The IMPACTOR-CTO Trial

Obedinskiy, Anton A.; Kretov, Еvgeny; Boukhris, Marouane; Kurbatov, Vladislav P.; Осиев, А. Г.; Elhadj, Zied Ibn; Obedinskaya, N. R.; Kasbaoui, Sami; Grazhdankin, Igor; Прохорихин, А. А.; Зубарев, Д. Д.; Biryukov, Alexey; Pokushalov, Evgeny; Galassi, Alfredo R.; Baystrukov, V. I.

doi:10.1016/j.jcin.2018.04.017

Cited by 112 publications

(83 citation statements)

References 3 publications

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“…The (inappropriate) usage of a DR technique can lead to long dissection planes with a potential for side branch loss, longer stent lengths and stent under‐sizing due to hematoma formation, and in this study these unfavorable features could hypothetically have led to less recovery of hyperemic MBF. However, the recently published results of the randomized IMPACTOR‐CTO trial showed that only a marginal nonsignificant reduction in ischemic burden could be realized with optimal medical therapy alone (without successful crossing and stenting) in patients with a CTO . Although hyperemic MBF after the usage of DR techniques was relatively lower in this study, it should be noted that these techniques led to successful CTO crossing and subsequent reduction in ischemic burden in 48% of the patients, and they can be considered as essential additives in CTO PCI .…”

Section: Discussionmentioning

confidence: 55%

“…24,25 After the introduction of more controlled device-based However, the recently published results of the randomized IMPACTOR-CTO trial showed that only a marginal nonsignificant reduction in ischemic burden could be realized with optimal medical therapy alone (without successful crossing and stenting) in patients with a CTO. 27 Although hyperemic MBF after the usage of DR techniques was relatively lower in this study, it should be noted that these techniques led to successful CTO crossing and subsequent reduction in ischemic burden in 48% of the patients, and they can be considered as essential additives in CTO PCI. 5 The potential differences in restoration of myocardial perfusion after intraplaque crossing and DR 30 With lack of angiographic control at time of follow-up PET imaging, it cannot be excluded that recurrent luminal narrowing has influenced the results in a negative manner in some patients.…”

Section: The Influence Of a Cto Versus A Non-cto Lesion On Myocardimentioning

confidence: 58%

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Recovery of myocardial perfusion after percutaneous coronary intervention of chronic total occlusions is comparable to hemodynamically significant non‐occlusive lesions

Schumacher

Driessen

Stuijfzand

et al. 2018

Cathet Cardio Intervent

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Background The benefits of chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) are being questioned. The aim of this study was to assess the effects of CTO PCI on absolute myocardial perfusion, as compared with PCI of hemodynamically significant non‐CTO lesions. Methods Consecutive patients with a preserved left ventricular ejection fraction (≥50%) and a CTO or non‐CTO lesion, in whom [15O]H2O positron emission tomography was performed prior and after successful PCI, were included. Change in quantitative (hyperemic) myocardial blood flow (MBF), coronary flow reserve (CFR) and perfusion defect size (in myocardial segments) were compared between CTOs and non‐CTO lesions. Results In total 92 patients with a CTO and 31 patients with a non‐CTO lesion were included. CTOs induced larger perfusion defect sizes (4.51 ± 1.69 vs. 3.23 ± 2.38 segments, P < 0.01) with lower hyperemic MBF (1.30 ± 0.37 vs. 1.58 ± 0.62 mL·min−1·g−1, P < 0.01) and similarly impaired CFR (1.66 ± 0.75 vs. 1.89 ± 0.77, P = 0.17) compared with non‐CTO lesions. After PCI both hyperemic MBF and CFR increased similarly between groups (P = 0.57 and 0.35) to normal ranges with higher hyperemic MBF values in non‐CTO compared with CTO (2.89 ± 0.94 vs. 2.48 ± 0.73 mL·min−1·g−1, P = 0.03). Perfusion defect sizes decreased similarly after CTO PCI and non‐CTO PCI (P = 0.14), leading to small residual defect sizes in both groups (1.15 ± 1.44 vs. 0.61 ± 1.45 segments, P = 0.054). Conclusions Myocardial perfusion findings are slightly more hampered in patients with a CTO before and after PCI. Percutaneous revascularization of CTOs, however, improves absolute myocardial perfusion similarly to PCI of hemodynamically significant non‐CTO lesions, leading to satisfying results.

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Section: Discussionmentioning

confidence: 55%

Section: The Influence Of a Cto Versus A Non-cto Lesion On Myocardimentioning

confidence: 58%

Recovery of myocardial perfusion after percutaneous coronary intervention of chronic total occlusions is comparable to hemodynamically significant non‐occlusive lesions

Schumacher

Driessen

Stuijfzand

et al. 2018

Cathet Cardio Intervent

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“…Observational studies have reported that successful recanalisation of CTOs can improve angina and quality of life as well as left ventricular ejection fraction (LVEF) and survival [3]. However, randomised controlled trials examining the outcome of CTO-PCI are limited and not definitive [4][5][6][7].…”

Section: What's New?mentioning

confidence: 99%

Development and first results of a dedicated chronic total occlusion programme

et al. 2019

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Objective To describe the development and first results of a dedicated chronic total occlusion (CTO) programme in a tertiary medical centre. Background Because of the complexity and the increased risk of complications during percutaneous coronary intervention (PCI) for CTO, it is essential that less experienced and evolving CTO centres perform regular quality analyses. Methods We therefore performed analyses to describe the results during the first 3 years of a dedicated CTO programme at a high-volume PCI centre. In addition, we discuss the strategies employed to develop such a programme. Results A total of 179 consecutive patients undergoing 187 CTO procedures were included in the study. The complexity of the CTO lesions increased from a mean J-CTO (Japanese Multicentre CTO Registry) score of 1.3 in 2015 to 2.1 in 2017. In the majority of cases, the antegrade wire escalation technique was performed. Final technical success rate was 78.5% in 175 patients with a single CTO and 80.2% of all 187 CTO procedures. No peri-procedural or in-hospital deaths occurred. One peri-procedural myocardial infarction occurred. Cardiac tamponade occurred in 2 cases, both managed by pericardiocentesis. No urgent cardiac H.W. van der Werf and P.J. Vlaar contributed equally to this work.

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“…Several studies and clinical trials have examined the effect of successful percutaneous coronary intervention (PCI) of coronary chronic total occlusion (CTO) on clinical outcomes. Some studies have suggested that successful CTO PCI is associated with improvement in survival [1,2] and quality of life [3,4]. However, this conclusion is not consistent.…”

Section: Introductionmentioning

confidence: 97%

Early Improvement of Left Ventricular Dyssynchrony After Percutaneous Coronary Intervention in Patients with Single Chronic Total Occlusion Vessel

Wang

et al. 2020

Preprint

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Background The effect of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) on left ventricular dyssynchrony was unclear. Methods Patients with one CTO vessel were included. Tissue Doppler imaging was used to assess the left ventricular dyssynchrony index (DI) in twelve segments before and after successful CTO PCI. Multiple regression was used to identify independent correlates of DI reduction. Results 41 patients were included with the mean age of 65.88 years. 39(95.12%) had left ventricular DI more than 33. It decreased significantly from 67.48 ± 28.73 to 44.69 ± 23.90 (P < 0.01) after successful CTO PCI. PCI of infarct-relative CTO was associated with less percentage of DI reduction (Coefficient [Coef.], 25.60; 95% confidence interval [CI], 8.13–43.08; P < 0.01). Higher initial DI was associated with more percentage of DI reduction (Coef., -0.35; 95% CI, -0.67- -0.03; P = 0.03). Percentage of DI reduction was associated with ejection fraction (EF) improvement (Coef., -5.09; 95% CI, -7.45- -2.72; P < 0.01) with linear relationship (P < 0.01). Conclusion Left ventricular dyssynchrony was reduced early after successful CTO PCI, which predicted EF improvement. The association between dyssynchrony reduction and long-term benefits of CTO PCI are expected.

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The IMPACTOR-CTO Trial

Cited by 112 publications

References 3 publications

Recovery of myocardial perfusion after percutaneous coronary intervention of chronic total occlusions is comparable to hemodynamically significant non‐occlusive lesions

Recovery of myocardial perfusion after percutaneous coronary intervention of chronic total occlusions is comparable to hemodynamically significant non‐occlusive lesions

Development and first results of a dedicated chronic total occlusion programme

Early Improvement of Left Ventricular Dyssynchrony After Percutaneous Coronary Intervention in Patients with Single Chronic Total Occlusion Vessel

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