuse disease landing zone remain unclear. Consecutive CTO patients with distal diffuse lesions that underwent percutaneous coronary intervention by the CrossBoss/Stingray system at Xijing Hospital from April 2016 to October 2020, were included. Patients were analyzed by two groups according to the extent of stenosis in the distal landing zone: 50%-70% stenosis (moderate stenosis group) and >70% stenosis (severe stenosis group). The primary efficacy outcome was technical success, defined as the frequency of true lumen guidewire placement distal to the CTO. The composite endpoint of all-cause death, any stroke, or any revascularization was also explored. A total of 91 consecutive patients were included, with 32 patients in the moderate stenosis group and 59 patients in the severe stenosis group. The mean J-CTO score was 2.5 ± 1.1. The technical success rate was 79.1% (72/91) in the overall population and was similar between the 2 groups: 78.1% (25/32) and 79.7% (47/59) (p = 0.608). No coronary perforation occurred. With a median follow-up of 29 months (IQR: 53-92), the estimated rate of the composite endpoint of all-cause death, any stroke, or any revascularization was 50.4% (all-cause death: 16.6%, any stroke: 1.1%, any revascularization: 36.5%) in the overall population. No significant difference was observed in the rate of the composite endpoint between the moderate stenosis group and the severe stenosis group (45.1% vs. 54.3%, respectively, p = 0.797). In CTO lesions with distal diffuse disease landing zone, the technical success rates of CrossBoss/Stingray and the long-term clinical outcomes were not significantly different between the moderate stenosis group (50%-70%) and the severe stenosis group (>70%). However, the relatively high rate of long-term clinical outcomes, especially any revascularization, warrants further investigations on this indication in future studies.

Prevalence and correlated factors for chronic total occlusion in patients with coronary artery disease in Iraqi Kurdistan

Patients with significant coronary artery disease often have at least one vessel with Chronic Total Occlusion (CTO) as demonstrated by coronary angiography. However, the prevalence and determinants of CTO differ according to ethnicity. We aimed to investigate the prevalence and determinants of CTO in the Iraqi Kurdistan population in 2015. Clinical and angiographic data were collected in consecutive patients that underwent coronary angiography at our institution between January and December 2015. Coronary artery disease (CAD) was determined as 50% diameter stenosis in one coronary artery and CTO as total coronary artery occlusion of 3-month duration. Among 260 patients diagnosed with ischemic coronary artery disease and undergone coronary angiography, 28.5% (n=74) were diagnosed to have at least one CTO vessel and 69 (26.5%) patients had a previous history of myocardial infarction. CTOs were located in the left anterior descending coronary artery in 45% of patients while in the right coronary artery in 32%. CTO patients were substantially older (61 vs 56 years; p <0.0001) and more likely to live in non-urban areas. They frequently had more hypertension, dyslipidemia, diabetes mellitus, previous myocardial revascularization, being an exsmoker, and renal dysfunction as compared to patients without CTOs. At univariate analysis, a previous history of coronary artery bypass graft (CABG) surgery was the only predictor of having a diagnosis of CTO. Patients diagnosed with CTO in Iraqi Kurdistan had several comorbidities including cardiovascular risk factors and renal dysfunction. Previous CABG was the only predictor of CTO diagnosis.

The ReCross dual-lumen microcatheter versatility during percutaneous coronary intervention of chronic total coronary occlusions

The ReCross dual-lumen microcatheter versatility during percutaneous coronary intervention of chronic total coronary occlusions

Investigation of the effect of coronary collateral circulation quality on postoperative atrial fibrillation after coronary artery bypass graft operations in patients with right coronary artery total occlusion

Objectives: Postoperative atrial fibrillation (PoAF) may occur in 25-50% of patients after coronary artery bypass graft (CABG) surgery. The severity of coronary artery disease and the quality of coronary collateral circulation (CCC) in the coronary artery with chronic total occlusion (CTO) are known as indirect indicators of myocardial ischemia. In this study, we aimed to investigate the effect of CCC quality on PoAF in patients with right coronary artery (RCA) total occlusion who underwent CABG operation. Methods: Patients who underwent isolated CABG operation between May 15, 2016 and June 15, 2020 and had RCA CTO were included in the study retrospectively. The patients were recorded as Group 1 who developed PoAF in the postoperative period and Group 2 who did not. Results: A total of 99 patients were included in the study. Those who develop PoAF were determined as Group 1 (n = 32, mean age = 66.9 ± 11 years), and those who did not were determined as Group 2 (n = 67, mean age = 54.4 ± 12.8, years). There were no statistically significant differences between the two groups in terms of gender, smoking, diabetes mellitus, hypelipidemia and chronic obstuctive pulmonary disease rates. In multivariate analysis, being over 70 years old (OR: 1.396, 95% CI: 1.080-2.190, p = 0.007), poor CCC (OR: 1.090, 95% CI: 1.045-1.338, p = 0.014) and left atrial diamater (OR: 0.557, 95% CI: 0.471-0.783, p = 0.032) were determined as independent predictors of development of PoAF. Conclusions: In this current study, we demonstrated that low CCC quality increases the risk of POAF in patients with right coronary CTO. CCC quality can be used as an evaluation parameter in identifying groups at risk for PoAF in these special patient groups.

A novel use of small ballons to reduce the risk of subintimal hematoma formation during recanalization of chronic total occlusion: two case reports

BackgroundSubintimal hematoma remains a major challenge associated with unnecessary technical complexity, failure of the antegrade approach or imperfection of revascularization in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Some techniques and devices release the hematoma after its formation. Here, we describe a novel use of small ballons to prevent the hematoma formation during antegrade approach in two cases.Case presentationWe report two cases of CTO-PCI in which balloon occlusion was successfully applied to prevent haematoma formation. The first case, a 72-year-old female with diabetes, was hospitalized because of unstable angina. Angiography showed right coronary artery (RCA) CTO, which initiated from the proximal part to the trifurcation at the distal part of the RCA. Considering the high likelihood and serious consequences of subintimal haematoma, a small balloon is employed to prevent subintimal hematoma formation. A balloon and microcatheter or double-lumen microcatheter are placed in the proximal coronary CTO lesion; then the balloon was dilated beside the catheter, most of the antegrade blood flow was sealed which reduced the likelihood of haematoma formation. The procedure was successfully completed without subintimal hematoma formation. The second case a 62-year-old male with unstable angina, was hospitalized for PCI. Angiography showed left anterior descending coronary artery CTO. Similar to case 1, we also used a small balloon to prevent hematoma formation. Both patients underwent PCI, which employed a small balloon to prevent hematoma formation and both procedures were successful without complications.ConclusionIn patients who underwent CTO-PCI, balloon occlusion offers an alternative for reducing the incidence of subintimal haematomas.

Stress perfusion cardiovascular magnetic resonance and serial fractional flow reserve assessment of the left anterior descending artery in patients undergoing right coronary artery chronic total occlusion revascularization.

BackgroundFractional flow reserve (FFR) assessment of remote arteries, in the context of a bystander chronic total occlusion (CTO), can lead to false positive results. Adenosine stress cardiovascular magnetic resonance (CMR) evaluates perfusion defects across the entire myocardium and may therefore be a reliable tool in the work-up of remote lesions in CTO patients. The IMPACT-CTO study investigated donor artery invasive physiology before, immediately post, and at 4 months following right coronary artery (RCA) CTO percutaneous coronary intervention (PCI). The aim of this subanalysis was to assess the concordance between baseline perfusion CMR and serial FFR evaluation of left anterior descending artery (LAD) ischemia in patients from the IMPACT-CTO study.MethodsBaseline adenosine stress CMR examinations from 26 patients were analyzed for qualitative evidence of LAD ischemia. The results were correlated with the serial LAD FFR measurements.ResultsThe present findings demonstrated that before RCA CTO PCI, there was 62% agreement between perfusion CMR and FFR (ischemic threshold ≤ 0.8) in the assessment of LAD ischemia (k = 0.29; fair concordance). At 4 months after revascularization, there was 77% agreement (k = 0.52; moderate concordance) between the index CMR assessment of LAD ischemia and the follow-up LAD FFR. Concordance was improved at a LAD FFR ischemic threshold of ≤ 0.75.ConclusionsIn this hypothesis generating study, baseline CMR assessment of LAD ischemia correlated better with the 4 months LAD FFR data (threshold ≤ 0.8) as compared to the FFR measurements taken prior to RCA CTO revascularization.

Chronic Renal Insufficiency and Coronary Chronic Total Occlusion: A Most Perilous Combination

Chronic Renal Insufficiency and Coronary Chronic Total Occlusion: A Most Perilous Combination

CRT-100.65 Does Diabetes Matter in Chronic Total Coronary Occlusion?

CRT-100.65 Does Diabetes Matter in Chronic Total Coronary Occlusion?

Quantification of strain analysis and late gadolinium enhancement in coronary chronic total occlusion: a cardiovascular magnetic resonance imaging follow-up study.

The present study aimed to investigate the benefits of percutaneous coronary intervention (PCI) in patients with chronic total occlusions (CTOs) by using cardiac magnetic resonance imaging (CMR) feature tracking. Fifty-five CTOs with successful CTO-PCI underwent CMR at baseline and 12 months. Feature tracking was applied to measure left ventricle strain index in CTOs with decreased and preserved left ventricular ejection fraction (LVEF). CTOs were also divided into two groups according to the infarct size of 10% or combined with multi-vessel disease. We also measured these parameters in 40 healthy subjects. Three quarters of CTOs showed preserved ejection fraction and no enlargement of left ventricle at baseline, but the global strains were lower than the controls (all P<0.01). In the entire CTO population, left ventricular ejection fraction did not show significant improvement in the 1-year follow-up (59.8%±11.3% vs. 62.0%±8.6%, P=0.08). However, global strains improved over time, and peak global radial strain and circumferential strain showed significant treatment effect of CTO-PCI in the entire CTO population (31.1%±9.9% vs. 34.3%±8.7%, P<0.01; -17.9±3.6 vs. -19.2±3.1, P<0.01), and the subgroup with decreased LVEF, infarct size less than 10%, or multi-vessel disease, but not with the 1-vessel disease. In the LAD and LCX CTO territory, radial and circumferential strain showed treatment effect of CTO-PCI on the recovery of strain parameters (P<0.01 for both). In the RCA CTO territory, circumferential and longitudinal strain showed treatment effect of CTO-PCI on the recovery of strain parameters (P<0.05 for both). In this single center study, global radial strain and circumferential strain showed treatment effect of successful CTO-PCI at 1-year follow-up in CTOs with the decreased LVEF, infarct size less than 10%, or multi-vessel disease, and the regional strain also showed a similar trend. However, the benefit of CTO-PCI on the strain recovery was not shown in patients with 1-vessel disease. Therefore, whether patients with CTO benefit from PCI still needs further verification.

CRT-100.67 Treatment of Coronary Chronic Total Occlusions Using Drug-Coated Balloons – Perspectives From the SIROOP Registry

CRT-100.67 Treatment of Coronary Chronic Total Occlusions Using Drug-Coated Balloons – Perspectives From the SIROOP Registry

Same-Day Discharge After Elective Percutaneous Coronary Intervention for Chronic Total Occlusion in the UK.

This study examines the safety and feasibility of same-day discharge (SDD) in patients undergoing percutaneous coronary intervention (PCI) to coronary chronic total occlusions (CTOs) and explores independent associations of clinical and procedural characteristics with SDD. While the recently published consensus statements recommend SDD following uncomplicated CTO-PCI, there are limited studies to support this approach. Data were obtained from the British Cardiovascular Intervention Society (BCIS) registry dataset including 21,330 patients who underwent CTO-PCI electively from 2007 to 2014 in England and Wales. We used multiple logistic regression to evaluate associations with SDD and the BCIS national risk model to examine for safety of SDD. Although overnight stay remained the standard of care following elective CTO-PCI, SDD practice increased from 21.7% to 44.7%. Women were less likely to have SDD than males. SDD was more common in higher CTO volume centers (36.3%) than low CTO volume centers (31.6%), and SDD patient profiles grew riskier over time, with the average age of SDD patients increasing from 61.4 years to 63.2 years. Transradial PCI was most strongly independently associated with SDD (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.80-2.09). Finally, the SDD observed 30-day mortality rates were not different vs those predicted by the BCIS risk model, and SDD was not independently associated with 30-day mortality (OR, 0.54; 95% CI, 0.25-1.15). This study illustrates that SDD is safe in selected patients undergoing CTO-PCI.