RCA CTO Research Articles

QRS score: A simple marker to quantify the extent of myocardial scarring in patients with chronic total arterial occlusion

BackgroundChronic total occlusion (CTO) is a critical and unique subgroup of coronary lesions. This study aimed to investigate the correlation between the Selvester QRS score and late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMRI) in quantifying myocardial scarring to provide a simple and feasible method for treating CTO. MethodsThe medical records of 134 patients with absolute CTO who underwent coronary angiography between May 1, 2014 and December 30, 2017 were retrospectively reviewed. All patients were grouped according to the CTO location (RCA CTO, LAD CTO, LCX CTO, and multi-vessel CTO groups). The degree of myocardial scarring was determined according to the Selvester QRS score and using the LGE-CMRI. All patients were followed up for at least 12 months. ResultsAmong the 62 CTO patients, 55 had occlusion of a single vessel and seven had occlusion of multiple vessels, of which 27 (43.55%) were in the RCA CTO group, 16 (25.81%) in the LAD CTO group, 12 (19.35%) in the LCX CTO group, and 7 (11.29%) in the multi-vessel CTO group. The area under the receiver operating characteristic curve for the QRS score that was used to determine the degree of myocardial scarring was 0.806, with a sensitivity and specificity of 94.7% and 42.1%, respectively. The Selvester QRS score and LGE-CMRI measures of scar size were correlated in the RCA CTO, LCX CTO, and multi-vessel CTO groups (r = 0.466, 0.593, and 0.775, respectively). ConclusionThe Selvester QRS score was feasible for detecting myocardial scarring in patients with CTO.

TCTAP C-094 Primary Revascularization of Occluded Saphenous Vein Graft to Detect Anastomosis with IVUS Guidance for Treatment of Long RCA CTO Lesion

### Patient Initials or Identifier Number E.I ### Relevant Clinical History and Physical Exam A 70’s old man that had undergone previous coronary artery bypass surgery was admitted for angina of effort. Coronary angiography showed proximal RCA was occluded, proximal LAD and distal LCX was

TCTAP C-068 Successful PCI for RCA CTO Lesion with Reverse CART Procedure

### Patient Initials or Identifier Number 3675623 ### Relevant Clinical History and Physical Exam A 71-year-old male admitted to our hospital due to rest chest pain at night. Exercise ECG showed horizontal ST depression from V4 to V6. CAG revealed occlusion at the proximal portion of RCA and 90%

TCTAP C-070 The Successful Bail Out Case of Large Hematoma and Perforation from Retrograde in RCA CTO PCI

### Patient Initials or Identifier Number N.T ### Relevant Clinical History and Physical Exam Dec/2009: Patients complained chest discomfort. CAG showed #1 CTO, but recommended medical therapy. Aug/2015: Patients feel exacerbation of chest pain during exertion. Jan/2016: CAG showed #1 CTO, #7

TCTAP C-149 Multivessel Coronary Artery Disease with Aberrant RCA CTO Lesion by Retrograde Approach

### Patient Initials or Identifier Number 0617925 ### Relevant Clinical History and Physical Exam A 66 old male admitted to our hospital for congestive heart failure. He had a medical history of IHD, mid LAD was implanted Cypher stent. His coronary risk factors were diabetes, hypertension, and

TCTAP C-097 Successful PCI to RCA CTO with Extended Reverse CART Technique

### Patient Initials or Identifier Number K.N. ### Relevant Clinical History and Physical Exam Case; 60's Male Clinical diagnosis; silent myocardial ischemia He had known history of hypertension. This time he received UCG for preoperative evaluation of lung surgery. UCG revealed LV diffuse

TCTAP C-143 How to Approach a RCA CTO Lesion in Uremic Patients with Bilateral Common Iliac Artery Severe Stenosis?

TCTAP C-143 How to Approach a RCA CTO Lesion in Uremic Patients with Bilateral Common Iliac Artery Severe Stenosis?

TCTAP C-076 Secondary Attempt for RCA CTO – How We Succeeded

TCTAP C-076 Secondary Attempt for RCA CTO – How We Succeeded

TCTAP C-065 Child-in-Mother Technique During Reverse CART Technique for RCA CTO

### Patient Initials or Identifier Number Y.H ### Relevant Clinical History and Physical Exam This is 70’s male known history of prior MI (unknown detail), right atelectasis, type2 diabetes mellitus, and aplastic anemia. He had been in the other hospital for checkup of right atelectasis on Mar

24 The physiological impact of coronary chronic total occlusion (cto) percutaneous coronary intervention (pci) on donor vessel coronary pressure-derived measurements and the influence of collateral circulation

BackgroundThere is strong evidence of FFR guided treatment in multi-vessel disease. Multi-vessel disease is present in up to 66% of patients with CTO in a large registry analysis. The presence...

23 The influence of collateral regression post coronary chronic total occlusion (cto) percutaneous coronary intervention (pci) on donor vessel coronary pressure-derived measurements

Background There is strong evidence of FFR guided treatment in multi-vessel disease. The presence of a concomitant CTO may influence the FFR measurement in donor vessel as suggested in previous studies and reports. This has an important implication on clinical decision making for complete revascularisation in patients with chronic total occlusion. We sought to investigate the influence of collateral regression after successful CTO recanalisation on donor vessel pressure-derived indices. Methods The study participants were patients with angina who had RCA CTO. 28 out of 34 consecutive patients underwent successful PCI to RCA CTOs during the study period and completed the follow study (at 3 months post CTO PCI) were included in this analysis. Coronary pressure-derived indices (resting PD/PA, iFR and FFR) were measured pre and post successful RCA CTO PCI in donor vessels and at follow up procedures. Results The mean age was 62.38 years. The mean estimated CTO duration was 238.72 weeks and CTO length was 32.44 mm. 25 patients had ischaemia and or viability in the RCA territory assessed with cardiac MRI. LAD was the major donor vessel in 24 patients and LCX was the minor donor vessel in 4 patients. Percent stenosis on QCA in the major and minor donor vessel were 40.6% and 35.1% respectively. The mean resting Pd/Pa, iFR and FFR pre and post RCA CTO PCI and at follow-up procedures in major donor vessel were (0.893, 0.862, 0.764), (0.907, 0.886, 0.753) and (0.918, 0.901, 0.787) respectively. The mean resting Pd/Pa, iFR and FFR pre and post RCA CTO PCI and at follow-up procedures in minor donor vessel were (0.979, 0.966, 0.890), (0.983, 0.979, 0.880) and (0.981, 0.974, 0.898) respectively. The changes in coronary pressure-derived indices pre and post RCA CTO PCI and at follow up procedures are summarised in table 1. In major donor vessel, there was significant changes in the difference between follow up and pre-CTO PCI values for Pd/Pa, iFR and FFR values (p values 0.006, 0.003 and 0.047 respectively). There was also significant change in the difference between follow up and post-CTO PCI FFR value (P value 0.002). FFR collateral reduced significantly at follow-up (p value 0.000). Conclusion Successful recanalisation of a RCA CTO results in increase in major donor vessel coronary pressure-derived indices at follow up procedure associated with the regression of collateral function. In patients with multi-vessel disease, the expected change and the optimal timing to perform PCI in donor vessel should be considered when planning multi-vessel revascularisation in this setting.

TCTAP C-108 A Tough Case of RCA CTO with Anomalous Origin

### Patient initials or identifier number JK ### Relevant clinical history and physical exam (Case) 57 year-old Male. (Present Illness) He was carried to our hospital due to AMI and culprit lesion of LCX sub total occlusion treated. 1 months later, PCI for RCA CTO performed. (Coronary Risk

TCTAP C-122 Angina Pectoris with Heart Failure Remaining LAD and RCA CTO in Spite of Post CABG

TCTAP C-122 Angina Pectoris with Heart Failure Remaining LAD and RCA CTO in Spite of Post CABG

TCTAP C-115 Retrograde PCI to Calcified RCA CTO Using Antegrade and Retrograde Conquest Pro12 Wires

TCTAP C-115 Retrograde PCI to Calcified RCA CTO Using Antegrade and Retrograde Conquest Pro12 Wires

TCTAP C-098 RCA CTO Case Successfully Treated with Classical rCART

### Patient initials or identifier number KH ### Relevant clinical history and physical exam A 54-year old man admitted our institute with electrocardiographic abnormality pointed out at periodic health examination. He had never felt chest pain. His coronary risk factors were diabetes,

TCTAP C-104 Recanalization of RCA CTO by Contemporary Reverse CART and Long-Torturous Epicardial Collaterals

TCTAP C-104 Recanalization of RCA CTO by Contemporary Reverse CART and Long-Torturous Epicardial Collaterals

TCTAP C-093 Successful PCI of a Heavy Calcified RCA CTO Lesion by Antegrade See-saw Wiring Technique with Rotablator Rotational Artherectomy

TCTAP C-093 Successful PCI of a Heavy Calcified RCA CTO Lesion by Antegrade See-saw Wiring Technique with Rotablator Rotational Artherectomy

TCTAP C-062 Successfully RCA CTO Recanalization Complexed by Imperfect Previous Donor Vessel PCI Resolved by CART Technique

TCTAP C-062 Successfully RCA CTO Recanalization Complexed by Imperfect Previous Donor Vessel PCI Resolved by CART Technique

TCTAP C-225 Application of BVS in a RCA CTO Lesion

TCTAP C-225 Application of BVS in a RCA CTO Lesion

TCTAP C-066 PCI for In-stent RCA CTO After Drug Coated Balloon

TCTAP C-066 PCI for In-stent RCA CTO After Drug Coated Balloon