Stenting For Chronic Total Occlusion Research Articles

Use of heparin coated vascular stents in femoropopliteal chronic total occlusions: Long term outcomes

PurposeTo evaluate the long-term clinical efficacy of the Tigris © stent (Gore ©) in femoropopliteal chronic total occlusions (CTOs). Material and methodsThis single centre retrospective study included 29 patients treated with 47 Tigris© stents for CTOs. Lesion location, type, length, revascularisation method, smoking status and diabetes were reviewed. Clinical follow-up was performed. Primary safety points were complications and adverse events. Secondary efficacy points were symptom deterioration, freedom from target lesion revascularization (TLR) and amputation rate. Freedom from TLR was evaluated with Kaplan-Meier analysis; Cox multivariable logistic regression analysis of the factors associated with stent re-occlusion was also performed. ResultsAll procedures were technically successful without any peri- or post-procedural complications and adverse events. Median follow-up was 48 months (range: 7–70). Lesions were located in the superficial femoral (19), popliteal (3) and femoropopliteal (7) arteries with mean lesion length 13.9 ± 7.6 cm. In 12 patients subintimal recanalization was performed. Freedom from TLR rates at 6, 12, 18, 24 and 36 months were 96.6 %, 85.7 %, 81.9 %, 78.2 % and 74.3 % respectively. No stent fracture was observed and no amputation was performed in any of the patients. Smoking status, the presence of diabetes, lesion localization and recanalization type were not associated with stent re-occlusion. ConclusionThis study demonstrated that use of a heparin coated vascular stent for femoropopliteal CTOs appears to offer satisfactory long-term results.

Feasibility of Implanting 50-60 mm-Tapered Drug Eluting Stents in Chronic Total Occlusions.

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) usually involves multiple overlapping stents implantation to cover long coronary segments. A higher rate of restenosis has been described with stent overlapping. Recently, new long tapered stents emerged as a potential tool for treating long coronary lesions. Feasibility of using these new devices for the CTO PCI has not been described. The aim of this work was to describe our initial experience with 50 and 60 mm-long tapered sirolimus-eluting stents (SES) in CTO PCI. We included 54 consecutive patients who underwent a CTO PCI and in whom an attempt to implant a 50 or 60 mm-long tapered SES was performed. Baseline clinical, angiographic, and procedural characteristics were recorded. The median (IQR) age was 64 (58-73) years, and 45 (83.3%) patients were male. The tapered SES 50 and 60 mm-long was successfully implanted in 51 (94.4%) patients. In three patients, a 60 mm-long stent could not be implanted, and two or three overlapped shorter drug-eluting stents were deployed instead. An average of 1.4 ± 0.6 stents per patient was implanted. A single stent was deployed in 32 (59.3%) patients. During a median follow-up of 330 (149-551) days, repeat PCI in the target vessel was performed in two patients. The use of the new BioMime Morph™ tapered SES for the treatment of CTO appears to be feasible in a high proportion of procedures. Further studies confirming the feasibility of this approach and its potential clinical advantages are needed.

TCT-718 A Meta-Analysis of Long-term Clinical Outcomes following Successful Percutaneous Coronary Intervention with Drug-Eluting Stents for Chronic Total Occlusions

TCT-718 A Meta-Analysis of Long-term Clinical Outcomes following Successful Percutaneous Coronary Intervention with Drug-Eluting Stents for Chronic Total Occlusions

Efficacy and Safety of Polymer-Free Ultrathin Strut Sirolimus-Probucol Coated Drug-Eluting Stents for Chronic Total Occlusions: Insights from the Coroflex ISAR 2000 Worldwide Registry.

Objective Coronary revascularization in chronic total occlusion (CTO) is associated with improved clinical outcomes. The choice of the coronary stent is crucial in maintaining long-term vessel patency after CTO revascularization. We investigated the efficacy and safety of polymer-free ultrathin strut sirolimus-probucol coated drug-eluting stents (PF-SES) for CTO lesions. Methods Patients with CTO lesions treated with PF-SES were identified from the prospective multicenter international ISAR 2000 registry. The primary endpoint was clinically driven target lesion revascularization (TLR) at 9 months. Secondary endpoints were 9-month major adverse cardiac events (death, myocardial infarction, or TLR) (MACE) and the occurrence of stent thrombosis. Results A total of 111 patients with CTO lesions (n=127) were available for analysis. The 9-month clinical follow-up rate was 91%. The mean reference vessel diameter and lesion length were 2.76 mm ± 0.40 and 26.8 mm ± 13.1, respectively. The overall DAPT duration was 9.7 ± 2.8 months. Only one (1%) in-hospital MI was reported. The TLR and MACE rates at 9 months were 2% (2/101) and 5.9% (6/101), respectively. The 9-month accumulated rates of definite or probable stent thrombosis was 0% (0/101). Conclusion Revascularizations for CTO with PF-SES are associated with low rates of TLR and MACE at 9 months with no stent thrombosis. These initial findings need to be compared with results of other new generation DES of larger studies.

GW28-e1000 Comparative efficacy of drug-eluting stents in chronic total occlusions: A report from the SCAAR

GW28-e1000 Comparative efficacy of drug-eluting stents in chronic total occlusions: A report from the SCAAR

TCTAP C-280 Successful 6F TRI PCI Using Modified Mini-crushing Stenting for Chronic Total Occlusion with Bifurcation Lesion

TCTAP C-280 Successful 6F TRI PCI Using Modified Mini-crushing Stenting for Chronic Total Occlusion with Bifurcation Lesion

Long-term clinical outcomes of successful revascularization with drug-eluting stents for chronic total occlusions: A systematic review and meta-analysis.

To determine whether successful percutaneous coronary intervention (PCI) using drug-eluting stents (DESs) have beneficial effects on long-term outcomes in patients with chronic total occlusions (CTOs) compared with failed PCIs for CTOs. Several observational studies have evaluated the long-term clinical outcomes of successful PCIs using DESs for CTOs. However, the results of these studies were inconsistent and inconclusive. We searched five online electronic databases to identify all the publications assessing the long-term outcomes of successful and failed PCIs using DESs for CTOs. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by STATA software. A total of nine studies involving 5958 CTO patients who underwent successful PCI and 1511 CTO patients who underwent failed PCI were included in this meta-analysis. The results of the analysis indicated that successful CTO PCIs using DESs were associated with lower long-term all-cause mortality(OR = 0.55, 95% CI = 0.45-0.67, P < 0.001), lower risk of myocardial infarction (OR = 0.45, 95% CI = 0.23-0.74, P = 0.002), lower risk of major adverse cardiac events (MACEs, OR = 0.44, 95% CI = 0.27-0.72, P = 0.001), and less incidence of subsequent coronary artery bypass grafting (OR = 0.10, 95% CI = 0.05-0.21, P < 0.001) than failed CTO PCIs. However, there was no difference in the incidence of target vessel revascularization (OR = 1.06, 95% CI = 0.17-6.60, P > 0.05) between the two groups. Successful CTO PCI using DESs can reduce long-term all-cause mortality and the risks of MI, MACEs, and CABG in patients with CTOs. © 2017 Wiley Periodicals, Inc.

Correction to: Procedural and Long-Term Outcomes of Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions: The BONITO Registry (Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions).

HomeCirculation: Cardiovascular InterventionsVol. 10, No. 2Correction to: Procedural and Long-Term Outcomes of Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions: The BONITO Registry (Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions) Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection to: Procedural and Long-Term Outcomes of Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions: The BONITO Registry (Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions) Originally published17 Jan 2017https://doi.org/10.1161/HCV.0000000000000021Circulation: Cardiovascular Interventions. 2017;10:e000021This article corrects the followingProcedural and Long-Term Outcomes of Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total OcclusionsIn the article by Azzalini et al, “Procedural and Long-Term Outcomes of Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions: The BONITO Registry (Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions),” which published online October 7, 2016, and appeared in the October 2016 issue of the journal (Circ Cardiovasc Interv. 2016;9:), a correction is needed.On page 5, Table 2, the table rows read, “Right coronary artery, 110 (20.5%), 29 (19.0%), 81 (21.1%); Left circumflex artery, 229 (42.6%), 53 (34.6%), 176 (45.8%).” It has been changed to read, “Right coronary artery, 229 (42.6%), 53 (34.6%), 176 (45.8%); Left circumflex artery, 110 (20.5%), 29 (19.0%), 81 (21.1%).”On page 5, Table 2, table rows J-CTO score; and Reference vessel diameter, mm, the data has been updated.On page 6, Table 3, table rows Diameter of largest stent/scaffold, mm; Diameter of largest balloon used for postdilatation, mm; Minimal luminal diameter post-PCI, mm; Diameter stenosis post-PCI, %; Contrast volume, mL; Fluoroscopy time (min); and Total procedure time (min), the data has been updated.This correction has been made to the current online version of the article, which is available at http://circinterventions.ahajournals.org/content/9/10/e004284. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesProcedural and Long-Term Outcomes of Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total OcclusionsLorenzo Azzalini, et al. Circulation: Cardiovascular Interventions. 2016;9 February 2017Vol 10, Issue 2 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/HCV.0000000000000021PMID: 28096169 Originally publishedJanuary 17, 2017 PDF download Advertisement

TCT-310 Comparative efficacy of drug-eluting stents in chronic total occlusions: A report from the SCAAR

TCT-310 Comparative efficacy of drug-eluting stents in chronic total occlusions: A report from the SCAAR

Procedural and Long-Term Outcomes of Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions

There is little evidence regarding the efficacy and safety of bioresorbable scaffolds (BRS) for the percutaneous treatment of chronic total occlusions. We performed a multicenter registry of consecutive chronic total occlusion patients treated with BRS (Absorb; Abbott Vascular) and second-generation drug-eluting stents (DES) at 5 institutions. Long-term target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target-lesion revascularization) was the primary end point. Inverse probability of treatment weight-adjusted Cox regression was used to account for pretreatment differences between the 2 groups. A total of 537 patients (n=153 BRS; n=384 DES) were included. BRS patients were younger and had lower prevalence of comorbidities. Overall mean Japan-Chronic Total Occlusion (J-CTO) score was 1.43±1.16, with no differences between groups. Procedural success was achieved in 99.3% and 96.6% of BRS- and DES-treated patients, respectively (P=0.07). At a median follow-up of 703 days, there were no differences in target-vessel failure between BRS and DES (4.6% versus 7.7%; P=0.21). By adjusted Cox regression analysis, there were still no significant differences between BRS and DES (hazard ratio, 1.54; 95% confidence interval, 0.69-3.72; P=0.34). However, secondary analyses suggested a signal toward higher ischemia-driven target-lesion revascularization with BRS. Implantation of BRS versus second-generation DES in chronic total occlusion was associated with similar risk of target-vessel failure at long-term follow-up. However, a signal toward increased ischemia-driven target-lesion revascularization with BRS was observed. Large randomized studies should confirm these findings.

Usefulness of Intravascular Ultrasound Guidance in Percutaneous Coronary Intervention With Second-Generation Drug-Eluting Stents for Chronic Total Occlusions (from the Multicenter Korean-Chronic Total Occlusion Registry)

Despite the usefulness of intravascular ultrasound (IVUS) in percutaneous coronary intervention (PCI), the impact of IVUS guidance on clinical outcomes, particularly for chronic total occlusion (CTO) intervention, has rarely been studied. We sought to investigate the clinical usefulness of IVUS-guided CTO intervention with second-generation drug-eluting stent implantation. From 2007 to 2009, a total of 2,568 patients were enrolled in the Korean-CTO registry and 534 patients with successful implantation of second-generation drug-eluting stents were analyzed. IVUS-guided PCI was performed on 206 patients (39%). Clinical outcomes at 2years were compared between the IVUS-guidance group and the angiography-guidance group in 201 propensity score-matched pairs. The primary end point was the occurrence of definite or probable stent thrombosis. Clinical characteristics were similar between both groups after matching. At 2years, the IVUS-guidance group showed significantly less stent thrombosis than the angiography-guidance group (0% vs 3.0%, p= 0.014) and a lesser trend toward myocardial infarction (1.0% vs 4.0%, p= 0.058). Target lesion revascularization (TLR) and major adverse cardiovascular event rates were similar. However, a significant interaction was observed between the use of IVUS and lesion length for predicting the TLR (p= 0.037), suggesting usefulness of IVUS in long-lesion (≥3cm) relative to short-lesion CTO. In conclusion, although IVUS-guided CTO PCI was not associated with a reduction in overall major adverse cardiovascular events, IVUS guidance appears to be associated with a reduction of stent thrombosis and myocardial infarction compared with angiography-guided CTO PCI. Additionally, TLR occurred less frequently in the IVUS-guidance group, especially for long lesions.

Midterm Outcomes of Subintimal Angioplasty Supported by Primary Proximal Stenting for Chronic Total Occlusion of the Superficial Femoral Artery

To investigate the midterm outcomes of subintimal angioplasty in occluded superficial femoral arteries (SFA) and evaluate the clinical and procedural factors affecting these results. Between April 2004 and April 2012, 150 patients (122 men; mean age 69±10 years) with chronic total occlusions in the SFA underwent subintimal angioplasty with primary stenting in 172 limbs. The average lesion length was 22.6±8.5 cm. Stents were routinely implanted at the proximal entry into the subintimal channel. The primary endpoint was binary restenosis. Technical success was achieved in 161 (94%) limbs; there were no procedure-related deaths or complications requiring surgery, but distal embolization and arterial perforation occurred in 2 and 4 limbs, respectively. The cumulative freedom from binary restenosis rates at 1 and 3 years were 77% and 59%, respectively, in the entire study group. The 96 patients without critical limb ischemia (CLI) had significantly higher patency rates at 1 and 3 years (84% and 66%, respectively) than the 54 patients with CLI (66% and 43%, respectively; p=0.011). Based on multivariate analysis, a larger number of stents, lower post-procedure ankle-brachial index, and lower body mass index were each independent predictors of binary restenosis. Subintimal angioplasty with routine stenting at the proximal stump is safe and effective for the treatment of chronic total SFA occlusions.

Use of drug‐eluting stents for chronic total occlusions: A systematic review and meta‐analysis

To perform a systematic review and meta-analysis of studies reporting outcomes after drug-eluting stent (DES) implantation in chronic total occlusions (CTOs). A review of publications and online databases in January 2010 retrieved 17 published studies that reported outcomes after DES implantation in CTOs: eight uncontrolled studies, seven nonrandomized comparative studies with bare-metal stents (BMS), one post-hoc analysis of a randomized trial, and one randomized trial. Data were pooled using random-effects meta-analysis models. All published studies evaluated sirolimus- or paclitaxel-eluting stents. All studies reporting comparative angiographic outcomes revealed less binary angiographic restenosis with DES implantation compared to BMS (odds ratio: 0.15, 95% CI: 0.08, 0.26). Over a mean follow-up period of 18.9±16.5 months, the cumulative incidence of death, myocardial infarction, or stent thrombosis was similar between DES and BMS in all studies. Target lesion revascularization (odds ratio: 0.13, 95% CI: 0.06, 0.26) and target vessel revascularization (odds ratio 0.18, 95% CI: 0.11, 0.31) at 6-12 months were consistently lower among DES-treated patients. Similar patterns of safety and efficacy event rates were also observed in studies reporting>12 month outcomes. Compared with BMS, treatment of chronic total coronary occlusions with DES is associated with significant reductions in angiographic and clinical restenosis with similar safety. The consistency and magnitude of treatment effect across both individual trials and the pooled analysis establish DES as the preferred therapy for percutaneous revascularization of CTOs.

TCT-29: Long-Term Clinical Outcomes after Percutaneous Coronary Intervention with Drug-eluting Stents versus Bare Metal Stents for Chronic Total Occlusions: Two-Year Outcomes from a 1,781 Patient Multi-National Registry

TCT-29: Long-Term Clinical Outcomes after Percutaneous Coronary Intervention with Drug-eluting Stents versus Bare Metal Stents for Chronic Total Occlusions: Two-Year Outcomes from a 1,781 Patient Multi-National Registry

TCT-212: High Residual Platelet Reactivity After Clopidogrel Loading and Clinical Outcome After Drug-Eluting Stenting for Chronic Total Occlusion

TCT-212: High Residual Platelet Reactivity After Clopidogrel Loading and Clinical Outcome After Drug-Eluting Stenting for Chronic Total Occlusion

AS-213: Clinical Impact of Stent Fracture after Stenting of Chronic Total Occlusions: A Comparison between Sirolimus- and Paclitaxel-Eluting Stent Implantation

AS-213: Clinical Impact of Stent Fracture after Stenting of Chronic Total Occlusions: A Comparison between Sirolimus- and Paclitaxel-Eluting Stent Implantation

Successful Carotid Stenting for Chronic Total Occlusion of the Internal Carotid Artery

A 64-year-old man complaining of pulsatile headache was admitted. Imaging studies revealed a near-total occlusion of the right proximal internal carotid artery (ICA) with slow antegrade flow into the distal ICA. Right cerebral flow was supplied by collateral flow through the posterior communicating and ophthalmic arteries. He was successfully treated by carotid artery stenting. No new neurological deficit or transient ischemic attack occurred after treatment.

Carotid Stenting for Chronic Total Occlusion of the Internal Carotid Artery

In 1954, Eastcott et al1 opened the era of the surgical treatment of carotid atherosclerosis. In the ensuing 54 years, much has been learned about the benefits of carotid endarterectomy (CEA) for the treatment of symptomatic and asymptomatic carotid artery stenosis. Recently, carotid artery stenting has gained acceptance as a reasonable alternative to CEA for patients who are deemed at high risk for complications from surgery.2 Despite all of the advancements in the techniques of carotid artery revascularization, little progress has been made in the treatment of chronic total occlusion. Article see p 119 Through extensive personal experience, the early leaders of vascular surgery defined the parameters for carotid surgery. In 1965, De Bakey3 first highlighted the challenges associated with the treatment of internal carotid artery occlusion when he pointed out that “because of intracranial extension of the thrombotic process and its organization, the incidence of restoration of circulation for complete occlusion at (the internal carotid artery) declined sharply after 24 hours.” In 1970, Thompson et al4 published a landmark series of 592 patients undergoing CEA that included 118 totally occluded internal carotid arteries. In this subgroup, flow was restored in only 41%, with …

Percutaneous Transluminal Angioplasty and Stenting for Chronic Total Occlusion of Intracranial Carotid Artery

Chronic total occlusion of cerebrovascular lesions is regarded as a contraindication to revascularization. We describe a case of chronic total occlusion of intracranial internal carotid artery that iwass successfully recanalized by endovascular treatment. A 72-year-old man who presented with slight right hemiparesis was proved to have chronic total occlusion of the left intracranial internal carotid artery. Percutaneous transluminal angioplasty/stenting was achieved using reversal of flow with the Parodi Anti-Embolic System. The present case indicates that percutaneous transluminal angioplasty/stenting can be an effective therapeutic option in selected patients with chronic total occlusion of cerebrovascular lesions.

Drug-eluting stents for chronic total occlusions make sense, but it is too early to close the discussionThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

Stent implantation compared with balloon angioplasty alone has proved not only to increase procedural safety but also to reduce elastic recoil and vascular remodelling and to improve immediate and long-term clinical and angiographic outcomes in patients with coronary artery disease. The use of intravascular ultrasound-guided high pressure stent implantation has reduced the frequency of stent thrombosis. However, stents induce a neo-intimal hyperplasia during the initial 9 months after implantation, and this hyperplasia results in a binary restenosis rate of 10–40%. In addition, patient subsets with small vessels, long lesions, multivessel disease, diabetics, renal failure, or complex lesions morphology, such as bifurcations or total occlusions have an even higher incidence of in-stent restenosis. Most large pivotal studies of stent implantation included patients with coronary lesions of non-complex morphology, and the treatment results of these studies cannot necessarily be generalized to patients with more complex lesion morphology. Smaller studies have demonstrated the effect of stenting in some complex lesions such as stenosis of the proximal part of the left anterior descending coronary artery, restenotic lesions, and recanalized total coronary occlusions, whereas results have been less convincing in long lesions and lesions located in small vessels. Patients, who have stents implanted seem to fare only marginally better than those with a ‘stent-like’ result after balloon angioplasty alone. The survival rate of patients in whom the attempt to re-open a chronic total coronary occlusions fails is lower when compared with that of patients in whom the procedure is successful (10-year survival 65 and 75%, respectively). A challenge in treating total coronary occlusions percutaneously is to successfully force the guide wire through the occluded segment to the peripheral part of the vessel, and procedural success is a combination of gaining this access and obtaining a stable lumen in the vessel segment after the recanalization. Procedural success rates between 50 and 80% have been reported, but the rate seems closely linked to the selection of patients and to the morphology of the lesions. To increase success rates of chronic total occlusions treatment, special wires, and steerable dissecting and ablating devices have been introduced. However, a ‘break-through’ device is still awaited. Patients with chronic total coronary occlusion have been studied in randomized studies comparing balloon angioplasty with stent implantation. The restenosis rate was reduced from 70% in the balloon treated groups to 30% in the stent groups, with a corresponding reduction in the need for revascularisation and with no increased risk of stent thrombosis. Similar figures have been reproduced in other studies. In one study restenosis rate in the stent group was as high as 55%, which was partially explained by a very high level of lesion complexicity. A key effort in the improvement of clinical outcomes after stent implantation in chronic total occlusions is to foster a device that kills two birds with one stone, i.e. fulfils lesion scaffolding properties necessary after balloon dilatation and allows sufficient but restricted endothelialization of the stented segment. Recently, the macrolide antifungal agent, sirolimus, originally