Treatment Of Occlusion Research Articles

Retrograde coronary chronic total occlusion intervention (JR-CTO) score: from the Japanese CTO-PCI expert registry

Abstract Background Despite the effectiveness of the retrograde approach for chronic total occlusion (CTO) lesions, there are no standardized tools to predict the success of retrograde percutaneous coronary intervention (PCI). Purpose The objective of this study was to develop a prediction tool to identify CTO lesions that will achieve successful retrograde PCI. Methods This study evaluated data from 2,374 patients who underwent primary retrograde CTO-PCI and were enrolled in the Japanese CTO-PCI Expert Registry between January 2016 and December 2022. All observations were randomly assigned to the derivation and validation cohorts at a 2:1 ratio. The prediction score for guidewire failure in retrograde CTO-PCI was determined by assigning one point for each factor and summing all accrued points. Results The JR-CTO score (moderate–severe calcification, tortuosity, Werner collateral connection grade ≤ 1, and non-septal collateral channel) demonstrated a c statistic for guidewire failure of 0.72 (95% confidence interval: 0.67–0.76) and 0.71 (95% confidence interval: 0.64–0.77) in the derivation and validation cohorts, respectively. Patients with lower scores had higher guidewire and technical success rates and decreased guidewire crossing time and procedural time (P < 0.01). Conclusions The JR-CTO score, a simple four-item score that predicts successful guidewire crossing in patients undergoing retrograde CTO-PCI, has the potential to support clinical decision-making for the retrograde approach.

INCIDENCE OF CONTRAST-INDUCED NEPHROPATHY FOLLOWING CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION

Contrast-induced nephropathy (CIN) is a potentially serious complication following percutaneous coronary intervention (PCI), particularly in patients with chronic total occlusion (CTO). It is characterized by an acute deterioration in renal function after exposure to contrast media. CIN is associated with increased morbidity, hospital stays, and long-term renal outcomes, making it crucial to identify and mitigate its incidence. This study aimed to evaluate the incidence of CIN in patients undergoing CTO-PCI and its associated complications. Objective: To assess the incidence of contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) and evaluate in-hospital complications, hospital stay duration, and short-term mortality. Methods: This cross-sectional study was conducted with ethical approval at a tertiary care hospital, including 118 patients who underwent PCI for CTO at the Department of Cardiology, Lady Reading Hospital Peshawar, Pakistan from 10th June 2023 to 09th June 2024. Standardized pre- and post-procedural hydration protocols were implemented to reduce the risk of CIN, and non-ionic, iso-osmolar contrast agents were used. CIN was defined as a 25% increase in serum creatinine or an absolute increase of ≥0.5 mg/dL within 48–72 hours post-procedure. Data on demographic characteristics, complications, and mortality were collected and analyzed using SPSS Version 25, with categorical variables expressed as percentages and continuous variables as means. Chi-square tests were used to assess statistical significance, with P-values < 0.05 considered significant. Results: Of the 118 patients included, the mean age was 56.34 years, and 52.5% were male. Age distribution showed that 43.2% were between 51-60 years, while 33.1% were between 61-70 years. CIN was observed in 6.8% of patients, with 9.7% of males and 3.6% of females affected (P=0.188). In-hospital complications included arrhythmias in 4.2% of patients, heart failure in 0.8%, and mortality in 0.8%. Hospital stay averaged 5.94 days, with no significant differences in CIN incidence across age groups (P=0.186). Conclusion: The incidence of contrast-induced nephropathy following PCI for chronic total occlusion is a clinically significant issue, affecting 6.8% of patients despite preventative measures. This emphasizes the need for ongoing risk assessment, monitoring, and the implementation of effective prevention strategies. Further research is warranted to refine risk stratification tools and develop targeted interventions to minimize CIN incidence, particularly in high-risk patient populations.

Outcomes of percutaneous coronary intervention in patients with chronic total occlusion (CTO): a single-center study evaluating a new dedicated CTO program in Egypt

PurposeThe conundrum of limited resources in developing countries leads to the abonnement and underutilization of percutaneous coronary intervention for chronic total occlusion, in addition to lack of expertise, limited supplies, and success rates. We embraced this challenge by initiating a dedicated program in a tertiary academic center in Egypt, aiming for optimum utilization of resources, limit cost, and gaining experience. We present our outcomes and the proficiency in establishing the program.MethodsWe enrolled all patients undergoing percutaneous coronary intervention for chronic total occlusion during the first year of initiating our dedicated program. Analysis of clinical data, angiographic findings, and procedural features were evaluated, aiming to evaluate outcomes. Our primary outcome was successful recanalization achievement, utilization of available resources and cost. Secondary outcomes such as peri-procedural myocardial infarction, coronary perforation, urgent need of coronary artery bypass grafting, cerebrovascular stroke, and mortality were assessed.ResultsOur study enrolled 64 patients electively admitted to the Critical Care Department, Cairo University, undergoing percutaneous coronary intervention for chronic total occlusion. The median J-CTO score was 2 (0–5). We achieved successful recanalization in 47 patients (73%). The mean procedural time was 123 ± 48.8 min, mean contrast volume was 359.03 ± 151.9 ml, and mean radiation dose was 9.4 ± 4.2 Gy. The mean number of wires per patient was 2.69 ± 1.32, and the most successful crossing strategy was antegrade wiring (56.3%). The commonest cause of failure was failure of re-entry (46.7%). One patient had peri-procedural MI (1.6%), and one patient required urgent CABG. There was no in-hospital mortality or cerebrovascular stroke. The cost ranged from 6520 Egyptian Pounds (EP) ($415) to 63,720 EP ($4058), with a mean of 26,213 EP ($1670).ConclusionsEstablishing a dedicated program for percutaneous coronary intervention for chronic total occlusion proved to be feasible and proficient, achieving high success rates with limited complications in view of limited resources, rationalized utilization of equipment, and limitation of hospital costs.

Basilar Stenosis Reduces the Impact of Successful Recanalization on Outcome in Basilar Artery Occlusion

Background: Evidence from randomized controlled trials has shown a benefit for endovascular treatment in basilar artery occlusion. We aimed to show the effect of the recanalization result on outcome and determine the role of underlying basilar stenosis in a real-world setting. Methods: A retrospective, single-center study of patients who received endovascular treatment for basilar artery occlusion from March 2008 to June 2022 was conducted. Clinical and outcome characteristics were gathered. Multivariate logistic regression analysis was performed to predict poor outcomes (post-treatment mRS 5 or 6). MRS shift analysis was performed. Results: This study includes 210 patients (mean age, 71.4 years +/− 13.3 [standard deviation]; 124 men). The variables age (OR, 1.04; 95% CI: 1.01–1.08; p = 0.014), underlying basilar stenosis (OR: 4.86; 95% CI: 2.15–10.98; p < 0.001), admission NHISS (OR: 1.09; 95% CI: 1.04–1.13; p < 0.001), and TICI (OR: 1.89; 95% CI: 1.09–3.25; p = 0.022) independently predicted a poor outcome. Patients with occlusions due to underlying stenosis had significantly worse recanalization rates. Median post-treatment mRS in all patients with embolic occlusion was 4; IQR, 2–5 (only patients with embolic occlusion: mTICI 0-2a, median: 5 [IQR, 4–5.5]; mTICI 2b, median: 4 [IQR, 2.5–6]; mTICI 3, median: 3 [IQR, 1–5]; p = 0.037). Median post-treatment mRS in all patients with occlusions due to underlying stenosis was 5; IQR, 4–6 (only patients with embolic occlusions: mTICI 0-2a, median: 6 [IQR, 4.5–6]; mTICI 2b, median: 6 [IQR, 4.25–6]; mTICI 3, median: 5 [IQR, 3.5–5.25]; p = 0.059). Conclusions: Successful recanalization is essential for preventing poor outcomes in basilar artery occlusion. Underlying basilar stenosis diminishes the effect of successful recanalization on the overall outcome.

A telemedicine-enabled intravenous thrombolytic treatment pathway for patients with hyperacute non-arteritic central retinal artery occlusion

PurposeTo describe the visual acuity (VA) outcomes from a telemedicine-enabled pathway allowing for rapid diagnosis and administration of intravenous (IV) thrombolytic treatment for non-arteritic central retinal artery occlusion (naCRAO) within 4.5 hours (4.5 h) of visual loss. DesignRetrospective observational case series. MethodsSetting: A large managed healthcare consortium.Patient Population: Eighty-five patients with naCRAO and vision loss for less than 4.5 h presenting between 2021 and 2023. Thirty-five patients received IV thrombolytic therapy and 50 patients were closely observed.Intervention: A collaborative telemedicine-enabled pathway employing fundus photography was previously established by Ophthalmology, Emergency Medicine, and Stroke services to rapidly evaluate and manage patients presenting with acute painless monocular vision loss and allow for administration of IV tenecteplase (0.25 mg/kg) for eligible consenting patients diagnosed with naCRAO within 4.5 h. Retrospective chart review was conducted to collect data on demographics, vascular risk factors, clinical features, VA outcomes, and adverse events. Comparison was made between patients who received intravenous thrombolysis and those who were observed.Main Outcome Measures: Improvement in VA of at least 0.3 logarithm of the minimum angle of resolution (logMAR) and/or from 20/200 or worse to 20/100 or better. ResultsA greater percentage of patients in the treated group had VA improvement of ≥0.3 logMAR (54.3 % vs 28 %, p = .014), and a greater percentage of patients in the untreated group had VA worsening of ≥0.3 logMAR (30 % vs 5.7 %, p = .006). Twice the percentage of treated versus untreated patients had improved VA from 20/200 or worse to 20/100 or better, but this difference was not statistically significant (20 % vs 10 %, p = .192). There was a significantly shorter mean time to treatment for those patients who had VA improvement from 20/200 or worse to 20/100 or better compared to those who did not (118 versus 171 min, p = .031). Two patients experienced intracranial bleeding after IV thrombolysis. ConclusionsThe evaluation and treatment of hyperacute naCRAO is possible on a large scale via an integrated telemedicine-enabled approach utilizing fundus photography. The use of IV thrombolytic was associated with better VA outcomes compared to observation alone. Prospective randomized controlled trials are needed to confirm these findings and determine optimal management.

Pain Catastrophizing and Functional Activation During Occlusion in TMD Patients-An Interventional Study.

In temporomandibular disorder (TMD), the effects of standard interventions such as using an occlusal splint and its impact on pain relief and pain catastrophizing are poorly understood. Earlier work pointed to a crucial role of insula activation with changes in pain relief by occlusal splint treatment. We performed a functional imaging study using specially developed splint systems to allow for a placebo-controlled longitudinal design. Using functional MRI we examined 20 TMD patients during repetitive occlusal movements at baseline and over the course of splint therapy and also collected self-reported pain catastrophizing. For balancing performance between baseline and after intervention we used occlusion force measures in an individualized fMRI-splint system. Splint therapy lasted for approximately 7 weeks with one group selected by randomization wearing a palatine placebo splint over the first 3 weeks (delayed start; 11 individuals). As expected, fMRI activation in areas involved in pain processing (insula, primary and secondary somatosensory cortex) decreased with intervention. At baseline a positive correlation between activation of the left anterior insula and pain catastrophizing was present. Both parameters decreased over intervention while associations were primarily observable for patients with rather mild TMD.

Endovascular treatment versus medical management for basilar artery occlusion with low-to-moderate symptoms (National Institutes of Health Stroke Scale < 10).

Patients with acute basilar artery occlusion (BAO) and low-to-moderate symptoms (National Institutes of Health Stroke Scale [NIHSS] < 10) are poorly represented in thrombectomy trials. Our objective is to compare thrombectomy and best medical management (BMT) in this population. We compared data of all consecutive patients presenting with an initial NIHSS < 10 and acute symptomatic BAO included in two registries. The main outcome was the proportion of patients achieving a 3-months favorable outcome (mRS 0-2 or equal to the pre-stroke value). Secondary outcomes included the proportion of patients with an excellent outcome (mRS 0-1 or equal to pre-stroke value), overall mRs distribution (shift analysis) and mortality. Effect sizes for thrombectomy versus BMT alone were calculated using binary or ordinal logistic regression model before after considering confounders using the inverse probability of treatment weighting (IPTW) propensity score method. One hundred twenty-seven patients were included: sixty-four patients treated with thrombectomy (mean ± SD age: 63.4 ± 16.1) and sixty-three with BMT (mean ± SD age: 69.0 ± 14.3). There was no significant difference between groups for the rate of 3 month-favorable outcome or mortality. After propensity-score adjustment, thrombectomy was associated with a significantly higher chance of excellent outcome at 3 months (mRS 0-1 or equal to pre-stroke value; adjusted OR, 2.68; 95%CI, 1.04-6.90; p = 0.041). Our study suggests that thrombectomy in patients with low-to-moderate symptoms (NIHSS < 10) due to BAO does not improve the rate of favorable outcome but could lead to a higher chance of excellent outcome at 3 months.Trial Registration: ETIS Registry. http://www.clinicaltrials.govNCT03776877.

A Case of Coronary Artery Aneurysm Occurring After Drug-Coated Balloon Intervention for De Novo Chronic Total Occlusion

AbstractDrug-coated balloons (DCBs) have been proposed as a viable alternative to drug-eluting stents (DES) for managing chronic total occlusion (CTO), reducing adverse reactions associated with DES. However, adverse events after DCB treatment are rarely reported. We present a case of coronary artery aneurysm (CAA) formation after DCB treatment. A 55-year-old active smoker presented with exertional chest pain and positive ischemic response on the exercise stress test. Diagnostic coronary angiography revealed CTO in the mid-left anterior descending (mid-LAD) coronary artery with collateral circulation arising from the contralateral side. The patient underwent DCB treatment using a paclitaxel-coated balloon after predilatation with a noncutting balloon and a semi-compliant balloon. The final angiogram showed minimal recoil, type B coronary dissection nonflow limiting, and thrombolysis in myocardial infarction (TIMI) grade 3 flow. A follow-up coronary angiogram at 6 months revealed a fusiform aneurysm at the treated lesion with DCB. Despite the asymptomatic nature of the patient, good distal flow in the LAD, and the patient achieving a TIMI grade 3 flow, a decision was made to observe and closely monitor the patient. Despite potential risks, DCB remains a viable alternative to DES in CTO cases. Our case suggests that, although CAA occurred, it did not lead to significant adverse cardiac events. Further research is needed to understand the predictors and long-term outcomes of CAA.

Effects of intravitreal Bevacizumab (Avastin) monotherapy in central retinal vein occlusion in young subjects.

To evaluate the efficacy of anti-angiogenic agent Bevacizumab in central retinal venous occlusion treatment. To determine the efficacy of Bevacizumab and ophthalmological parameters such as best corrected visual acuity (BCVA) and central macular thickness (CMT) using optical coherence tomography (OCT) in central retinal venous occlusion in patients aged less than 30. This is a prospective, interventional study, done on 25 eyes of 25 patients aged 30 years and below with central retinal venous occlusion, who received intravitreal Bevacizumab injections for three consecutive months. The mean change in best corrected visual acuity (BCVA), and central macular thickness (CMT) measured by optical coherence tomography were compared and correlated at baseline after 3 months and 6 months follow-up. The mean best corrected visual acuity and the central macular thickness on OCT improved significantly from 1.08±0.29 and 454.80±114.5µm at baseline to 0.77±0.32 logMAR units and 339.7±82.5µm after 6 months follow up. The current study showed that intravitreal Bevacizumab at a dose of 1.25 mg and with strict control of systemic contributory parameters seemed to improve BCVA and CMT and macular edema measured at baseline to 3 months and 6 months follow-up after three consecutive monthly injections.

Emergent endovascular treatment versus medical treatment for acute large vessel occlusions with nondisabling symptoms.

The aim of this study is to analyze the effectiveness and safety of medical treatment (MT) versus endovascular treatment (EVT) in acute large vessel occlusion patients with mild nondisabling stroke symptoms. This study is a multicenter observational study in which data from patients at three stroke centers were prospectively obtained and retrospectively analyzed. Patients were included if they arrived for treatment within 6 h of stroke onset or last known well time and had a baseline National Institutes of Health Stroke Scale (NIHSS) score of ≤5. Primary outcome was modified Rankin Scale (mRS) score 0-2 at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH), discharge NIHSS score, 90-day all-cause mortality and length of stay. Clinical outcomes were compared through a multivariable logistic regression after adjusting for age, treatment type admission and discharge NIHSS score, admission Alberta Stroke Program Early CT (ASPECT) score and length of stay. Of the 82 patients included in the study, 42 were in the EVT group and 40 were in the MT group. The groups were similar in age (MT:66, EVT:64 age; p = .62), gender (MT:55%, EVT:54.8%; male) admission NIHSS score (MT:2, EVT:3 points; p = .26), ASPECT score (MT:10, EVT:9; p = .15). While discharge NIHSS score was found to be statistically significant between the groups (MT:1, EVT:2; p = .04). There was no difference between the two groups in terms of 90-day mRS scores (MT:1, EVT:1, p = .86) and mortality rates (MT:4, EVT:4; p = .94). In unadjusted analysis, sICH rates were similar between the MT and EVT groups (MT 5%, EVT 7.1%, p = .52). Neurological intensive care unit length of stay (MT:5 days, EVT:2 days p < .001), inpatient clinic length of stay (MT:3, EVT:2 days p = .041), and total length of stay (MT:9 days, EVT:4 days p < .001) were significantly longer in the MT group. Our multicenter study demonstrated that MT with blood pressure augmentation and anticoagulation at hyperacute stage is an alternative option for emergency large vessel occlusion patients with nondisabling mild stroke symptoms.

Outcomes of Hyperbaric Oxygen Treatment for Central Retinal Artery Occlusion: A Single Center Experience

PurposeTo describe the outcomes of hyperbaric oxygen therapy (HBOT) for patients with central retinal artery occlusion (CRAO) at a single tertiary care center. DesignRetrospective clinical cohort study. MethodsMedical records of all patients diagnosed with CRAO who received HBOT at Mayo Clinic in Rochester, Minnesota from 1/1/2009 to 12/31/2020 were reviewed to confirm diagnosis, time from onset to presentation, exam findings, treatments, and follow-up data. Main outcome measures included final visual acuity (VA) and number of lines of improvement. ResultsThere were 41 patients diagnosed with CRAO who received HBOT during the 12 year study period. Median time from symptom onset to HBOT treatment was 9.5 hours (interquartile range [IQR] 6.5, 14.0 hours), and patients received a median of 4 HBOT sessions (IQR 2.5, 6.0 sessions). There were 20 patients who received HBOT within 9 hours, 14 (70%) of which had clinically meaningful improvement in VA of ≥0.3 logMAR. In comparison, of the 21 patients treated after 9 hours, 6 (28.6%) had VA improvement of ≥0.3 logMAR (p=0.008). For all patients, the median logMAR VA at presentation was 2.00 (IQR 1.70, 2.30) and the median logMAR VA at follow-up was 1.94 (IQR 1.00, 2.00) (p<0.001), with median lines of improvement of 3.0 (IQR 0.0, 7.0). For patients treated within 9 hours, the median logMAR VA at presentation was 2.00 (IQR 1.93, 2.30) and the median logMAR VA at follow-up was 1.70 (IQR 0.54, 2.00). Patients treated within 9 hours had statistically significant greater median lines of VA improvement than cases that were treated after >9 hours from symptom onset at 5.9 (IQR 3.0, 10.0) and 0.0 (IQR 0.0, 3.0), respectively (p<0.001). There was no difference in VA recovery associated with specific retinal exam findings such as cherry-red spot (p=0.22) and cilioretinal artery perfusion (p=0.36) compared to patients without those findings. ConclusionThere was a statistically significant improvement in VA after HBOT treatment in CRAO patients among patients that received early HBOT, with patients receiving the most benefit when receiving treatment within 9 hours. Randomized control trials in patients with CRAO are required to confirm the efficacy of HBOT.

TCT-411 Assessment of Left Ventricular Function After Percutaneous Coronary Intervention for Chronic Total Occlusion

TCT-411 Assessment of Left Ventricular Function After Percutaneous Coronary Intervention for Chronic Total Occlusion

TCT-496 Long-Term Clinical Outcomes of Drug-Coated Balloons for the Treatment of In-Stent Chronic Total Occlusions

TCT-496 Long-Term Clinical Outcomes of Drug-Coated Balloons for the Treatment of In-Stent Chronic Total Occlusions

Guidewire Entrapment During Percutaneous Intervention for Chronic Total Occlusion: A Rare Case Report

Iatrogenic complications occur in approximately 0.21% of percutaneous coronary interventions (PCI), which are critical for diagnosing and treating acute coronary syndrome. This case report details a rare complication involving guidewire entrapment during a PCI procedure for chronic total occlusion (CTO). A 71-year-old male with a diagnosis of myocardial infarction (MI) was admitted to the catheterization laboratory, where imaging revealed total occlusion of the Left Anterior Descending (LAD) artery. During the intervention, a balloon shaft breakage prevented the stent balloon from being withdrawn, necessitating an emergency surgical intervention. The guidewire was successfully removed, and urgent revascularization was performed through coronary artery bypass grafting (CABG). The patient experienced a stable recovery, being discharged after one week of intensive care unit monitoring and five days of ward observation. This case highlights the potential for severe complications in CTO interventions and suggests that pre-intervention consultation between cardiology and cardiovascular surgery teams could mitigate such risks and improve outcomes.

Catheter-Directed Thrombolysis in the Management of Thrombotic Peripheral Artery Occlusions-Acute and Mid-Term Clinical Outcomes.

Objectives: To evaluate the safety and efficacy of catheter-directed thrombolysis (CDT) with the recombinant tissue plasminogen activator (rt-PA) in all patients with symptomatic peripheral artery disease in real world practice. Methods: Consecutive patients treated with CDT between January 2013 and December 2020 were included in this retrospective analysis. The primary endpoint was the rate of serious adverse events (SAEs) until discharge. Secondary endpoints included interventional success, predictors for SAEs, bleeding and reperfusion edema/compartment syndrome, limb salvage, and clinical outcomes including target lesion revascularization rate (TLR). Results: Overall, 1238 patients were treated with CDT. SAEs occurred in 511 (41.3%) of the patients, 314 (25.4%) being bleeding complications. There were 95 cases of reperfusion edema/compartment syndrome. Forty-two patients underwent amputation and 33 patients (2.7%) died. CDT was successful in 1177 cases (95.1%). Multivariate logistic regression analysis identified age, abciximab and alprostadil usage, and lysis duration as predictors for SAEs and the use of abciximab as a predictor of reperfusion edema/compartment syndrome. Predictors for bleeding were age, alprostadil usage, and lysis duration. At 12 and 24 months, the limb salvage rate was 91.6% and 88.8%, and TLR rate was 46% and 57.2%, respectively. Conclusions: CDT is an effective endovascular method for the treatment of thrombotic peripheral artery occlusions but is associated with a high complication rate. For SAEs in general and bleeding specifically, increasing age, alprostadil use, and lysis duration were independent risk factors.

CLINICAL AND ANGIOGRAPHIC OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION IN CHRONIC TOTAL OCCLUSION PATIENTS: A RETROSPECTIVE STUDY AT A TERTIARY CARE HOSPITAL

Chronic total occlusion (CTO) presents a unique challenge in percutaneous coronary intervention (PCI), requiring specialised techniques to achieve successful revascularisation. Despite the complexity, PCI in CTO cases has evolved significantly, showing promising outcomes. Objectives: To assess percutaneous coronary intervention's clinical and angiographic outcomes in chronic total occlusion patients. Methods: This retrospective observational study was conducted at NICVD Karachi, Pakistan, following approval from the hospital's ethical committee. It reviewed the medical records of 150 patients who underwent percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) from January 2024 to July 2024. Data was collected retrospectively from electronic medical records, including demographic details (age, gender, cardiovascular risk factors, and comorbidities), baseline clinical characteristics (presentation, symptoms, angina status, and prior cardiac history), and angiographic data (pre- and post-procedural findings, including the Thrombolysis in Myocardial Infarction (TIMI) flow grade). Clinical outcomes were assessed for both short-term and long-term results, including major adverse cardiac events (MACE) such as myocardial infarction, repeat revascularisation, target lesion revascularisation, and all-cause mortality. Statistical analysis was performed using SPSS Version 25. Results: 150 patients were enrolled, with a mean age of 54.81±8.97 years. The cohort included 54.7% males (82 patients) and 45.3% females (68 patients). Before PCI, 87.3% of patients (131) had no blood flow in the occluded artery, while 12.7% (19) had minimal flow. Post-PCI, 91.3% (137 patients) achieved full blood flow (TIMI Flow Grade 3), and 8.7% (13 patients) had partial flow. The procedural success rate was 91.3%. In terms of short-term major adverse cardiac events (MACE), 116(77.3%) patients had no events, while 22.7% (34 patients) experienced a myocardial infarction (MI). For long-term MACE, 84.0% (126 patients) had no adverse events, 10.0% (15 patients) required target lesion revascularisation, 4.7% (7 patients) underwent repeat revascularisation, and 1.3% (2 patients) experienced mortality. Conclusion: This study confirms the efficacy and safety of PCI for CTO patients, demonstrating high procedural success rates, significant clinical improvements, and relatively low long-term adverse events. However, advancing procedural techniques and fostering specialised training are essential to enhance patient outcomes due to the risks and complexities involved. Further research, including large-scale randomised controlled trials, is needed to validate these results and refine patient selection and management strategies for CTO PCI.

Endovascular treatment for proximal middle cerebral artery occlusion due to underlying intracranial atherosclerotic disease: A retrospective single-center case series

ObjectiveTo compare treatment outcomes between patients who received a front-line stent-retriever thrombectomy (SRT) or first stenting without retrieval (FRESH) for treating proximal M1 occlusion due to underlying intracranial atherosclerotic disease (ICAD). MethodsWe retrospectively reviewed consecutive acute ischemic stroke (AIS) patients with intracranial large vessel occlusion (LVO) in the anterior circulation who underwent endovascular treatment (EVT) between January 2017 and August 2021 at Yeungnam University Medical Center. LVO in the anterior circulation was classified according to etiology as follows: Embolic group and ICAD group. Occlusion of the proximal M1 due to ICAD were enrolled in this study. The ICAD group was divided into SRT and FRESH groups according to the treatment method. ResultsAmong the 72 patients in the ICAD group, 55 patients had occlusion of the M1, and 27 had occlusion of the proximal M1 (27/55, 49.1 %). Among the 27 patients, 11 (40.7 %) underwent SRT and 16 (59.3 %) underwent FRESH. The puncture-to-recanalization time was significantly shorter in the FRESH group (28 min vs. 52 min, p = 0.023). Symptomatic ICH tended to occur more frequently in the SRT group than in the FRESH group (27.3 % vs. 0.0 %, p=0.056). There was a nonsignificant trend towards a good functional outcome in the FRESH group compared to the SRT group (81.3 % vs. 45.5 %, p=0.097). ConclusionIn the FRESH group, the puncture-to-recanalization time was significantly shorter, symptomatic ICH tended to occur less frequently, and good functional outcomes were more common.

Potential of Sulodexide in the Treatment of Diabetic Retinopathy and Retinal Vein Occlusion.

Retinal vascular diseases, such as diabetic retinopathy or retinal vein occlusion, are common causes of severe vision loss. Central to the pathophysiology of these conditions are endothelial dysfunction, inflammation, capillary leakage, ischemia, and pathological neoangiogenesis. Capillary damage leads to leakage and the development of macular edema, which is associated with vision loss and requires complex treatment. Sulodexide, a glycosaminoglycan composed of heparan sulfate and dermatan sulfate with high oral bioavailability, exhibits several favorable pharmacologic properties, including antithrombotic, anti-inflammatory, and endothelium-protective effects. Additionally, treatment with sulodexide has been associated with the reduction of oxidative stress and decreased expression of angiogenic growth factors, such as vascular endothelial growth factor. This review aims to provide an overview of the pharmacological properties, mechanisms of action, and therapeutic effects of sulodexide. Furthermore, its potential for clinical application in venous and diabetic diseases, such as venous thromboembolism, chronic venous insufficiency, peripheral artery disease, or diabetic nephropathy, is summarized. We also present experimental and clinical studies evaluating the potential of sulodexide in ocular conditions and discuss its therapeutic implications for the treatment of retinal vascular diseases.

Rescue stenting in refractory mechanical thrombectomy: A review

Despite advancements in mechanical thrombectomy (MT) in the treatment of large vessel occlusions, failure to achieve recanalization remains a challenge in 10 &amp;ndash; 30% of patients. Several underlying pathologies have been postulated in refractory MT, including intracranial atherosclerotic stenosis, intracranial dissection, and recalcitrant emboli. Rescue strategies to maximize recanalization rates, such as alternative access routes, local thrombolysis, stent-assisted angioplasty, and acute &amp;ldquo;rescue&amp;rdquo; stenting, have been proposed. Considered an emerging treatment strategy for refractory MT, rescue stenting (RS) has been shown in non-randomized observational studies as a safe and effective strategy for increasing reperfusion rates and consequently improving clinical outcomes. The effective use of RS approach requires consideration of patient-specific characteristics, clot characteristics, and lesion anatomy. This review provides an overview of the understanding of refractory MT, epidemiology, pathophysiology, current evidence supporting RS in the anterior and posterior circulation, stents used, endovascular techniques, patient selection criteria, antithrombotic use, risks, and complications.

Impact of Intracranial Hemorrhage After Endovascular Treatment for Medium Vessel Occlusion.

Endovascular treatment (EVT) for medium vessel occlusion (MeVO) raises concern about hemorrhagic complications; however, its clinical impact has not been elucidated. Therefore, we investigated the association between intracranial hemorrhage (ICH) after EVT for MeVO and functional outcomes. We conducted a post hoc analysis of the Japan Registry of NeuroEndovascular Therapy 4, a nationwide registry in Japan from 2015 to 2019 including 13 479 patients who underwent EVT for acute ischemic stroke. This study included 2465 patients with MeVO from 166 participating centers in Japan. We compared patients who underwent EVT for MeVO according to their hemorrhagic complication after EVT (no ICH, asymptomatic ICH, and symptomatic ICH). Outcomes included a modified Rankin scale (mRS) score at 30 days and all-cause mortality within 30 days. We estimated the odds ratios (ORs) and their CIs using a multivariable logistic regression model. Among 2394 patients analyzed, 302 (12.6%) developed ICH, with 95 (31.5%) being symptomatic. Compared with the no-ICH group (n = 2092), the asymptomatic and symptomatic ICH groups had a lower proportion of patients with an mRS score of 0 to 2 at 30 days (41% vs 34%, vs 7.4%, P for trend <.001), with an adjusted ORs of 0.77 (95% CI, 0.53-1.12) and 0.12 (95% CI, 0.05-0.30) in the asymptomatic and symptomatic ICH groups, respectively. The adjusted common ORs of one-point shift of mRS score at 30 days in the asymptomatic ICH group was 0.76 (95% CI, 0.57-0.99) and that of the symptomatic ICH group was 0.13 (0.07-0.23), compared with the no-ICH group. ICH after EVT for MeVO was associated with worse outcomes, whether they were symptomatic or not. The optimal treatment devices or techniques to reduce ICH after EVT for MeVO are crucial.