International randomized trial on the effect of revascularization or optimal medical therapy of chronic total coronary occlusions with myocardial ischemia - ISCHEMIA-CTO trial – rationale and design

Råmunddal, Truls; Holck, Emil Nielsen; Karim, Salma Raghad; Eftekhari, Ashkan; Escaned, Javier; Ioanes, Dan; Walsh, Simon; Spratt, James C.; Veien, Karsten Tange; Jensen, Lisette Okkels; Tilsted, Hans‐Henrik; Terkelsen, Christian Juhl; Havndrup, Ole; Olsen, Niels Thue; Kajander, Olli A.; Faurie, Benjamin; Lanematt, Peep; Jakobsen, Lars; Christiansen, Evald Høj

doi:10.1016/j.ahj.2022.11.016

Cited by 13 publications

(10 citation statements)

References 23 publications

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“…However, using myocardial functional parameters as the indication to perform CTO PCI remains debated due to the limited evidence of improving hard outcomes [ 3 , 29 ] and the lack of cut-off values of ischemia and viability quantification in patients with CTO. The CARISMA_CTO study [ 30 ] and the ongoing ISCHEMIA-CTO trial [ 31 ] can provide more definitive answers in this area shortly.…”

Section: Resultsmentioning

confidence: 99%

Coronary chronic total occlusion on coronary CT angiography: what radiologists should know?

Xu,

Ma,

Chen

et al. 2024

Insights Imaging

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Coronary chronic total occlusion (CTO) often occurs in patients with obstructive coronary artery disease, which remains one of the greatest challenges for interventional cardiologists. Coronary computed tomography angiography (CCTA) with its emerging post-processing techniques can provide a detailed assessment of CTO lesions before percutaneous coronary intervention (PCI), playing an important role in the clinical management of CTO PCI, from early diagnosis, pre-procedural outcome prediction, the crossing algorithm planning, intraprocedural guidance, and finally post-procedural assessment and follow-up. In addition, the feasibility of CT perfusion (CTP) in patients with CTO has been validated. Combined CCTA and CTP have the great potential to be the one-stop-shop imaging modality for assessing both anatomy and function of CTO lesions. This review aims to make radiologists understand the role of CCTA in the diagnosis and assessment of CTO lesions, thus assisting interventionalists in optimizing CTO PCI crossing strategies with the expertise of radiologists.Critical relevance statement The anatomical features of CTO on CCTA can reveal the complexity of CTO lesions and are associated with CTO PCI outcome, thus helping interventionalists optimize CTO PCI crossing strategies.Key points • CTO is the common lesion in invasive coronary angiography, and CTO PCI is technically difficult and its success rate is relatively low.• Length, collaterals, and attenuation-related signs can help distinguish CTO from subtotal occlusion.• The anatomical features of CTO lesions can help grade the difficulty of CTO PCI and predict procedural outcomes and long-term outcomes of CTO PCI.• The real-time fusion of CCTA with fluoroscopic angiography can be applied in highly complicated CTO lesions.• After CTO PCI, CCTA can help guide a second CTO PCI re-entry or follow up stent patency. Graphical Abstract

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Section: Resultsmentioning

confidence: 99%

Coronary chronic total occlusion on coronary CT angiography: what radiologists should know?

Xu,

Ma,

Chen

et al. 2024

Insights Imaging

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“…A O-15-H 2 O positron emission tomography scan showed severe hypo-perfusion in the RCA territory. With a Seattle Angina Questionnaire Quality of Life score of 50 out of 100, she fulfilled the criteria for inclusion in the Ischemia CTO trial and she was randomized to PCI of the RCA CTO [ 6 ]. Electrocardiogram (ECG) showed sinus rhythm with a long QT interval (QTc corrected by Bazett's and Fridericia's formula of 521 ms and 495 ms, respectively) which was known for several years (Fig.…”

Section: Case Reportmentioning

confidence: 99%

A case report of ventricular fibrillation following Shockwave intravascular lithotripsy during percutaneous coronary intervention

Jakobsen,

Christiansen,

Thim

2024

BMC Cardiovasc Disord

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Background Shockwave intravascular lithotripsy (S-IVL) is widely used during percutaneous coronary intervention (PCI) of calcified coronary arteries. Ventricular capture beats during S-IVL are common but arrhythmias are rare. Case presentation A 75-year-old woman was scheduled for PCI to a short, heavily calcified chronic total occlusion of the right coronary artery. After wiring of the occlusion, S-IVL was used to predilated the calcified stenosis. During S-IVL, the patient developed ventricular fibrillation twice. Conclusion To our knowledge, this is only the second reported case of VF during S-IVL. Although very rare, it is important to be aware of this potential and serious complication.

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“…Several studies are currently being conducted on the benefits of the procedure. The ISCHEMIA-CTO trial is designed to assess, whether percutaneous revascularization improves quality of life (QoL) and MACE in CTO patients after 6 months [74]. This study may answer questions about whether recanalization of the total occluded coronary artery improves prognosis in asymptomatic patients and/or relieve symptoms in the symptomatic group.…”

Section: Indicationsmentioning

confidence: 99%

Percutaneous Coronary Intervention for Chronic Total Occlusion—Contemporary Approach and Future Directions

Dąbrowski,

Święczkowski,

Dudzik

et al. 2023

JCM

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In the aging society, the issue of coronary chronic total occlusion (CTO) has become a challenge for invasive cardiologists. Despite the lack of clear indications in European and American guidelines, the rates of percutaneous coronary interventions (PCI) for CTO increased over the last years. Well-conducted randomized clinical trials (RCT) and large observational studies brought significant and substantial progress in many CTO blind spots. However, the results regarding the rationale behind revascularization and the long-term benefit of CTO are inconclusive. Knowing the uncertainties regarding PCI CTO, our work sought to sum up and provide a comprehensive review of the latest evidence on percutaneous recanalization of coronary artery chronic total occlusion.

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International randomized trial on the effect of revascularization or optimal medical therapy of chronic total coronary occlusions with myocardial ischemia - ISCHEMIA-CTO trial – rationale and design

Cited by 13 publications

References 23 publications

Coronary chronic total occlusion on coronary CT angiography: what radiologists should know?

Coronary chronic total occlusion on coronary CT angiography: what radiologists should know?

A case report of ventricular fibrillation following Shockwave intravascular lithotripsy during percutaneous coronary intervention

Percutaneous Coronary Intervention for Chronic Total Occlusion—Contemporary Approach and Future Directions

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