Long-Term Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients Who Have Undergone Coronary Artery Bypass Grafting vs Those Who Have Not

Azzalini, Lorenzo; Ojeda, Soledad; Karatasakis, Aris; Maeremans, Joren; Takao, Masaki; Manna, Alessio La; Dautov, Rustem; Ybarra, Luiz F.; Benincasa, Susanna; Bellini, Barbara; Demir, Ozan M.; Hidalgo, Francisco; Karácsonyi, Judit; Gravina, Giacomo; Miccichè, Eligio; D’Agosta, Guido; Venuti, Giuseppe; Tamburino, Corrado; Pan, Manuel; Carlino, Mauro; Dens, Joseph; Brilakis, Emmanouil S.; Colombo, Antonio; Rinfret, Stéphane

doi:10.1016/j.cjca.2017.12.016

Cited by 46 publications

(61 citation statements)

References 22 publications

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“…[ 3 ] Therefore, we decided to treat native RCA CTO. However, CTO PCI in post-CABG patients is challenging [ 4 ] as post-CABG status is associated with accelerated atherosclerosis progression including multivessel CTOs, [ 5 ] higher degree of calcification, and negative remodeling. [ 6 ] Therefore, the procedure success was lower in CTO PCI in post-CABG patients compared with non-CABG patients.…”

Section: Discussionmentioning

confidence: 99%

“…[ 6 ] Therefore, the procedure success was lower in CTO PCI in post-CABG patients compared with non-CABG patients. [ 3 , 4 ] As the majority of distal segments of CTO exhibited a tapered pattern, it is easier to place wire in the true lumen by retrograde approach compared with antegrade approach. [ 6 ] Also, several studies have demonstrated higher use of retrograde approach in CTO PCI in post-CABG patients compared with CTO patients without prior CABG.…”

Section: Discussionmentioning

confidence: 99%

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Retrograde recanalization of native right coronary artery chronic total occlusion (CTO) through left coronary artery CTO after bypass graft failure

Qin

Ma²,

Ge³

2020

Medicine

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Rationale: With the development and standardization of modern chronic total occlusions (CTOs) recanalization technique, percutaneous coronary intervention has become a promising treatment alternative to surgery after bypass graft failure. Treatment of a native coronary CTO lesion is preferable to treatment of a saphenous vein graft (SVG) CTO supplying the same territory; however, technical expertise is required. Patient concerns: This is a 69-year-old male with prior history of coronary artery bypass grafting presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration. Diagnosis: The patient was diagnosed as heart failure caused by ischemia after SVG failure (SVG to right coronary artery) according to electrocardiogram, plasma N-terminal pro-B-type natriuretic peptide levels, and coronary angiogram. Interventions: We recanalized native right coronary artery CTO by retrograde approach using septal collaterals by surfing technique after recanalization of totally occluded left coronary artery. Outcomes: Dyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea. Lessons: In case of SVG failure, percutaneous coronary intervention of native vessel should be considered as a treatment option. Retrograde approach through native vessel is safe but has requirements for operators’ volume, skill, and experience.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Retrograde recanalization of native right coronary artery chronic total occlusion (CTO) through left coronary artery CTO after bypass graft failure

Qin

Ma²,

Ge³

2020

Medicine

View full text Add to dashboard Cite

show abstract

“…However, CTOs in post-CABG exhibit extensive calcification and negative remodeling, compared with CTOs in non-CABG (52), thus PCI for such lesions is more challenging. Consequently, CTO PCI in post-CABG patients is associated with lower success rates and worse clinical outcomes at follow-up (median: 377 days), compared to those in non-CABG patients (53).…”

Section: When Would Pci Be Required After Cabg?mentioning

confidence: 99%

What the surgeon needs to know about percutaneous coronary intervention treatment of chronic total occlusions

Mitomo

Demir

Colombo

et al. 2018

Ann. Cardiothorac. Surg.

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Chronic total occlusion (CTO) accounts for 10-20% of lesions identified in coronary artery disease (CAD) patients. CTO percutaneous coronary intervention (PCI) is one of the most challenging of lesion subsets due to its technical difficulty, requiring specific operator expertise and equipment. There has been increased interest on CTO PCI evolving with the development of novel techniques and dedicated devices. Furthermore, in order to effectively and systematically utilize these techniques and devices, CTO PCI algorithms have been established. All of these developments have resulted in procedural success rates increasing to approximately 90%. In this review, we outline the evidence base for CTO PCI, conventional and contemporary CTO PCI techniques, CTO algorithms and outline integrated management strategies between cardiac surgeons and interventional cardiologists.

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“…However, repeat revascularization procedures are markedly different from de novo interventions performed on patients without prior CABG [3]. As a consequence of the specificity of vessel lesions and clinical characteristics in patients with prior CABG [4], previous surgery may increase procedural risk, technical complexity [5], and mortality [6, 7], especially for redo CABG. MT consists of antiplatelet agent, statins agent, β -blocker, and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), considered as optimal medical therapy (OMT) [8].…”

Section: Introductionmentioning

confidence: 99%

Coronary Angiography Characteristics of Symptomatic Patients with Prior Coronary Artery Bypass Graft: A Descriptive Study

Chen

Zhao

et al. 2019

BioMed Research International

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Objectives The target of this study was to explore the coronary angiography characteristics for symptomatic patients with prior coronary artery bypass graft (CABG). Methods Between 2009 and 2017, 993 patients who had undergone CABG but subsequently suffered recurrent symptoms in Beijing Anzhen Hospital were selected for this study and divided into either medical therapy (MT) group (n = 351) or percutaneous coronary intervention (PCI) group (n = 642) based on the treatment. Clinical data were analyzed between two groups. Results Patients in the MT group were older and more likely to have chronic lung disease (6.6% vs 3.4%, P=0.026) while patients in the PCI group were more likely to have prior MI (8.8% vs 17.0%, P < 0.001). In the MT group, 54.4% of patients had newly developed lesions both in the graft and native coronary artery while 58.1% in the PCI group (P=0.003), and in the MT group, 80.6% had type C coronary artery disease while 60.1% in the PCI group (P < 0.001). Patients in the MT group presented higher proportion of diffuse lesions (49.3% vs 15.0%, P < 0.001) in native coronary arteries. Conclusion Patients receiving MT (35.3%) likely had occluded grafts and type C coronary artery disease featuring as diffuse lesions.

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Long-Term Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients Who Have Undergone Coronary Artery Bypass Grafting vs Those Who Have Not

Cited by 46 publications

References 22 publications

Retrograde recanalization of native right coronary artery chronic total occlusion (CTO) through left coronary artery CTO after bypass graft failure

Retrograde recanalization of native right coronary artery chronic total occlusion (CTO) through left coronary artery CTO after bypass graft failure

What the surgeon needs to know about percutaneous coronary intervention treatment of chronic total occlusions

Coronary Angiography Characteristics of Symptomatic Patients with Prior Coronary Artery Bypass Graft: A Descriptive Study

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