[Safety indices for chronic total occlusion recanalisation by antegrade approach without scheduled contralateral injection: A consecutive series of 39 cases]. / Indices de sécurité d'une recanalisation antérograde d'occlusion coronaire chronique sans injection controlatérale en première intention. À propos d'une série consécutive de 39 cas.

INTRODUCTION: Current guidelines for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) recommend dual coronary angiography. AIM OF THE STUDY: Evaluate CTO-PCI with a single approach using safety indices through the microcatheter. POPULATION AND METHODS: Prospective observational study with a consecutive inclusion of 39 patients (mean age of 67 years) treated by antegrade approach without scheduled contralateral angiography. Following safety indices were collected: blood backflow, distal coronary pressure waveform, selective distal contrast injection. RESULTS: Technical success was obtained in 90% of the cases. Balloon dilation was used in 38% of the cases before placement of the microcatheter. Dual angiography was necessary in three cases (8%). A blood backflow and cyclic changes of the distal coronary pressure waveform were noticed in 87% and 84% of the cases, with a positive predictive value of 97% and 79% respectively, for a microcatheter location in the true lumen. Selective distal contrast injection was done in 36 cases with a visualization of the true lumen in 35 cases. One major complication was observed (3%). CONCLUSION: CTO-PCI with a single approach is feasible using safety indices to limit the risks of major complication. The principle of a systematic dual angiography as advocated in current guidelines may deserve to be revisited.

In-hospital and long-term outcomes after percutaneous coronary intervention for chronic total occlusion in elderly patients: A consecutive, prospective, single-centre study.

BACKGROUND: Elderly patients are increasingly referred for complex percutaneous coronary interventions (PCI), including recanalization of chronic total occlusion (CTO). AIMS: To assess the feasibility, safety and clinical benefits associated with CTO-PCI in elderly patients. METHODS: Consecutive patients (n=356) who underwent CTO-PCI in our institution between January 2008 and December 2011 were prospectively included. The short-term outcomes of CTO-PCI were assessed by comparing the rates of successful recanalization and postoperative complications in patients aged ≥ 75 years and those < 75 years. The clinical effect of successful recanalization was evaluated in a 20-month follow-up analysis in patients ≥ 75 years. RESULTS: Although patients ≥ 75 years (n = 93) had more complex coronary artery disease, the procedural success rate was similar to that in younger patients (78.2% vs. 74.3%, respectively; P = 0.41). Postoperative complications were more frequent in older patients (5.4% vs. 0.4%; P = 0.005). Major adverse cardiac event-free survival analysis at 20 months revealed that successful revascularization was indicative of a better prognosis in older patients (hazard ratio: 0.43, 95% confidence interval: 0.19-0.96; P = 0.039). CONCLUSION: Elderly patients have more complex coronary disease and are at a higher risk of postoperative complications. Nevertheless, we observed a similar success rate for CTO-PCI in elderly patients as for younger patients. Successful CTO recanalization improved the event-free survival rate at 20 months. Thus, CTO-PCI constitutes an alternative strategy for treating selected elderly patients.

[The use of the Five-in-Six System for stent delivery in challenging coronary lesions: a multi-center experience]. / L'utilisation du cathéter Heartrail II « 5-in-6 ¼ dans l'angioplastie coronaire complexe : expérience multicentrique.

BACKGROUND: The mother and child "5-in-6" technique using the Heartrail II catheter is a novel tool allowing stent delivery in challenging lesions, when conventional techniques have failed. METHODS: A total of 147 consecutive patients underwent percutaneous coronary intervention (PCI) using the "5-in-6" Heartrail II catheter was restrospectively identified in the Institut Cardiovasculaire Paris Sud, (Jacques-cartier hospital), Institut hospitalier Claude-Galien (Claude-Galien hospital) and European hospital of Paris between July 2009 and September 2012. RESULTS: Ten interventional cardiologists treated 147 patients with the new device. The patients mean age was 68.5 ± 21.5 years, 78% were men. Radial access was used in 128 cases (87.9%). The treated vessels were the right coronary artery in 82%, left anterior descending in 22%, left circumflex in 18%, marginal branch in 9%, the posterior descending artery in three patients, retroventricular artery in one patient and a saphenous graft in two patients. Most lesions (70%) had American Heart Association/American College of Cardiology (AHA/ACC) type B2 or C, and greater than 50% were located in distal vessel segments. Mean lesion length was 16 ± 4 mm, which is indicative of long lesion. Most (62%) lesions were moderately to heavily calcified and 22 (14%) were chronic total occlusions. Problems with stent delivery were due to poor guide catheter support or excessive calcification. Introduction of the "Heartrail II" catheter allowed successful stent delivery in 139 cases (94%). CONCLUSION: The "5 in 6" Heartrail II catheter is a simple and easy-to-use device that can improve the success of stent delivery in challenging coronary interventions.