Applied Pathology for Interventions of Coronary Chronic Total Occlusion

Tran, Phillip; Phan, Hung; Shah, Sara R.; Latif, Faisal; Nguyen, Thach

doi:10.2174/1573403x11666150909110915

Cited by 6 publications

(16 citation statements)

References 9 publications

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“…In a multicenter CTO PCI registry, overall technical success was 86%, and the retrograde approach was used in 34.9% of the successful cases 5 . The higher success rate with the retrograde approach is likely related to the histopathological features of the distal CTO cap which is more likely to be tapered and less fibro‐calcific and therefore less resistant to guidewire advancement 36,37 …”

Section: Discussionmentioning

confidence: 99%

Outcomes with retrograde versus antegrade chronic total occlusion revascularization

Megaly

Ali

Saad

et al. 2019

Cathet Cardio Intervent

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Objectives The aim of the study was to evaluate the outcomes of retrograde versus antegrade approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background The retrograde approach has increased the success rate of CTO PCI but has been associated with a higher risk for complications. Methods We conducted a meta‐analysis of studies published between 2000 and August 2019 comparing the in‐hospital and long‐term outcomes with retrograde versus antegrade CTO PCI. Results Twelve observational studies (10,240 patients) met our inclusion criteria (retrograde approach 2,789 patients, antegrade approach 7,451 patients). Lesions treated with the retrograde approach had higher J‐CTO score (2.8 vs. 1.9, p < .001). Retrograde CTO PCI was associated with a lower success rate (80.9% vs. 87.4%, p < .001). Both approaches had similar in‐hospital mortality, urgent revascularization, and cerebrovascular events. Retrograde CTO PCI was associated with higher risk of in‐hospital myocardial infarction (MI; odds ratio [OR] 2.37, 95% confidence intervals [CI] 1.7, 3.32, p < .001), urgent pericardiocentesis (OR 2.53, 95% CI 1.41–4.51, p = .002), and contrast‐induced nephropathy (OR 2.12, 95% CI 1.47–3.08; p < .001). During a mean follow‐up of 48 ± 31 months retrograde crossing had similar mortality (OR 1.79, 95% CI 0.84–3.81, p = .13), but a higher incidence of MI (OR 2.07, 95% CI 1.1–3.88, p = .02), target vessel revascularization (OR 1.92, 95% CI 1.49–2.46, p < .001), and target lesion revascularization (OR 2.08, 95% CI 1.33–3.28, p = .001). Conclusions Compared with antegrade CTO PCI, retrograde CTO PCI is performed in more complex lesions and is associated with a higher risk for acute and long‐term adverse events.

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Section: Discussionmentioning

confidence: 99%

Outcomes with retrograde versus antegrade chronic total occlusion revascularization

Megaly

Ali

Saad

et al. 2019

Cathet Cardio Intervent

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“…Before formulating a strategy, the interventionist needs to perform a detailed review of the coronary angiography and scrutinize various regions of the artery carrying the CTO lesion (Table 3). In each segment of the CTO lesion, its complexity and severity depends on the pathological composition, the degree of calcification, tortuosity, length or thickness of the segments and at the end, the presence and sizes of the microchannels 10 Table 3Areas of Focus in a Chronic Total Occlusion Lesion.1.…”

Section: Pathophysiology Overviewmentioning

confidence: 99%

“…Angiographically proximal cap with tapering stump is the starting place to probe the occlusion with a wire. In contrast, if the proximal cap has a blunt (non-tapered) occlusion, it is necessary to look in multiple projections for the ‘dimple sign’ that is the hallmark for entry point 9, 10, 13. Dimples are lumina inside CTO or potential recanalization channels which may not necessarily be present in all blunt proximal cap.…”

Section: Proximal Cap Pathologymentioning

confidence: 99%

“…However, there is a higher probability of subintimal wire navigation with eccentrically oriented stump. The probability of wire crossing decreases in presence extensive bridging CCs (caput medusae) 10 . The presence of a SB arising at the proximal cap will often repeatedly deflect the wire into it.…”

Section: Proximal Cap Pathologymentioning

confidence: 99%

“…The presence of a SB arising at the proximal cap will often repeatedly deflect the wire into it. However, due to high shear stress, a plaque is believed to be build up on the opposite side of the origin of a SB and this may point to the path of the main vessel course 10, 13. In several cases when the guide disengages with a wire tip pin-pointed to the center of the occlusion, inflation of over-the-wire [OTW] balloonas coaxial anchor maybe recommended to increase wire support.…”

Section: Proximal Cap Pathologymentioning

confidence: 99%

See 2 more Smart Citations

Coronary chronic total occlusion intervention: A pathophysiological perspective

Dash

2018

Indian Heart Journal

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Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is the last frontier in coronary intervention. PCI of CTO carries multiple advantages, such as significant improvement in symptoms, improvement in abnormal wall motion and left ventricular function and, possibly, increased long-term survival. As of today the procedural success is markedly improved because of technical innovations and is limited to highly experienced operators. To enhance the overall success rate from a worldwide perspective, a thorough understanding of its pathophysiology is critical to further development of newer techniques and technologies. In this review, the author outlines in-depth the evidence that underpins our understanding of CTO pathophysiology and its insight into CTO intervention that incorporates various steps and techniques to cross the lesion.

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Lesion characteristics and procedural complications of chronic total occlusion percutaneous coronary intervention in patients with prior bypass surgery: A meta‐analysis

Shi

Luo

et al. 2022

Clinical Cardiology

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Coronary artery bypass graft (CABG) accelerates the prevalence of native coronary chronic total occlusion (CTO), and this kind of CTO shows extensive challenging and complex atherosclerotic pathology. As a result, the procedural success rate of percutaneous coronary intervention (PCI) is inferior to another kind of lesions. The present meta-analysis aims to compare the lesion characteristics and procedural complications of CTO-PCI in patients with or without prior CABG. A total of 8 studies, comprising of 13439 patients, published from inception to August 2021 were included in this meta-analysis. Results were pooled using random effects model and are presented as odds ratio (OR) with 95% confidence intervals (95% CIs). From the 13439 patients enrolled, 3349 (24.9%) patients had previous CABG and 10090 (75.1%) formed the control group in our analysis. For the clinical characteristic, compared to the non-CABG patients, prior CABG patients were older (OR, 3.98; 95% CI,

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Applied Pathology for Interventions of Coronary Chronic Total Occlusion

Cited by 6 publications

References 9 publications

Outcomes with retrograde versus antegrade chronic total occlusion revascularization

Outcomes with retrograde versus antegrade chronic total occlusion revascularization

Coronary chronic total occlusion intervention: A pathophysiological perspective

Lesion characteristics and procedural complications of chronic total occlusion percutaneous coronary intervention in patients with prior bypass surgery: A meta‐analysis

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