Initial Success Rate of Percutaneous Coronary Intervention for Chronic Total Occlusion in a Native Coronary Artery Is Decreased in Patients Who Underwent Previous Coronary Artery Bypass Graft Surgery

Teramoto, Tamio; Tsuchikane, Etsuo; Matsuo, Hitoshi; Suzuki, Yoriyasu; Ito, Tetsuhide; Itô, Tatsuya; Habara, Maoto; Nasu, Kenya; Kimura, Masashi; Kinoshita, Yoshihisa; Terashima, Mitsuyasu; Asakura, Yasushi; Matsubara, Takehiro; Suzuki, Takahiko

doi:10.1016/j.jcin.2013.08.012

Cited by 80 publications

(53 citation statements)

References 15 publications

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“…We also found that selected SVGs, either patent or occluded, can become very effective conduits for retrograde CTO PCI, and their use is associated with a very high final technical success and low complication. When we compared our single center CTO program data to those from Europe, Japan, and the USA [10][11][12]19,20 (Table 8), we found that our study population had one of the highest number of post-CABG CTO cases, comparable only to 1 American multicenter study of 2013 by Michael et al 20 We used a retrograde approach in post-CABG patients more frequently than anyone else. In the same post-CABG cohort, we performed retrograde CTO PCI via SVG more often than others.…”

Section: Discussionmentioning

confidence: 76%

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Recanalization of Chronic Total Occlusions in Patients With Previous Coronary Bypass Surgery and Consideration of Retrograde Access via Saphenous Vein Grafts

Dautov

Nguyen

Altisent

et al. 2016

Circ: Cardiovascular Interventions

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Background-The prevalence of native coronary chronic total occlusions (CTOs) after coronary artery bypass grafts (CABGs) is higher than in non-CABG population. We examined outcomes of CTO percutaneous coronary intervention (PCI) post-CABG versus without CABG. Then, we looked at feasibility and outcomes of retrograde CTO PCI via patent or occluded saphenous vein graft. Methods and Results-We compared patient and procedural characteristics of 470 CTO cases treated from January 2010 to December 2015 depending on history of CABG. We assessed major adverse cardiac events, including cardiac death, myocardial infarction, ischemia-driven target-vessel revascularization, or reocclusion 1 year after successful CTO PCI in patients treated before February 2015. Post-CABG patients (175 cases) had a higher J-CTO score (2.5 versus 2.1; P=0.002). In-hospital complications were similar, although the incidence of contrast-induced nephropathy was higher in post-CABG patients (4.6% versus 1%; P=0.01). With multivariable analysis, post-CABG status was associated with higher incidence of 1-year major adverse cardiac event (hazards ratio=2.2; P=0.02). As a second level analysis, we looked at the feasibility and safety of CTO PCI via saphenous vein grafts (19% of post-CABG cases) versus collateral channels (36%) versus with an antegrade-only approach (45%), and assessed short-term outcomes and complications. High success was achieved in the saphenous vein graft group. In-hospital events were similar in the 3 groups. Conclusions-Post-CABG CTO PCI is associated with similar high success and low complications compared with CTO PCI in patients who never had CABG. However, it is associated with higher recurrent events at 1 year. To achieve high success rate, use of saphenous vein grafts as retrograde conduits seems to be safe and effective. (Circ Cardiovasc Interv. 2016;9:e003515.

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Section: Discussionmentioning

confidence: 76%

“…Histologically, native coronary CTO lesions of patients post-CABG are more extensively calcified 9 and therefore offer additional challenges that may also affect long-term outcomes. Only few studies have evaluated outcomes following CTO PCI in post-CABG patients, [10][11][12] and none reported longer-term outcomes.…”

mentioning

confidence: 99%

Recanalization of Chronic Total Occlusions in Patients With Previous Coronary Bypass Surgery and Consideration of Retrograde Access via Saphenous Vein Grafts

Dautov

Nguyen

Altisent

et al. 2016

Circ: Cardiovascular Interventions

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“…Prior CABG has been associated with higher procedural complexity and lower success rates, 20 although more recently we have demonstrated that similarly high success rates can be achieved among patients with and without prior CABG. 21 Achieving similarly high success rates among older lesions may in part be explained by use of the hybrid approach, which advocates early change of crossing strategy in case the initially selected approach does not provide prompt results.…”

Section: Discussionmentioning

confidence: 80%

Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary US Multicenter Registry

Danek

Karatasakis

Karmpaliotis

et al. 2016

Canadian Journal of Cardiology

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Background We sought to determine the impact of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012–2016 at 11 experienced US centers. Results Mean patient age was 66 ± 10 years and 85.6% of patients were men. Overall technical and procedural success were 90.1% and 87.5%, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ± 62 months and 12 months [interquartile range 3–64 months], respectively. Patients were stratified into tertiles by lesion age (3–5, 5–36.3, and >36.3 months). Older lesion age was associated with older patient age (68±8 vs. 65±10 vs. 64±11 years, p=0.009), prior coronary artery bypass grafting (62% vs. 42% vs. 30%, p<0.001) and moderate/severe calcification (75% vs. 53% vs. 59%, p=0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8% vs. 89.6% vs. 93.0%, p=0.37) or procedural (86.3% vs. 87.4% vs 89.0%, p=0.80) success, or the incidence of MACE (3.1% vs. 3.0% vs. 6.3%, p=0.31) for older vs. younger occlusions. Conclusions Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/reentry. Older CTOs can be recanalized with high technical and procedural success rates and acceptable MACE. Lesion age appears unlikely to be a significant determinant of CTO PCI success.

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“…If disease progression is not observed in the native coronary artery, then PCI for the native coronary vessel can be performed with equivalent risk and difficulty as observed preoperatively. On the contrary, if the proximal lesion in the native coronary artery progresses from ≤99 % stenosis to occlusion, then the difficulty and risk associated with PCI increase [3,4], and longer stents are usually required.…”

Section: Introductionmentioning

confidence: 99%

Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting

et al. 2015

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Coronary artery bypass grafting (CABG) is an established treatment for multivessel coronary artery disease. However, problematic situations are occasionally encountered after CABG, such as disease progression in the native coronary artery with graft occlusion, which causes difficulty in revascularization. The purpose of this study was to evaluate changes in the native coronary artery after CABG. Between 2009 and 2012 in our institution, 351 patients underwent CABG, and 768 bypass grafts were anastomosed to non-occluded coronary arteries. Of these, 489 bypass grafts had available early postoperative angiographic results (≤6 months) suitable for assessment in this study. We defined malignant graft failure after CABG to be bypass graft occlusion and de novo complete occlusion of the target native coronary artery proximal to the graft anastomosis site. In the early angiographic results, 17 grafts were occluded (17/489; 3.5 %). Two of the grafts displayed malignant graft failure (a saphenous vein graft to the right coronary artery and a saphenous vein graft to the diagonal branch) (2 of 17 occluded grafts, and 2 of 489 studied grafts). Of the patent bypass grafts, 24 involved progression to occlusion in the proximal native coronary artery (19 saphenous vein grafts, 4 left internal thoracic artery grafts, and 1 right internal thoracic artery graft). Malignant graft failure was uncommon during short-term follow-up after CABG. At the same time, disease progression in the proximal native coronary artery from stenosis to occlusion following patent bypass grafting was relatively common, especially for vein grafts.

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Initial Success Rate of Percutaneous Coronary Intervention for Chronic Total Occlusion in a Native Coronary Artery Is Decreased in Patients Who Underwent Previous Coronary Artery Bypass Graft Surgery

Cited by 80 publications

References 15 publications

Recanalization of Chronic Total Occlusions in Patients With Previous Coronary Bypass Surgery and Consideration of Retrograde Access via Saphenous Vein Grafts

Recanalization of Chronic Total Occlusions in Patients With Previous Coronary Bypass Surgery and Consideration of Retrograde Access via Saphenous Vein Grafts

Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary US Multicenter Registry

Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting

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