41 lesions, 22 lesions were followed without treatment. Angiographic characteristics of septal channel perforation were Ellis class I (nϭ14), class II (nϭ2), and class IIICS (nϭ6). Septal channel perforation occurred in guidewire (nϭ13), balloon dilatation (nϭ8), and microcatheter (nϭ1). The angiographic follow up rate was 81.8% (class I: nϭ11, class II: nϭ2, and class IIICS: nϭ5). Persistent septal channel perforation disappeared at follow up angiography in all lesions. Conclusions: Persistent septal channel perforation into the ventricle and coronary sinus or of non-spreading myocardial blush may have a good outcome.
Background:The impact of successful chronic total occlusion (TO) recanalisation and completeness of revascularisation after PCI on long-term survival remains unsettled. Methods: Within the All-Comers SYNTAX Trial (nϭ2636), the PCI and CABG arms were stratified by the presence of TOs and complete (CR) vs. incomplete (ICR) revascularisation. Clinical outcomes (Kaplan-Meier) were analysed with log-rank and Cox regression analyses. Results: In the randomised population, recanalisation/bypass rates of 49.4% (PCI) vs. 68.1% (CABG) were reported. In the All-Comers population, 840 patients (PCI: 26.3%, CABG: 36.4%, pϽ0.001) with 1007 TOs were identified. The presence of TOs was significantly associated with less CR by PCI (CR: TO 34.3%, non TO 59.8%, pϽ0.001) and CABG (CR: TO 64.8%, non TO 69.8%, pϭ0.048). The presence of a TO was the strongest independent predictor of ICR after PCI (Hazard Ratio [95% CI]: 2.85 [2.09, 3.87], pϽ0.001). Regardless of the presence of a TO in the PCI & CABG arms, CR (compared to ICR) was associated with significant reductions in 4-year mortality, all-cause revascularisation, and MACCE. Four-year stent thrombosis rates in the PCI arm were significantly lower with CR (3.7%) vs. ICR (6.5%, pϭ0.046), an effect that was more pronounced in the TO group.Conclusions: Within the PCI and CABG arms of the All-Comers SYNTAX Trial -and specifically in all patients with TOs -whatever the acceptable threshold of revascularisation is appropriate for an individual patient, the identification of ICR (compared to CR) using the SYNTAX Trial definition identifies patients who have an adverse longer-term prognosis.Background: Interventions on chronic total occlusions (CTO) demand expert operator skills, longer procedural time and are more frequently associated with complications. Current guidelines for percutaneous coronary interventions (PCI) for CTO are based on small retrospective studies and expert consensus. Consequently, there is a necessity to strengthen such a recommendation with more evidence. The aim of this study was to report and describe prevalence, demographics, clinical characteristics, treatment decisions and trends in reporting on CTO at the level of one whole nation using data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Methods: SCAAR contains data on all consecutive patients who undergoes coronary angiography or PCI in Sweden since 1989. Diagnosis of C...