In-stent Total Occlusion Research Articles

TCTAP C-052 A Nightmare of Main Branch Ostium In-Stent Total Occlusion Intervention and Plaque Shift to Left Main Lesion: A Dilemma of Rescue Order

TCTAP C-052 A Nightmare of Main Branch Ostium In-Stent Total Occlusion Intervention and Plaque Shift to Left Main Lesion: A Dilemma of Rescue Order

Lower Level of Low Density Lipoprotein Cholesterol is Associated with a Higher Increase in the Fractional Flow Reserve in Patients with Fixed-dose Rosuvastatin.

Aim: Fractional flow reserve (FFR) reflects on the diffuse atherosclerosis per coronary artery. It is unknown whether the statin therapy affects long term FFR after stenting. The aim of this study was to evaluate the long term FFR after stent implantation in patients who are intaking fixed-dose rosuvastatin.Methods: A total of 22 patients with stable angina pectoris were enrolled. The values of FFR were measured before, immediately after, and 18 months after (follow-up day) the implantation of everolimus eluting stent (EES; Promus Element™ or Promus Element Plus™). A fixed dose of rosuvastatin at 5 mg/day was administrated to all patients.Results: Of the 22 patients, 2 were excluded because of adverse effect of rosuvastatin and in-stent total occlusion after EES implantation. Overall, the values of FFR immediately after and 18 months after EES implantation did not show significant change (from 0.90 ± 0.05 to 0.88 ± 0.06, p = 0.16). However, there was a significant negative correlation between low density lipoprotein (LDL) cholesterol level at follow-up day and changes in the value of FFR (p = 0.01, r = −0.74). There was an increase in the FFR value after stenting in 8 out of 9 patients with LDL cholesterol level below 75 mg/dl (area under the curve 0.92, p = 0.0005).Conclusions: LDL cholesterol level was associated with the change in the FFR value in patients following stent implantation. Lower LDL cholesterol tended to improve in the long-term FFR, underscoring the importance of lowering LDL cholesterol to prevent the progression of coronary atherosclerosis.

Long Coronary Lesions Requiring Long Stents 20 mm. Analysis And Outcome In Patients Treated At Queen Alia Heart Institute

Objective: To determine the outcome after using long coronary stents >20 mm for long coronary lesions among patients treated at Queen Alia Heart Institute. Methods: This is a descriptive, and a retrospective non randomized study which was conducted at Queen Alia Heart Institute on 900 adult patients who underwent coronary angiography and intervention for either stable or unstable angina pectoris during the period between 2006 to 2011. Those patients had coronary intervention using a single long stent for each long lesion (>20 mm). Their follow up was analyzed and the outcome of these long stents was studied for in stent restenosis or in stent total occlusion in each specific coronary artery. A specially designed form was used to record the following data in the involved patients: age, gender, size and type of coronary stent (drug eluting or bare metal), the presence of diabetes mellitus, hypertension or hypercholesterolemia, and the status of the left ventricle. Results: The total number of patients who had long coronary stent intervention was 900 cases. Four hundred eighty patients (53.3%) had restudy cardiac catheterization within 6-8 months, which showed instent restenosis or instent total occlusion in 90 patients. Males constituted the majority (88.9%) of the affected patients. Smoking was the commonest (83.3%) factor associated with instent restenosis followed by Diabetes Mellitus (61.1%). About half the cases of long instent restenosis was found in left anterior descending artery, whereas right coronary artery and circumflex artery had almost equal ratios: 23.3% and 22.2% respectively. Long instent restenosis was commoner (33.3%) in ostial lesions and was the least (14.5%) in mid segment lesions. Bare metal stents were associated with the majority (77.8%) of cases of instent restenosis. About two thirds of the affected patients had small caliber stents (2.5 and 2.75 mm diameter). Conclusion: Instent restenosis or instent total occlusion in long coronary stents is a well recognized and not uncommon clinical entity. Men are more commonly affected than women. Ostial left anterior descending artery is more affected than other coronaries. Smoking, Diabetes Mellitus and the use of bare metal stents of small sized caliber (≤ 2.75 mm) were common in our study patient population and associated with increased incidence of long instent restenosis

Successful outside-the-stent stenting for in-stent chronic total occlusion in the common iliac artery

Several studies showed durable long-term clinical benefit of endovascular therapy with stenting in aorto-iliac occlusive disease. Although in-stent restenosis is easily treated in routine practice, we experienced an uncommon case of failed reconstitution of in-stent total occlusion at the common iliac artery (CIA). The case was treated with nitinol stent implantation outside of the in-stent occlusion site, and good vessel patency was observed at 14 months after the procedure. Nitinol stent implantation outside of an in-stent occlusion in the CIA is a novel reconstitution strategy when the guide wire cannot pass the occlusion site within a previously implanted stent.

A case of newly demonstrated coronary spasm 4 months after paclitaxel-eluting stent implantation for in-stent restenosis

A 56-year-old woman with hypertension and hypercholesterolemia was admitted to our hospital with acute inferior myocardial infarction. The patient had total occlusion of the right coronary artery (RCA) segment 2, and bare-metal stents were placed. Four months later, plain old balloon angioplasty was performed for in-stent restenosis. Follow-up coronary angiography (CAG) 6 months later showed in-stent total occlusion, so a stent-in-stent procedure was performed using paclitaxel-eluting stents (PESs). Four months later, the patient began complaining of early morning chest pain at rest. CAG showed no in-stent restenosis, so coronary spastic angina was suspected. Intracoronary infusion of ergonovine to the right and left coronary arteries revealed spasm of the RCA with total occlusion just proximal to the PES in segment 1. Her chest pain was reproduced with ST-elevation in leads II, III, and aVF, so the diagnosis of coronary spastic angina was made. Treatment with a Ca-channel blocker and nitrates relieved the symptoms. The PES was the probable cause of the coronary spasm.

Coronary brachytherapy is an effective treatment for chronic in-stent total occlusions

Coronary brachytherapy is an effective treatment for chronic in-stent total occlusions