Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.
Objective: In recent years, transcatheter aortic valve replace (TAVR) has revolutionized the interventional treatment of aortic stenosis, however, only scarce evidence considers it as treatment for Aortic Regurgitation (AR). At present, the treatment of Pure AR of Native Valve with TAVR does not fall within the recommendations of international guidelines, as it poses multiple challenges with immediate and long-term variable and unpredictable results. The objective of this paper is to present the case of a patient with prohibitive operative risk that benefited of TAVR treatment for AR. Materials and methods: We present the case of a 79-year-old male patient who has severe Pure Native Aortic Valve Regurgitation, considered inoperable. Based on the heart team's decision, TAVR was planned with the use of an Edwards SAPIEN 3 valve. After TAVR, the patient developed complete heart block and a pacemaker was implanted. He improved to NYHA II functional class. At 15-month follow-up, he suffered intracranial hemorrhage and passed away. Results and Conclusions: Management of patients with severe symptomatic AR with high surgical risk continues to be a special challenge. They have high mortality if left untreated with valvular change, despite medical treatment. Even though it is strictly off-label, TAVR might be a reasonable solution for a select type of patients who are considered inoperable due to surgical high mortality risk.
Background: Exercise cardiac stress testing in patients with significant aortic stenosis is generally avoided for safety reasons. Furthermore, the studies that actually addressed the value of exercise testing both with and without myocardial Tc99MIBI scintigraphy for the diagnosis of coronary artery disease (CAD) proved to yield low specificity. Nowadays there are no safe and accurate means for noninvasive assessment of the presence, extent and severity of CAD in patients with significant aortic stenosis. Our study aimed to assess overall safety and usefulness of dipirydamole stress myocardial perfusion scintigraphy for detection of CAD using single-photon emission computed tomography (SPECT) in patients with aortic stenosis. Methods: The study comprised 20 patients with significant aortic stenosis who were compared with 20 patients with CAD designated as CCS II and III. All patients underwent a 5-minute dipirydamole infusion (1.5 mg/kg body weight) protocol stress technetium-99m sestamibi SPECT. Visual 17-segment SPECT analysis used a standard five-point scoring system ranging from 0 (normal tracer uptake) to 4 (absent uptake). The SPECT results were considered abnormal if more than two segments had a stress score 3 2. These results were compared to the same number of patients diagnosed with CAD. All patients also underwent coronary angiography procedure. The respective results in the groups were subsequently compared using the U-Mann-Whitney test and Pearson's correlation nonparametric test. Results: Sensitivity of gated SPECT study was calculated at the level of 83% in the studied group vs. 100% in the controls, with positive predictive value at 88% vs. 90%, respectively. Hemodynamic responses during dipirydamole stress testing demonstrated no significant differences in the net change in systolic blood pressure (30% vs. 25%, patients with aortic stenosis vs. control subjects), heart rate (20% vs. 20%), dyspnea (25% vs. 30%) or incidence of chest pain (30% vs. 30%). Conclusions: Dipirydamole Tc99m MIBI SPECT study was established to be well tolerated, safe and diagnostically accurate in patients with significant aortic stenosis and suspected CAD.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.