Success Rate Of Percutaneous Intervention Research Articles

The Utility of CT Coronary Angiography in Chronic Total Occlusion Percutaneous Coronary Intervention.

Chronic total occlusion (CTO) of the coronary arteries is a relatively common finding in routine coronary angiography. Of late, there has been considerable improvement in the success rate of percutaneous intervention for coronary CTO, attributed to technological advancement and skills development. CT coronary angiogram (CTCA) is a simple, non-invasive, and cost-effective test that aids in the diagnosis and management of coronary artery disease, including CTOs. The development of multi-slice CT and the use of 3D volume rendering images has revolutionised the diagnostic abilities of CTCA, with improvements in imaging quality and detailed anatomical and morphological characterisation of the plaque disease. In CTO percutaneous intervention, CTCA is used in pre-procedural planning, applying scoring systems to predict the likely success of the intervention as well as the post-procedural evaluation and follow-up. This review examines the different uses of CTCA in CTO intervention, its impact on successful recanalisation and the areas for future consideration.

Percutaneous Interventions in Failing “Necklace” Hemodialysis Grafts: Long-Term Outcomes

PurposeTo determine primary and secondary patency after percutaneous interventions for malfunctioning anterior chest wall (“necklace”) arteriovenous grafts (AVGs) for hemodialysis. Materials and MethodsRecords of six consecutive patients with subclavian artery–to–contralateral subclavian vein necklace AVGs were reviewed. Patients underwent 34 procedures, including 28 balloon angioplasties, 24 pharmacomechanical thrombolyses, and six stent placements. Patency intervals after graft placement and after first intervention were calculated. ResultsAfter 3 months, primary and secondary patency rates were 33% (two of six grafts) and 67% (four of six grafts), respectively. At 12 months, primary and secondary patency rates were 17% (one of six grafts) and 50% (three of six grafts), respectively. Median and mean primary patency times were 49 and 374 days, and median and mean secondary patency times were 293 and 575 days, respectively. The anatomic success rate of percutaneous interventions in malfunctioning AVGs was 97% (33 of 34 cases). At 3 years after implantation, the graft patency rate was 57% (four of seven grafts). ConclusionsPercutaneous interventions were effective at maintaining patency in failing necklace AVGs. However, their primary and secondary patency were inferior to those cited in extremity AVG guidelines set forth by the Society of Interventional Radiology.

Percutaneous Interventions in Subclavian Artery–to–Contralateral Subclavian Vein “Necklace” Hemodialysis Grafts: Experience in Five Patients

To describe clinical outcomes of endovascular interventions in the setting of thrombosis or dysfunction of anterior chest wall ("necklace") arteriovenous (AV) hemodialysis grafts. Eight percutaneous interventions (balloon angioplasty, pharmacologic thrombolysis, and mechanical thrombectomy) were performed in five patients with anterior chest wall AV grafts. Primary, assisted, and secondary patencies, as well as technical success and complication rates, were determined. The technical success rate of percutaneous interventions in re-establishing a normal blood flow pattern within the AV grafts was 100%. Primary patency ranged from one to 23 months (median, 5 months). Primary assisted patency and secondary patency were 36 months and 8 months, respectively, in two patients who underwent more than one intervention. Postintervention access patency ranged from 5 to 36 months (median, 9 months), whereas graft lifetime ranged from 12 to 45 months (median, 24 months). There were no complications related to revascularization procedures. Percutaneous interventions can be performed safely and effectively in anterior chest wall AV grafts. Technical success and long-term patency rates appear to be similar to those of percutaneous interventions in upper-extremity hemodialysis AV grafts.

Reporting Success Rate at 12 Months After Percutaneous Treatment for Peripheral Arterial Disease: The Impact of Outcome Criteria

The objectives of our study were to assess the influence of varying outcome criteria on the success rate at 12 months after percutaneous intervention for peripheral arterial disease and to suggest a reporting method that can be used in studies that report results of interventions as measured by parameters of daily clinical practice. The outcomes of 1,411 consecutive procedures in 1,583 limbs recorded in a multicenter registry involving six hospitals were analyzed. Six sets of outcome criteria were evaluated: one based on symptomatic change, three based on ankle-brachial index (ABI) measurements, and two based on combining the symptomatic and ABI outcome measures. Agreement among the outcome measures was compared using the kappa statistic. The ABI outcome measures alone showed good agreement (kappa = 0.74-0.94). The symptomatic outcome measures yielded a substantially higher 12-month success rate than the ABI outcome measures (difference, 18-24%) and the agreement was only fair (kappa = 0.52-0.60). The agreement between symptomatic outcome and ABI outcome measures was poor in patients with a pretreatment ABI measurement at rest of more than 0.90 (kappa = 0.20). Combining symptomatic outcome and the ABI outcome measures with the logical operator "OR" showed good agreement with the symptomatic outcome measures alone (kappa = 0.97) and using "AND" showed good agreement with the ABI outcome measures alone (kappa = 0.87). In patients with a pretreatment ABI measurement at rest of more than 0.90, classifying procedures using a criterion based on improvement in ABI measurements with more than 0.10 is inaccurate and underestimates the actual success rate at 12 months after percutaneous intervention. Furthermore, combining subjective improvement in symptoms and improvement in ABI measurements does not yield more information than reporting these outcome measures separately. Therefore, we suggest that improvement in symptoms and improvement in ABI measurements should be reported separately to indicate the 12-month success rate of percutaneous interventions for peripheral arterial disease.

Efficacy of abciximab readministration in coronary intervention

Abciximab, an Fab monoclonal antibody fragment that blocks the platelet glycoprotein IIb/IIIa receptor, is increasingly used as an adjunct to coronary intervention. Little is known, however, about the efficacy and safety of readministration of abciximab. This study examined and characterized outcomes of patients receiving abciximab for a second time. From April 1995 to June 1997, 164 consecutive patients were readministered abciximab at our 3 institutions. We retrospectively examined and analyzed in-hospital outcomes in this cohort. The median time to readministration was 95 days. The angiographic success rate of percutaneous intervention was 99.5%. Rates and 95% confidence intervals of in-hospital events were death 2% (0.7% to 6.1%), myocardial infarction 3% (1% to 7%), coronary bypass surgery 0% (0% to 2.2%), and intracranial hemorrhage 2% (0.4% to 5.3%). Severe thrombocytopenia was observed in 4% of patients (1.4% to 7.8%) after readministration. Allergic or anaphylactic reactions were not observed. Major bleeding was associated with excessive concomitant antithrombotic therapy. Patients undergoing readministration of abciximab within 2 weeks of first administration experienced a higher incidence of severe thrombocytopenia (12% vs 2%, p = 0.046). Thus, abciximab remains clinically efficacious when readministered as an adjunct to percutaneous coronary intervention. However, concomitant heparin administration must be carefully monitored and warfarin therapy should be avoided. Vigilant surveillance for thrombocytopenia should be employed. Reduced dosing may be necessary when abciximab is readministered within days of the initial administration.