Predicting endovascular intervention outcomes in patients with chronic total occlusion of coronary artery. Can we forecast the result?

Khelimskii, Dmitrii; Крестьянинов, О. В.; Шермук, А. А.; Ибрагимов, Р. У.; Марченко, А. В.; Редькин, Д. А.; Гранкин, Д. С.; Прохорихин, А. А.; Кретов, Е. И.

doi:10.21688/1681-3472-2017-1-91-97

Cited by 3 publications

(2 citation statements)

References 24 publications

(33 reference statements)

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“…Along with the increasing number of successful endovascular procedures for coronary atherosclerosis, the success rate of chronic occlusion recanalizations is still less than one-third and is associated with a high risk of intraoperative complications [3,4]. This is due to the insufficient or inadequate (about 74%) diagnostic visualization of the occluded and the downstream segments of the artery when the invasive selective coronary angiography (SCG) is used [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Among these drawbacks, the sub-optimal quality of visualization in respect to the shape of the vessel stump, the extent of the occlusion, and the calcification volume of the occluded segment; poor or insufficient visualization of the distal parts of the native coronary artery and the status of collateral networks [9,10]. At the same time, when combined, the above criteria help predict the success of endovascular correction of coronary artery occlusions [4,10].…”

Section: Introductionmentioning

confidence: 99%

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MSCT Coronary Angiography in Diagnosis of Chronic Coronary Occlusions

Shumakov¹,

Sukhova²

2018

Sovrem Tehnol Med

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The aim of the study was to evaluate the use of MSCT coronary angiography in the diagnosis of coronary artery occlusions. Materials and Methods. Fifty-six patients (mean age 51.7±3.0 years) were examined for coronary artery occlusions by selective coronary angiography (SCG) and MSCT coronary angiography. We followed the recommendations of the multicenter J-CTO trial (Multicenter CTO Registry, Japan) based on the SCG data, as well as their proposed scale for predicting the outcome of endovascular recanalization. The latter scale was modified in line with our own results of MSCT coronary angiography as an independent method of visualization.Results. The tomographic approach tested in this study was superior over the traditional invasive SCG in respect to the assessment of calcification, the length and the profile of the occlusion. The SCG was more advantageous in determining the shape and the size of the occluded artery stump and assessing the presence of a collateral network.When combined, the predictive power of these two methods provides an additional 10% of successful recanalization. MSCT coronary angiography can be an independent non-invasive method for diagnosing occlusive coronary disease and should be incorporated in the algorithm of patient examination prior to endovascular recanalization.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

MSCT Coronary Angiography in Diagnosis of Chronic Coronary Occlusions

Shumakov¹,

Sukhova²

2018

Sovrem Tehnol Med

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Predictive Score for Choosing Strategy for Chronically Occluded Coronary Artery Recanalization

Khelimskii

Крестьянинов

Бадоян

et al. 2018

Kompleks. probl. serdečno-sosud. zabol.

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Background. Despite signifcant progress in the feld of coronary interventions, chronic total occlusion (CTO) represents a signifcant challenge for interventional cardiologists.Aim. To develop the score, able to predict technical success of CTO PCI and facilitate the choice of recanalization strategy.Methods. A total of 665 CTO patients who underwent 681 PCI in the period from 2014 to 2018 in Meshalkin National Medical Research Center were included in this study. Clinical and angiographic characteristics were analyzed. 477 CTO PCI were randomly assigned to the derivation set, 204 CTO PCI – validation set. The prognostic model was developed by assigning a score for each independent predictor of procedural failure in accordance with beta coeffcients and summing up all scores.Results. Procedural success was 76.7%. Five predictors of procedural success were included into the fnal multivariable model: bending (1 score), calcifcation (1 score), ambiguous stump (1 score), “donor” artery disease (1 score), non-RCA CTO (0.5 scores). Based on these predictors, 4 categories of CTO complexity were highlighted: 0–1 scores (easy), 1–2 scores (intermediate), 2–3 scores (diffcult), > 3 scores (very diffcult). The score demonstrated a good discriminatory ability (AUC 0.709, 95% CI 0.658–0.760). According to the novel score retrograde approach may have an advantage in patients with a > 3 scores, which corresponds to the "very diffcult" class of complexity.Conclusion. The novel score can be used in clinical practice for predicting the success of CTO PCI and determining initial crossing strategy.

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Recanalization of Chronic Total Occlusions Using Modern Endovascular Techniques

et al. 2019

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Purpose:to assess results of percutaneous coronary intervention (PCI) with contemporary endovascular techniques of recanalization of chronic total coronary artery occlusions (CTO) in patients with ischemic heart disease (IHD). Occlusion (CTO) he procedural and in-hospital outcomes of consecutive patients undergoing chronic total occlusion percutaneous coronary intervention.Materials and methods.We retrospectively analyzed data from 456 consecutive patients (mean age 59.9±7.1 years, 18.2 % women) who underwent CTO PCI procedures (n=477) during 2014–2016 in the E. N. Meshalkin National Medical Research Center. CTO was localized in the right (61.2 %), left anterior descending (23.2 %) and left circumflex (15.3 %) coronary arteries. In one patient CTO was located in the left main coronary artery. According to the J-CTO score, 30 % of lesions were classified as easy, 36.4 % intermediate, 23.7 % difficult, and 18.9 % very difficult.Results.Technical and procedural successes were achieved in 374 (78.4 %) and 366 patients (76.7 %), respectively. Antegrade approach was used in 378 (79.2 %), retrograde approach – in 99 (20.7 %) cases. Retrograde approach as primary strategy was used in 27 cases (5.7 %). Most frequent access for CTO PCI was radial artery, contralateral injection was used in 151 cases (31.6 %). Total number of stents per lesion was 1.6±0.98. The mean fluoroscopy time was 36.2±31 min.Conclusions.The rate of procedural adverse events in our study was low and similar to the non-CTO PCI series. However, despite the large number of CTO PCIs, the procedural success rate was still lower than in centers with dedicated programs for the management of such patients. Thus, further work is required to overcome this difference. Possible solution of this problem might be development and introduction in clinical practice of an algorithm for CTO recanalization.

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Predicting endovascular intervention outcomes in patients with chronic total occlusion of coronary artery. Can we forecast the result?

Cited by 3 publications

References 24 publications

MSCT Coronary Angiography in Diagnosis of Chronic Coronary Occlusions

MSCT Coronary Angiography in Diagnosis of Chronic Coronary Occlusions

Predictive Score for Choosing Strategy for Chronically Occluded Coronary Artery Recanalization

Recanalization of Chronic Total Occlusions Using Modern Endovascular Techniques

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