Recanalization Of Total Coronary Occlusions Research Articles

Donor artery in coronary total occlusion recanalization: QFR versus FFR

Donor artery in coronary total occlusion recanalization: QFR versus FFR

Late catch-up in lumen diameter at five-year angiography in MACE-free patients treated with sirolimus-eluting stents in the Primary Stenting of Totally Occluded Native Coronary Arteries: a randomised comparison of bare metal stent implantation with sirolimus-eluting stent implantation for the treatment of total coronary occlusions (PRISON II)

The present study was designed to examine the five-year angiographic follow-up of MACE-free patients enrolled in the PRISON II study. In the PRISON II study a total of 200 patients were randomised to either bare metal stents (BMS) or sirolimus-eluting stents (SES) after successful recanalisation of total coronary occlusions (TCO). Patients free of MACE with available angiography at six months were approached for repeated angiography at five years. The primary endpoint was in-stent very late luminal loss (VLLL) at five years. The secondary endpoint was additional late luminal loss (ALLL) between six months and five years. At five years, repeated angiography was performed in 72 patients, 50/82 (61%) in the SES group and 22/58 (38%) in the BMS group. In-stent VLLL was lower in the SES group (0.19 mm ± 0.72 vs. 0.51 mm ± 0.71, p=0.09) compared to the BMS group and in-segment VLLL was comparable in both groups (0.01 mm±0.58 vs. 0.03 mm ± 0.73, p=0.89). Late catch-up in lumen diameter was observed in the SES group with a trend towards increased ALLL compared to the BMS group (in-stent, 0.35 mm ± 0.88 vs. 0.04 mm ± 0.81, p=0.16; in-segment, 0.20 mm ± 0.74 vs. -0.05 mm ± 0.73, p=0.19). At five-year angiographic follow-up, late catch-up was observed after successful recanalisation of TCOs treated with SES. Despite a late catch-up, the angiographic results of SES were superior in-stent and similar in-segment compared to BMS.

Effect of Progenitor Cells on Myocardial Perfusion and Metabolism in Patients After Recanalization of a Chronically Occluded Coronary Artery

Even after recanalization of a chronic total coronary occlusion, functional recovery is incomplete and parts of the myocardium remain hypoperfused. In this randomized, placebo-controlled, and double-blinded study, we investigated relative changes in myocardial perfusion and glucose metabolism induced by intracoronary administration of blood-derived circulating progenitor cells (CPCs), compared with the natural course in a control group after recanalization of total coronary occlusion. After recanalization of total coronary occlusion, 26 patients were randomly assigned to the CPC treatment or placebo group. Regional myocardial perfusion and glucose metabolism were assessed by 99mTc-tetrofosmin SPECT and 18F-FDG PET at baseline (after recanalization of total coronary occlusion) and 3 mo after the administration of 69 +/- 14 x 10(6) CPCs or cell-free serum, respectively. Segments were classified as "normal," "perfusion-metabolism mismatch" (dysfunctional segments with a 99mTc-tetrofosmin-18F-FDG mismatch), or "scar." In contrast to the placebo group, CPC administration resulted in a significant decrease in the number of segments with a perfusion-metabolism mismatch, from 3.0 +/- 0.5 to 1.7 +/- 0.6 segments (P < 0.05 vs. baseline). Of the normal segments at baseline, 2.7% in the CPC group and 30% in the placebo group revealed a perfusion-metabolism mismatch at follow-up after 3 mo (P < 0.05 vs. placebo). Intracoronary administration of CPCs significantly reduces the amount of myocardium with a perfusion-metabolism mismatch and prevents areas with normal perfusion and metabolism after recanalization of total coronary occlusion from becoming dysfunctional during the next 3 mo. These results show that PET and SPECT can be used to monitor the effect of progenitor cells on myocardial integrity. More important, they provide evidence supporting expansion of the use of progenitor cell treatment to chronic coronary artery disease.

Treating chronic total occlusions using subintimal tracking and reentry: The STAR Technique

Successful recanalization of coronary total occlusions (CTOs) remains an area where improvements are needed. We propose an approach similar to the one utilized in treating some peripheral artery occlusions and aimed to create a subintimal dissection with distal reentry. A 0.014' hydrophilic wire with a J-configuration is utilized for this purpose. We applied this technique to CTO of native coronaries in 31 patients where previous attempts failed in 21 of them (67%). The right coronary artery (RCA) was the index vessel in 87% of patients. Recanalization of the vessel and of most of distal branches was achieved in 21 patients; patency of at least one major distal branch was achieved in 9 patients. Drug-eluting stents (DESs) were implanted in 53% of patients. Three patients had intraprocedural vessel perforation without consequences. Five patients (16%) had in-hospital non-Q-wave myocardial infarction. No other adverse events occurred at a mean follow-up of 5.1 +/- 3.7 months except for one noncardiac death. Angiographic follow-up was performed in 21 (67%) patients and 53% of them developed restenosis. Reintervention on the target vessel was performed in 11 patients (52%). Complete success with the procedure was originally obtained in 8 of the 10 patients who did not develop restenosis and in 8 of them DESs were originally implanted. This technique appears a promising approach to recanalize difficult total occlusions, particularly the ones localize on the RCA, which has the most important side branches located distally.

Stent or angioplasty after recanalization of chronic coronary occlusions? (the SARECCO trial)

This study tests whether stent implantation without anticoagulation after catheter recanalization of coronary occlusions can improve outcome compared with balloon angioplasty alone. One hundred ten patients were randomly assigned to angioplasty alone (no stent group) or stent implantation (stent group) after successful recanalization and balloon angioplasty. The type of stent and angioplasty technique utilized were decided by the operator. The acute procedural success in both groups was 100%. The acute minimal lumen diameter (MLD) was 1.85 ± 0.44 mm in the no stent group versus 2.54 ± 0.53 mm in the stent group (p <0.01). The diameter stenosis was 21 ± 13% versus 3 ± 14% (p <0.01). This was achieved not only by the stent implantation itself but primarily by a larger maximum balloon diameter in the stent group after stent implantation (3.32 ± 0.55 mm vs 2.86 ± 0.4 mm, p <0.05). After 4 months, the MLD was 1.15 ± 0.73 mm in the no stent group versus 1.81 ± 0.9 mm in the stent group (p <0.01). The diameter stenosis was 56 ± 29% versus 34 ± 28% (p <0.01). After 2 years, event-free survival was 26% in the no stent group and 52% in the stent group (p <0.05). Thus, acute and long-term procedural and angiographic success of stent implantation without anticoagulation after recanalization of total coronary occlusions is superior to that of balloon angioplasty alone. This beneficial effect is mainly the result of the larger balloon diameters, which may be used after stent implantation.

Mechanical recanalization of total coronary occlusions with the use of a new guide wire

The mechanical approach in the recanalization of total coronary occlusions consisted of the use of a new 0.014-inch standard coronary guide wire with jointless spring coil design that improves steering characteristics and tip stiffness. In addition, a 0.014-inch soft tip wire with hydrophilic coating and low-profile 1.5 mm over-the-wire balloons were used. The first wire was used selectively in 86 patients to treat 95 total occlusions, of which 51 (54%) were older than 3 months. Unfavorable angiographic characteristics were present in 79 (83%) of 95 lesions. Overall crossing success was 71% (67 of 95 lesions). Complications were one coronary perforation with cardiac tamponade necessitating emergency bypass surgery. In conclusion, the mechanical approach with the use of the standard coronary guide wire with jointless spring coil design provides a high success rate in the recanalization of unfavorable total occlusions. (Am Heart J 1998;135:726-31.)

Mechanical Approach in the Recanalization of Total Coronary Occlusions: A Consecutive Series of 322 Lesions

Mechanical Approach in the Recanalization of Total Coronary Occlusions: A Consecutive Series of 322 Lesions

Mechanical approach in the recanalization of total coronary occlusions: a consecutive series of 322 lesions

Mechanical approach in the recanalization of total coronary occlusions: a consecutive series of 322 lesions

1000–31 Late Recanalization of Chronic Total Coronary Occlusion: Maintained Vessel Patency Improves Global and Regional Left Ventricular Function and Avoids Remodeling

To determine whether late recanalization of total coronary occlusions improved left ventricular (LV) function, we studied LV ejection fraction (EF) and regional wall motion (Stanford method) on RAO 30° LV angiography in 41 consecutive pts (31 M, 10 F; age: 56 ± 9 yrs) who underwent successful percutaneous recanalization of a chronic ( &gt; 10 days), complete (TIMI grade 0) occlusion of either the left anterior descending (LAD) or right coronary artery (RCA) and who had a complete evaluation before and at 6 months following recanalization. At 6 months, 11 pts had reocclusion (Grl) and 30 pts (Gr2) had maintained patency (TIMI grade 3). Evolution of global LV function: in Gr 1, LVEF increased from 53 ± 13 to 61 ± 19% (p = 0.09), due to an increase in LV enddiastolic volume (EDV) from 85 ± 25 to 112 ± 56 ml (p = 0.09), while LV endsystolic volume (ESV) was unchanged (42 ± 22 to 42 ± 29 ml). In contrast, in Gr 2, increase in LVEF (57 ± 14 to 64 ± 13%, P &lt; 0.005) corresponded to a decrease in LVESV (39 ± 29 to 33 ± 22 ml, p = 0.09) while LVEDV remained unchanged (85 ± 41 to 93 ± 53 ml, p = ns). Regional wall motion was assessed on 8 anterior radii for pts with LAD occlusions, and 8 inferior radii for pts with RCA occlusions. In Gr 1, none of the occluded artery-related radii improved. In Gr 2, a significant increase in fractional shortening was present in 7 of 8 occluded artery-related radii, both for LAD and RCA occlusions. Maintained vessel patency after late recanalization of totally occluded coronary arteries improves global and regional LV function without subsequent increase in LV enddiastolic volume; in contrast, when the artery reoceludes, LVEF tends to improve due to an increase in LV enddiastolic volume, corresponding to a remodeling phenomenon. Late ( &gt; 10 days) recanalization of complete coronary occlusions is beneficial to LV function.

New option for balloon recanalization of total coronary occlusions

In 9 out of 12 patients with a total coronary occlusion but definite signs of viable myocardium a new approach for the recanalization procedure was successfully employed: Following recanalization using an on-the-wire 2.0 or 2.5 mm angioplasty catheter, a standard coronary guidewire was placed along the angioplasty catheter. After withdrawal of the catheter, over-the-wire angioplasty with an appropriately sized balloon was performed for final dilatation. Pending further studies in a larger patient population, this new method may offer an alternative approach for revascularization of total coronary occlusions.