Objectives
Although successful recanalization of coronary chronic total occlusion (CTO) can induce subsequent positive vascular remodeling in the distal segment, the predictors are not fully understood. The aim of this study was to investigate the extent and predictors related to luminal gain after successful CTO recanalization.
Methods
A total of 134 patients who underwent intravascular ultrasound (IVUS)‐guided percutaneous coronary intervention (PCI) for CTO and follow‐up angiography were included. Angiographic parameters were assessed qualitatively and quantitatively at baseline and follow‐up. Gray‐scale IVUS images during the PCI procedure were also analyzed. Lumen diameter (LD) at distal reference on the post‐PCI angiogram was compared with corresponding LD at follow‐up coronary angiography.
Results
At the mean follow‐up of 10.0 ± 2.7 months, LD at distal reference was significantly increased by 15.9% from baseline to follow‐up (2.06 ± 0.62 vs. 2.30 ± 0.55 mm, p < 0.001). Univariable analysis indicated that the left anterior descending artery (LAD), no moderate or severe calcification, presence of peri‐medial high‐echoic band on IVUS, and impairment of final coronary flow and small distal reference diameter at baseline were associated with greater late lumen enlargement. Multivariable analysis showed the LAD, no moderate or severe calcification, and small LD at distal reference as independent predictors of greater late lumen enlargement.
Conclusion
The segment distal to recanalized CTO showed significant late lumen enlargement, especially in the cases with small distal reference, in the LAD, and without moderate or severe calcification.
This case report demonstrated the usefulness of scoring balloon when luminal narrowing occurred after balloon angioplasty in the left circumflex artery due to coronary intramural hematoma. Although a stent was placed, coronary flow was not improved. We intended to make a fenestra between the true lumen and the hematoma using a scoring balloon (Scoreflex® 2.0 × 10 mm, OrbusNeich, Tokyo, Japan) which was dilated in the distal segment of the branch. Angiograms showed restoration of TIMI-3 flow with a long dissection spanning from distal of the stent to the scored area. After 3 months and 1 year, follow-up coronary angiograms demonstrated occluded false lumen and good coronary flow in the treated vessel.
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