Abstract Background A retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs). Objectives The authors describe the European ...experience with and outcomes of retrograde PCI revascularization for coronary CTOs. Methods Follow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization. Results The mean patient age was 62.0 ± 10.4 years; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. The mean clinical follow-up duration was 24.7 ± 15.0 months. Compared with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p < 0.001), myocardial infarction (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p < 0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, respectively; p < 0.001). Female sex (hazard ratio HR: 2.06; 95% confidence interval CI: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO (Multicenter CTO Registry in Japan) score ≥3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p < 0.001) were independent predictors of major adverse cardiac and cerebrovascular events at long-term follow-up. Conclusions The number of retrograde procedures in Europe has increased, with high percents of success, low rates of major complications, and good long-term outcomes.
A retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs).
The authors describe the European experience with and outcomes of ...retrograde PCI revascularization for coronary CTOs.
Follow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization.
The mean patient age was 62.0 ± 10.4 years; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. The mean clinical follow-up duration was 24.7 ± 15.0 months. Compared with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p < 0.001), myocardial infarction (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p < 0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, respectively; p < 0.001). Female sex (hazard ratio HR: 2.06; 95% confidence interval CI: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO (Multicenter CTO Registry in Japan) score ≥3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p < 0.001) were independent predictors of major adverse cardiac and cerebrovascular events at long-term follow-up.
The number of retrograde procedures in Europe has increased, with high percents of success, low rates of major complications, and good long-term outcomes.
Unlike quantitative coronary angiography (QCA), intravascular imaging methods allow direct visualisation of the arterial wall. Our goal was to determine several intravascular ultrasound (IVUS) and ...optical coherence tomography (OCT) parameters of neointimal proliferation and stent endothelisation after complex lesion intervention compared to QCA. We examined 261 patients who had underwent percutaneous intervention with bare metal (BMS) or drug eluting stent (DES) implantation for complex coronary lesions and had IVUS or OCT images at six-month follow-up. Percent diameter stenosis (QCA) was 25.2 ± 16.0 in BMS vs 21.7 ± 17.4 in DES (P < 0.05). Percent neointimal volume obstruction (IVUS) was 19.5 ± 14.4 in BMS vs. 5.8 ± 7.7 in DES (P < 0.001). A moderate correlation was observed between QCA and IVUS with an r value of 0.384 overall, 0.472 for BMS and 0.416 for DES (P < 0.001 for all). In patients with chronic total occlusions (n = 161) QCA was similar in BMS and DES patients (P > 0.05) while IVUS showed less neointima in DES (P < 0.05). Total number of uncovered stent struts per OCT image was 0.4 ± 0.8 while per IVUS image 1.2 ± 1.5 (P < 0.001). In conclusion, angiographic indexes correlate with volumetric intravascular parameters. Although IVUS was more sensitive than QCA to assess neointimal proliferation, the assessment of stent endothelisation was more precise using OCT.
Ar intravaskulārās attēldiagnostikas metodēm, atšķirībā no kvantitatīvās koronārās angiogrāfijas (QCA), ir iespējams vizualizēt artērijas sieniņu. Mūsu mērķis bija salīdzināt dažādus neointīmu raksturojošus intravaskulārās ultraskaņas (IVUS) un optiskās koherences tomogrāfijas (OCT) parametrus ar QCA rādītājiem pacientiem pēc intervences sarežgītos koronāros bojājumos. Mēs analizējām 261 pacientu, kam veikta perkutāna koronāra intervence sarežgītos bojājumos ar parasta metāla (BMS) vai zālēm pildīta stenta (DES) implantāciju un sešu mēnešu apsekošanas angiogrāfijas laikā veikta IVUS vai OCT. Procentuālā diametra stenoze (QCA) bija 25,2 ± 16,0 BMS un 21,7 ± 17,4 DES grupās (P < 0,05). Procentuālā neointīmas tilpuma obstrukcija (IVUS) bija 19,5 ± 14,4 BMS un 5,8 ± 7,7 DES grupā (P < 0,001). Pacientiem ar hroniskām totālām oklūzijām (n = 161) QCA parametrs bija līdzīgs abās grupās (P > 0,05), bet IVUS neointīmu novēroja mazāk DES grupā (P < 0,05). Starp QCA un IVUS novēroja mērenu korelāciju ar r vērtību 0,384 kopējā populācijā, 0,472 BMS un 0,416 DES grupās (P < 0,001 visās populācijās). Kopējais nepārklāto stenta šūnu skaits uz vienu OCT attēlu bija 0,4 ± 0,8, bet uz vienu IVUS attēlu 1,2 ± 1,5 (P < 0,001). Angiogrāfiskie rādītāji korelē ar volumetriskajiem intravaskulārajiem rādītājiem. Tomēr IVUS ir daudz jūtīgāka metode nekā QCA neointīmas proliferācijas novērtēšanai, savukārt OCT ir jūtīgāka stenta endotelizācijas novērtēšanai.
To optimise percutaneous coronary intervention (PCI) strategy for unprotected left main (ULMCA) disease we performed a randomised study: IVUS-guided bare metal stent (BMS) versus paclitaxel-eluting ...stent (PES) implantation after lesion pre-treatment with cutting balloon (CB) for unprotected LM lesions. The purpose of this randomized study was to evaluate six-month and three-year clinical results. Several recent publications have demonstrated good short- and midterm outcomes in patients with left main artery disease after stent implantation. However, data on long-term comparison of BMS and PES for LM lesions are limited. Patients with left main coronary artery disease enrolled at Latvian Centre of Cardiology were randomly assigned to either BMS (n = 50) or PES implantation (n = 53). All interventions were IVUS-guided and CB pre-treatment before stenting was performed in all patients. All patients were scheduled for six-month and three-year follow-up. The primary endpoint was major adverse cardiac events (MACE) defined as death, Q wave myocardial infarction or target lesion revascularisation (TLR). Baseline clinical and procedural characteristics were comparable in both groups. At six months, the MACE-free survival rate was 70% in BMS and 87% in PES patients (P < 0.05). At three years, MACE occurred in 18 patients (36.0%) in the BMS and seven patients (13.2%) in the PES group (P < 0.05). The current study demonstrates the benefit of IVUS guided paclitaxel-eluting stent implantation after cutting balloon pre-treatment in left main coronary artery disease over bare metal stent implantation at six months and three years.
Lai optimizētu perkutānās koronārās intervences stratēīju neprotektētiem kreisās koronārās artērijas kopējā stumbra bojājumiem, veicām randomizētu pētījumu: intravaskulārās ultraskaņās (IVUS) kontrolētu parasta metāla stentu (BMS) un ar paklitakselu pildītu stentu (PES) implantācijas salīdzinājumu, pēc aterosklerotiskās plāksnes sagatavošanas ar griezošo balonu. Pētījuma mērķis bija apsekot pacientus pēc sešiem mēnešiem un trim gadiem, vērtējot viņu klīnisko stāvokli. Vairāki nesen publicēti ziņojumi demonstrējuši labus īstermiņa un vidēja termiņa rezultātus pacientiem pēc stentu implantācijas kreisās koronārās artērijas kopējā stumbra bojājumos. Tomēr dati par parasta metāla stentu un ar paklitakselu pildītu stentu ilgtermiņa rezultātiem šai pacientu kohortai ir limitēti. Randomizējām Latvijas Kardiologijas centra pacientus ar kreisās koronārās artērijas kopējā stumbra aterosklerotiskiem bojājumiem BMS (n = 50) vai PES (n = 53) stentu implantācijai. Visas koronārās intervences bija IVUS kontrolētas, visiem pacientiem pirms stenta implantācijas aterosklerotisko plāksni sagatavoja ar griezošo balonu. Visiem pacientiem nozīmēta sešu mēnešu un trīs gadu apsekošana. Primārais beigu punkts bija liels kardiāls nelabvēlīgs notikums, ko definēja kā nāvi, Q miokarda infarktu vai mērķa bojājuma atkārtotu intervenci. Vispārējie pacientu un procedūras parametri bija salīdzināmi abās grupās. Pēc sešiem mēnešiem lielos nelabvēlīgos kardiālos notikumus nebija piedzīvojuši 70% BMS un 87% PES grupas pacienti (P < 0,05). Trīs gados lielos nelabvēlīgos kardiālos notikumus bija piedzīvojuši 18 BMS pacienti (36,0%) un septiņi PES pacienti (13,2%) (P < 0,05). Mūsu pētījuma sešu mēnešu un trīs gadu apsekošanas rezultāti pierādījuši IVUS kontrolētu, ar paklitakselu pildītu stentu implantācijas pārākumu pār parasta metāla stentu implantāciju pacientiem ar kreisās koronārās artērijas kopējā stumbra bojājumiem, pirms stenta implantācijas bojājumu sgatavojot ar griezošo balonu.
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