Long-term results of successful and failed angioplasty for chronic total coronary arterial occlusion

Finci, Léo; Meier, Bernhard; Favre, J. P.; Righetti, A; Rutishauser, W.

doi:10.1016/0002-9149(90)91125-p

Cited by 97 publications

(34 citation statements)

References 6 publications

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“…Typically, the success rates in most reports were less than favourable, the most common reason for failure being the inability to pass a guidewire through the occlusion into the distal true lumen [1,2] . As several reports have demonstrated the clinical relevance of successful recanalization of occluded coronary arteries [3][4][5][6][7][8] , further exploration and improvement of percutaneous techniques seemed justifiable. As a result, a laser wire (laser guidewire), the Spectranetics Prima Coronary Total Occlusion System Model 018-003 (Spectranetics, Colorado Springs, CO, U.S.A.) was developed.…”

Section: Introductionmentioning

confidence: 99%

Total occlusion trial with angioplasty by using laser guidewire. The TOTAL trial

et al. 2000

European Heart Journal

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Aims A randomized trial was performed to assess the safety and efficacy of a laser guidewire, in the treatment of chronic coronary occlusions. Methods and ResultsIn 18 European centres, 303 patients with a chronic coronary occlusion were randomized to treatment with either the laser guidewire (n=144) or conventional guidewires (mechanical guidewire, n=159). The primary end-point of the study was treatment success, defined as reaching the true lumen distal to the occlusion by the allocated wire within 30 min of fluoroscopic time: laser guidewire vs mechanical guidewire; 52·8% (n=76) vs 47·2% (n=75), P=0·33. Serious adverse events following the initial guidewire attempt were 0% (laser guidewire) and 0·6% (mechanical guidewire), respectively. Angioplasty (performed following successful guidewire crossing) was successful in 179 patients (91%, laser guidewire n=79, mechanical guidewire n=100), followed by stent implantation in 149 (79%). At the 6-month angiographic followup, the difference in binary restenosis rate (laser guidewire vs mechanical guidewire; 45·5% vs 38·3 %, P=0·72) or reocclusion rate (25·8% vs 16·1%, P=0·15) did not reach statistical significance. At 1, 6 and 12 months, angina and event-free survival were 69%, 35% and 24% (laser guidewire) vs 74%, 40% and 31% (mechanical guidewire). ConclusionAlthough laser guidewire technology was safe, the increase in crossing success did not reach statistical significance.

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Section: Introductionmentioning

confidence: 99%

Total occlusion trial with angioplasty by using laser guidewire. The TOTAL trial

et al. 2000

European Heart Journal

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“…In a meta-analysis of six observational studies [27][28][29][30][31][32] that evaluated angina post-CTO PCI, patients undergoing successful PCI experienced a significant reduction in recurrent angina during a six-year follow-up compared with patients undergoing unsuccessful PCI (odds ratio, 0.45; 95 % confidence interval, 0.30 to 0.67). 33 …”

Section: Anginamentioning

confidence: 99%

Percutaneous Treatment of Coronary Chronic Total Occlusions Part 1: Rationale and Outcomes

Galassi

Grantham

Kandzari

et al. 2014

Interventional Cardiology Review

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A chronic total occlusion (CTO) is defined as a completely occluded coronary artery with no antegrade flow (thrombolysis in myocardial infarction [TIMI] 0 flow) for at least three months.1 CTOs are present in 15-30 % of patients undergoing coronary angiography.2-5 In a Canadian prospective registry of 14,439 patients undergoing coronary angiography a CTO was present in 18.4 % of all patients with significant coronary artery disease (CAD).2 Approximately 1/3-1/2 6,7 of patients undergoing CTO percutaneous coronary intervention (PCI) have had a prior acute myocardial infarction (MI). This suggests acute onset of the occlusion, whereas in the remaining patients gradual development of CTO from high-grade lesions likely occurred.The basic histopathologic feature of a CTO is a proximal cap of the occlusion. This is often fibrotic or calcified and may provide considerable resistance to wire advancement during CTO PCI. Distal to the proximal cap and along the occlusion length follows a segment of loose fibrous tissue or organised thrombus, with various extent of calcification. 8,9 In several of these lesions, residual channels may be observed that are not visible under angiography. In addition, microchannels may appear during the CTO's consolidation process, however these are mostly located in the adventitia with extremely tortuous courses and do not generally traverse the entire occluded segment.10 A recent autopsy study of 95 CTO lesions from 82 patients reported frequent negative remodelling of the CTO body (more frequent with longer duration of the occlusion), very rare presence of microchannels and more frequent tapering of the distal cap as compared with the proximal cap (79 % vs. 50 %, P<0.0001). Successful CTO percutaneous coronary intervention (PCI) can significantly improve angina and improve left ventricular function. Although currently unproven, successful CTO PCI might also reduce the risk for arrhythmic events in patients with ischaemic cardiomyopathy, provide better tolerance of future acute coronary syndrome, and possibly improve survival. Evaluation by a heart team comprised of both interventional and non-interventional cardiologists and cardiac surgeons is important for determining the optimal revascularisation strategy in patients with coronary artery disease and CTOs. Ad hoc CTO PCI is generally not recommended, so as to allow sufficient time for (a) discussion with the patient about the indications, goals, risks, and alternatives to PCI; (b) careful procedural planning; and (c) contrast and radiation exposure minimisation. Use of drug-eluting stents is recommended for CTO PCI, given the lower rates of angiographic restenosis compared to bare metal stents.

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“…High procedural success rates in conjunction with low complication rates improve risk/benefit ratio and are paramount for the acceptance and dissemination of CTO PCI. Successful CTO recanalization has the ability to relieve angina [71], reduce ischemia [41] and the need for CABG [72], improve exercise tolerance [73], electrical stability [74], left ventricular function [44], and tolerance of future ACS [13,75], and possibly survival [76,77] with a similar risk compared to regular PCI of non-CTO lesions [3]. Table 1 summarizes the rationale for CTO PCI.…”

Section: Indications For Cto Pcimentioning

confidence: 99%

Chronic Total Occlusions

2008

The American Journal of Cardiology

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The following chapter provides a brief overview on the prevalence, clinical features, and histological findings in chronically occluded coronary arteries. The role of coronary collaterals and myocardial viability as well as left ventricular function for the evaluation of treatment strategies of chronic total occlusions (CTO) will be discussed. Imaging modalities such as computed tomography and intracoronary imaging are discussed for their significance in CTO assessment and intervention. Finally, important clinical and procedural aspects, latest interventional strategies and techniques, the armamentarium of dedicated tools for CTO interventions, as well as evidence from published trials and clinical research in the field will be presented.

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Long-term results of successful and failed angioplasty for chronic total coronary arterial occlusion

Cited by 97 publications

References 6 publications

Total occlusion trial with angioplasty by using laser guidewire. The TOTAL trial

Total occlusion trial with angioplasty by using laser guidewire. The TOTAL trial

Percutaneous Treatment of Coronary Chronic Total Occlusions Part 1: Rationale and Outcomes

Chronic Total Occlusions

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