Stent or angioplasty after recanalization of chronic coronary occlusions? (the SARECCO trial)

Sievert, Horst; Rohde, Stefan; Utech, A; Schulze, R; Scherer, D; Merle, H; Ensslen, R; Schräder, Rainer; Spies, Hans; Fach, Andreas

doi:10.1016/s0002-9149(99)00320-3

Cited by 43 publications

(15 citation statements)

References 21 publications

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“…These included 23 studies comparing stenting with PTCA in patients with non-specific CAD, 11 comparing stents with PTCA following AMI, 59-69 eight 70-77 including patients with small coronary arteries and eight including patients whose vessels had chronic total occlusion (CTO). [78][79][80][81][82][83][84][85] Thirty-nine studies were assessed from reports published in peer-reviewed journals. The remainder were abstracts of conference proceedings.…”

Section: Ptca: Included Studies Introductionmentioning

confidence: 99%

Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

144

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Section: Ptca: Included Studies Introductionmentioning

confidence: 99%

Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

144

View full text Add to dashboard Cite

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“…The results have improved because of recent advances in technology and increased operator experience. [1][2][3][4][5][6][7] Recent studies show that successful PCI of a CTO is associated with improved survival; 8,9 however, the total fluoroscopic time (TFT) tends to be long in this procedure compared with PCI for non-CTO. 10 The patient's entrance skin doses (ESD) are higher 10,11 and severe skin injury can occur, so the physician must estimate the ESD in order to prevent radiation skin injuries during the procedure.…”

mentioning

confidence: 99%

Factors Affecting the Patient's Skin Dose During Percutaneous Coronary Intervention for Chronic Total Occlusion

Suzuki

Furui

Isshiki

et al. 2007

Circ J

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hronic total occlusion (CTO) has been considered as a relative contraindication for percutaneous coronary intervention (PCI), because of its low success rate and high restenosis rate. The results have improved because of recent advances in technology and increased operator experience. [1][2][3][4][5][6][7] Recent studies show that successful PCI of a CTO is associated with improved survival; 8,9 however, the total fluoroscopic time (TFT) tends to be long in this procedure compared with PCI for non-CTO. 10 The patient's entrance skin doses (ESD) are higher 10,11 and severe skin injury can occur, so the physician must estimate the ESD in order to prevent radiation skin injuries during the procedure. However, there is inadequate assessment of this issue in the literature.The purpose of this research was to measure the patient's ESD during PCI for CTO, analyze the factors that affect it and assess the methods used to estimate the maximum ESD from both patient and angiographic data. Circulation Journal Vol.71, February 2007 Methods Patient PopulationThis study focused on 23 consecutive patients (6 women, 17 men) who underwent PCI for CTO with evaluation of the ESDs from July 2004 to September 2005. The average patient age was 68.9±7.7 years (range: 53.6-82.2). AngiographyAdvantX LC and AdvantX LC/LP equipment (General Electric Medical Systems, Milwaukee, WI, USA) were used for angiography. The image intensifiers of both units were renewed in April 2004. Each unit had an undercouch tube and an overcouch image intensifier with 3 fields of view: 9, 6, and 4.5 inches in diameter. A 6-inch field of view was used mainly in this assessment. In both units, the total filtration was equivalent to 2.7 mm aluminum. Procedures were performed using pulse-mode fluoroscopy. The period of use was 9 years for each unit. PCI and ESD MeasurementThe patient wore a jacket with 52 radiosensitive indicators (Nichiyu Giken Kogyo Co, Ltd, Saitama, Japan) placed on the back. Radiosensitive indicators use a functional dye in which the color changes from translucent to red with Xray absorption. Indicators were arranged in 6 rows (from top to bottom: 1, 2, 3, 4, 5, and 6) and 8 columns (from left to right: A, B, C, D, E, F, G, and H) at intervals of 7 cm. An additional 4 indicators were placed in the 7th row (C7, D7, E7, and F7), except for 2 patients. Four experienced cardiologists performed the procedures using standard tech- Background The aim of this study was to measure the patient entrance skin dose (ESD) during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), and assess the factors that affect it. Methods and ResultsRadiosensitive indicators were used to measure ESDs during 23 procedures. Multiple regression analysis identified the strength of the linear relationship of the dependent variable (the natural logarithm of the maximum ESD) with the set of multiple independent variables (the natural logarithm of both the patient and angiographic data). The methods for estimating the maximum ESD and the estimated ESDs w...

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“…Stent implantation decreased the restenosis rates compared to PTCA, however, the restenosis rates in PCI for CTO are still high compared to PCI for stenotic lesions. [2][3][4][5][6][7] The introduction of drug-eluting stents can be promising in this era. Nakamura, et al 12) showed that few cardiac events occurred in the 60 patients who underwent implantation of a sirolimus-eluting stent compared to 120 patients in the bare metal stent group after one year (P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…Despite the development of interventional techniques, many clinicians prefer not to recanalize the CTO by percutaneous coronary intervention (PCI) because of the difficulty and low clinical success of PCI for CTO. The restenosis rate for PCI in CTOs is still higher than stenotic lesions despite the routine usage of stents, which have successfully decreased the restenosis rates [2][3][4][5][6][7] when compared to only percutaneous transluminal coronary angioplasty (PTCA). …”

mentioning

confidence: 99%

<b>The Clinical Outcomes of Percutaneous Coronary Intervention in Chronic Total Coronary Occlusion</b>

et al. 2006

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SUMMARYThe objective of the present study was to investigate the effects of percutaneous coronary intervention (PCI) on the development of major cardiac events in patients with chronic total coronary occlusion (CTO). Patients determined to have CTO in at least one coronary artery with stable coronary artery disease were retrospectively enrolled in this study. Among 262 patients (197 males, 65 females), PCI was attempted in 172 while 90 were followed-up conservatively because they had unsuitable angiographic lesions for PCI. PCI was successful in 117 (68.0%) patients. Thirty of the remaining 55 patients, who had multivessel coronary artery disease, underwent coronary artery bypass surgery. The remaining 25 patients were added to the conservative group. Mean follow-up time was 32 ± 12 months. Although a slight degree of development of non-ST elevation acute coronary syndrome was observed in the PCI group (34 [29.1%] versus 21 [18.3%] patients, P = 0.053) mostly because of restenosis (14 of 34 patients, [41.2%]), a significant mortality benefit was observed in patients who underwent successful PCI (17 [14.5%] versus 32 [27.8%] patients, P = 0.013). This benefit was mainly due to the lower number of deaths from heart failure (7 [6.0%] versus 17 [14.8%] patients, P = 0.028) and sudden death (6 [5.1%] versus 12 [10.4%] patients, P = 0.131). In conclusion, despite the low success rate and high restenosis rate of PCI for CTO, it is worthwhile to deal with the revascularization of a CTO for its mortality benefit. (Int Heart J 2006; 47: 811-819) Key words: Heart failure, Mortality, PCI, Total coronary occlusion THE clinical approach to chronic total coronary occlusion (CTO), a common problem seen in 10-15% of patients 1) undergoing coronary angiography, remains controversial. Despite the development of interventional techniques, many clinicians prefer not to recanalize the CTO by percutaneous coronary intervention (PCI) because of the difficulty and low clinical success of PCI for CTO. The restenosis rate for PCI in CTOs is still higher than stenotic lesions despite the routine usage of stents, which have successfully decreased the restenosis rates [2][3][4][5][6][7] when compared to only percutaneous transluminal coronary angioplasty (PTCA).

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Stent or angioplasty after recanalization of chronic coronary occlusions? (the SARECCO trial)

Cited by 43 publications

References 21 publications

Coronary artery stents: a rapid systematic review and economic evaluation

Coronary artery stents: a rapid systematic review and economic evaluation

Factors Affecting the Patient's Skin Dose During Percutaneous Coronary Intervention for Chronic Total Occlusion

<b>The Clinical Outcomes of Percutaneous Coronary Intervention in Chronic Total Coronary Occlusion</b>

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