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1.
Catheter Cardiovasc Interv ; 103(1): 12-19, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-37983649

RESUMEN

BACKGROUND: Contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) practice has received limited study. AIM: To examine the contemporary CTO PCI practice. METHODS: We performed an online, anonymous, international survey of CTO PCI operators. RESULTS: Five hundred forty-five CTO PCI operators and 190 interventional cardiology fellows with an interest in CTO PCI participated in this survey. Almost half were from the United States (41%), most (93%) were men, and the median h/week spent in the hospital was 58. Median annual case numbers were 205 (150-328) for PCIs and 20 (5-50) for CTO PCIs. Almost one-fifth (17%) entered CTO cases into registries, such as PROGRESS-CTO (55%) and EuroCTO (20%). More than one-third worked at academic institutions (39%), 31% trained dedicated CTO fellows, and 22% proctored CTO PCI. One-third (34%) had dedicated CTO PCI days. Most (51%) never discharged CTO patients the same day, while 17% discharged CTO patients the same day >50% of the time. After successful guidewire crossing, 38% used intravascular imaging >90% of the time. Most used CTO scores including J-CTO (81%), PROGRESS-CTO (35%), and PROGRESS-CTO complications scores (30%). Coronary artery perforation was encountered within the last month by 19%. On a scale of 0-10, the median comfort levels in treating coronary artery perforation were: covered stents 8.8 (7.0-10), coil embolization 5.0 (2.1-8.5), and fat embolization 3.7 (0.6-7.3). Most (51%) participants had a complication cart/kit and 25% conducted regular complication drills with catheterization laboratory staff. CONCLUSION: Contemporary CTO PCI practices vary widely. Further research on barriers to following the guiding principles of CTO PCI may improve patient outcomes.


Asunto(s)
Oclusión Coronaria , Lesiones Cardíacas , Intervención Coronaria Percutánea , Masculino , Humanos , Estados Unidos , Femenino , Resultado del Tratamiento , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/terapia , Enfermedad Crónica , Factores de Tiempo , Sistema de Registros , Angiografía Coronaria/métodos , Factores de Riesgo
2.
Catheter Cardiovasc Interv ; 103(6): 863-872, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38563074

RESUMEN

BACKGROUND: There is limited data on retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) via ipsilateral epicardial collaterals (IEC). AIMS: To compare the clinical and angiographic characteristics, and outcomes of retrograde CTO PCI via IEC versus other collaterals in a large multicenter registry. METHODS: Observational cohort study from the Prospective Global registry for the study of Chronic Total Occlusion Intervention (PROGRESS-CTO). RESULTS: Of 4466 retrograde cases performed between 2012 and 2023, crossing through IEC was attempted in 191 (4.3%) cases with 50% wiring success. The most common target vessel in the IEC group was the left circumflex (50%), in comparison to other retrograde cases, where the right coronary artery was most common (70%). The Japanese CTO score was similar between the two groups (3.13 ± 1.23 vs. 3.06 ± 1.06, p = 0.456); however, the IEC group had a higher Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) score (1.95 ± 1.02 vs. 1.27 ± 0.92, p < 0.0001). The most used IEC guidewire was the SUOH 03 (39%), and the most frequently used microcatheter was the Caravel (43%). Dual injection was less common in IEC cases (66% vs. 89%, p < 0.0001). Technical (76% vs. 79%, p = 0.317) and procedural success rates (74% vs. 79%, p = 0.281) were not different between the two groups. However, IEC cases had a higher procedural complications rate (25.8% vs. 16.4%, p = 0.0008), including perforations (17.3% vs. 9.0%, p = 0.0001), pericardiocentesis (3.1% vs. 1.2%, p = 0.018), and dissection/thrombus of the donor vessel (3.7% vs. 1.2%, p = 0.002). CONCLUSION: The use of IEC for retrograde CTO PCI was associated with similar technical and procedural success rates when compared with other retrograde cases, but higher incidence of periprocedural complications.


Asunto(s)
Circulación Colateral , Angiografía Coronaria , Circulación Coronaria , Oclusión Coronaria , Intervención Coronaria Percutánea , Sistema de Registros , Humanos , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/terapia , Oclusión Coronaria/fisiopatología , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Masculino , Resultado del Tratamiento , Enfermedad Crónica , Femenino , Anciano , Persona de Mediana Edad , Factores de Tiempo , Factores de Riesgo
3.
Catheter Cardiovasc Interv ; 93(4): 635-638, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30549189

RESUMEN

The standard treatment for large vessel coronary perforations is implantation of a covered stent. Antegrade attempts for crossing a right coronary artery chronic total occlusion resulted in guidewire and microcatheter exit with pericardial bleeding. A balloon was inflated proximal to the perforation site to achieve temporary hemostasis. Retrograde crossing of the chronic total occlusion was achieved through an epicardial collateral using the reverse controlled antegrade and retrograde tracking technique. Stent implantation resulted in hemostasis, likely due to creation of a subintimal flap that sealed the perforation site. If technically feasible, subintimal recanalization can be an alternative treatment strategy for coronary perforations occurring during chronic total occlusion percutaneous coronary intervention.


Asunto(s)
Angioplastia Coronaria con Balón , Oclusión con Balón , Oclusión Coronaria/terapia , Vasos Coronarios/lesiones , Lesiones Cardíacas/terapia , Intervención Coronaria Percutánea/efectos adversos , Calcificación Vascular/terapia , Anciano , Angioplastia Coronaria con Balón/instrumentación , Enfermedad Crónica , Oclusión Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Femenino , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Humanos , Stents , Resultado del Tratamiento , Calcificación Vascular/diagnóstico por imagen
4.
Catheter Cardiovasc Interv ; 93(1): 48-56, 2019 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-30312992

RESUMEN

OBJECTIVES: We examined the contemporary incidence, types, predictors, angiographic characteristics, management and outcomes of coronary perforation. BACKGROUND: Coronary perforation is a rare, but important, complication of percutaneous coronary intervention (PCI). There is lack of data on perforations stratified as large and distal vessel perforations. METHODS: Retrospective, observational cohort study of all patients who underwent PCI at a high volume, tertiary hospital between the years 2009 and 2016. Angiograms of all coronary perforation cases were reviewed to determine the mechanism, type, and management of perforation. Risk-adjusted periprocedural complication rates were compared between patients with and without coronary perforation. One-year mortality outcomes of patients with large vessel vs. distal vessel perforation were also examined. RESULTS: Coronary perforation occurred in 68 of 13,339 PCIs (0.51%) performed during the study period: 51 (75%) were large vessel perforations and 17 (25%) distal vessel perforations. Most (67%) large vessel perforations were due to balloon/stent inflation, whereas most (94%) distal vessel perforations were due to guidewire exit. Patients with coronary perforations had significantly higher risk for periprocedural complications (adjusted odds ratio 7.57; 95% CI: 4.22-13.50; P < 0.001). Only one patient with large vessel perforation required emergency cardiac surgery, yet in-hospital mortality was high with both large vessel (7.8%) and distal vessel (11.8%) perforations. CONCLUSIONS: Coronary perforation is an infrequent, but potentially severe PCI complication. Most coronary perforations are large vessel perforations. Although coronary perforations rarely lead to emergency cardiac surgery, both distal vessel and large vessel perforations are associated with high in-hospital mortality, highlighting the importance of prevention.


Asunto(s)
Vasos Coronarios/lesiones , Lesiones Cardíacas/epidemiología , Enfermedad Iatrogénica/epidemiología , Intervención Coronaria Percutánea/efectos adversos , Lesiones del Sistema Vascular/epidemiología , Anciano , Anciano de 80 o más Años , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Femenino , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/mortalidad , Lesiones Cardíacas/terapia , Mortalidad Hospitalaria , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/mortalidad , Lesiones del Sistema Vascular/terapia
5.
Curr Cardiol Rep ; 20(12): 141, 2018 10 22.
Artículo en Inglés | MEDLINE | ID: mdl-30350111

RESUMEN

PURPOSE OF REVIEW: To summarize novel techniques and developments in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). RECENT FINDINGS: Using an algorithmic, step-by-step approach can help overcome several complex CTO lesions subsets, such as proximal cap ambiguity, ostial location, in-stent occlusion, bifurcations, balloon uncrossable and undilatable lesions. Similarly, an algorithmic approach can help prevent and optimally treat CTO PCI-related complication, such as perforation, radiation, and contrast-induced nephropathy. Continual update and reassessment of each operator's algorithm for performing CTO PCI can lead to improved outcomes.


Asunto(s)
Cardiología/tendencias , Oclusión Coronaria/cirugía , Intervención Coronaria Percutánea , Algoritmos , Enfermedad Crónica , Angiografía Coronaria , Humanos , Intervención Coronaria Percutánea/métodos , Intervención Coronaria Percutánea/tendencias , Resultado del Tratamiento
6.
Catheter Cardiovasc Interv ; 82(5): E672-5, 2013 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-23553919

RESUMEN

New techniques involving the use of retrograde channels have enabled successful revascularization of chronically occluded arteries previously not amenable to standard strategies. We describe the use of a simultaneous antegrade and retrograde approach to perform bifurcation kissing balloon angioplasty which was not possible using a standard antegrade approach. As the balloons are oriented in opposite rather than identical directions, we have named this technique "Head-to-Toe Kissing."


Asunto(s)
Angioplastia Coronaria con Balón/métodos , Oclusión Coronaria/terapia , Anciano , Angioplastia Coronaria con Balón/instrumentación , Catéteres Cardíacos , Enfermedad Crónica , Angiografía Coronaria , Oclusión Coronaria/diagnóstico , Diseño de Equipo , Humanos , Masculino , Resultado del Tratamiento
7.
Am J Cardiol ; 154: 33-40, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34243937

RESUMEN

The outcomes of patients with previous coronary bypass graft surgery (CABG) presenting with ST-segment elevation acute myocardial infarction (STEMI) have received limited study. We compared the clinical and procedural characteristics and outcomes of STEMI patients with and without previous CABG in a contemporary multicenter STEMI registry between 2003 and 2020. The primary outcomes of the study were mortality and major cardiac adverse events (MACE: death, MI or stroke). Survival curves were derived using the Kaplan-Meier method and compared with the log-rank test. Of the 13,893 patients included in the analyses, 7.2% had previous CABG. Mean age was 62.4 ± 13.6 years, most patients (71%) were men and 22% had diabetes. Previous CABG patients were older (69.0 ± 11.7 vs 61.9 ± 13.6 years, p <0.001) and more likely to have diabetes (40% vs 21%, p <0.001) compared with patients without previous CABG. Previous CABG patients had higher mortality and MACE at 5 years (p <0.001). Outcomes were similar with saphenous vein graft vs native coronary culprits. Previous CABG remained associated with mortality from discharge to 18 months (p = 0.044) and from 18 months to 5 years (p <0.001) after adjusting for baseline characteristics. Long term outcomes after STEMI were worse among patients with previous CABG compared with patients without previous CABG, even after adjustment for baseline characteristics.


Asunto(s)
Puente de Arteria Coronaria/estadística & datos numéricos , Mortalidad Hospitalaria , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Infarto del Miocardio/epidemiología , Modelos de Riesgos Proporcionales , Sistema de Registros , Accidente Cerebrovascular/epidemiología , Tiempo de Tratamiento/estadística & datos numéricos
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