Short- and long-term follow-up of percutaneous coronary intervention for chronic total occlusion through transradial approach: tips for successful procedure from a single-center experience.

BACKGROUND: There are limited data regarding transradial percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). OBJECTIVE: To assess the feasibility and safety of transradial coronary intervention (TRI) for CTO lesions, we analyzed our experience in PCI treatment of CTO lesion through transradial approach for the past 6 years. METHODS: From January 2003 to May 2009, among 134 CTO lesions, on which we performed PCI, 120 lesions were performed from transradial approach. RESULTS: Technical success for transradial CTO was 80%. Complication of access bleeding was zero. The most commonly selected guiding wire was Wave 3 for right coronary artery (RCA) lesions (82%) and Voda left for Left Coronary Artery (LCA) lesions (91%). The average number of wires used during procedure was 2.2 ± 0.8. Tapered wire was used in 8% of the cases, Rotablator was performed in 4.1% of cases, and Tornus catheter was performed in 12.5% of cases. The mean procedure time was 83 ± 39 minutes. The mean volume of contrast medium used was 228 ± 92 mL. There were two coronary artery perforations during procedure and one in-hospital cardiac death. Patients were followed up for 36 ± 21 months; restenosis rate was 19.5%-26.7% for bare metal stent (BMS) and 9.8% for drug-eluting stents (DES). Overall major adverse cardiac events (MACE) rate was 11.7%. CONCLUSION: It was demonstrated that transradial PCI for CTO lesions is safe, minimizing vascular complications without increasing procedural time and contrast use.

Impact of diabetes on long term follow-up of elderly patients with chronic total occlusion post percutaneous coronary intervention.

BACKGROUND: The prognosis of elderly patients with chronic total occlusion (CTO) and diabetes mellitus (DM) treated with percutaneous coronary intervention (PCI) is not known. OBJECTIVE: To investigate the effect of diabetes on long-term follow-up of CTO after PCI in elderly patients. METHODS: A total of 153 elderly patients (age > 65 years old) with CTO lesions which were successfully treated with PCI were enrolled. Fifty one patients with diabetes and 102 without diabetes were compared for long-term outcomes (mean follow up: 36 ± 12 months). Major adverse cardiac events (MACE) which include death, myocardial infarction or target lesion revascularization (TLR) were considered as a combined endpoint. RESULTS: The combined endpoint occurred in 29.4% of diabetes patients, and 11.3% of the patients without diabetes (P < 0.05). The Cox proportional hazards model identified: drug eluting stent (DES) or bare metal stent (BMS) (HR: 0.13, 95% confidence interval (95% CI): 0.03-0.62, P = 0.004), DM (HR: 6.69, 95% CI: 1.62-15.81, P = 0.01) and final minimal lumen diameter (MLD) (HR: 0.37, 95% CI: 0.13-0.90, P = 0.03 ) as independent predictors of MACE, DM with renal impairment (HR: 6.64, 95% CI: 1.32-33.36, P = 0.02), HBA1C on admission (HR: 1.79, 95% CI: 1.09-2.94, P = 0.02), as independent predictors of MACE at long term follow-up. CONCLUSIONS: The study demonstrates that DM is a predictive factor for MACE in elderly CTO patients treated with PCI, type of stent, final minimal lumen diameter and DM with renal impairment, and HBA1C level on admission are predictors of MACE.

[Significance of percutaneous transluminal coronary intervention for chronic total occlusions assessed as non-viable by myocardial scintigraphy].

OBJECTIVES: The effectiveness of percutaneous transluminal coronary intervention (PCI) was evaluated for chronic total occlusion (CTO) assessed as non-viable by myocardial scintigraphy. METHODS: In the period from January 2003 to October 2006, 17 patients who had successful reopening of the artery through revascularization by PCI for CTO assessed as non-viable were classified as the P group, and 30 patients whose course was observed while undergoing medical therapy after being assessed as nonviable formed the M group. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and SD/chord were measured in both groups before the procedure and at the chronic phase (mean 6.2 months). The incidences of chronic cardiac events at mean 20.5 months were compared. RESULTS: No significant differences were revealed between the two groups in LVEF and LVEDV prior to the procedure. No significant differences between the groups were revealed for Delta LVEF or Delta LVEDV. A significant improvement (p < 0.05) was revealed for SD/chord in the P group with - 1.50 +/- 0.25 before the procedure, becoming - 1.34 +/- 0.33 in the chronic phase, but the M group revealed no significant change. No significant difference was revealed in the avoidance of chronic cardiac events with 94.1% for the P group and 86.0% for the M group. CONCLUSIONS: Improvement in local left ventricular wall motion by revascularization is possible even in patients with chronic total occlusions assessed as non-viable by myocardium scintigraphy.

Impact of highly asymmetric stent expansion after sirolimus-eluting stent implantation on twelve-month clinical outcomes.

OBJECTIVES: This study investigated the impact of highly asymmetric stent expansion after sirolimus-eluting stent(SES)implantation on clinical outcomes from post procedure to 12 months later. METHODS: Subjects were 118 patients with 171 lesions who underwent SES implantation for angina pectoris and were studied by intravascular ultrasound (IVUS) following the procedure. The stent symmetry index (minimal stent diameter/maximal stent diameter) at the minimal stent area was calculated by IVUS analysis. The patients were divided into two groups for comparative study: those with stent symmetry index > or = 0.7 were classified into the optimal (O) group (93 patients; 145 lesions, mean age 66 +/- 12 years) and those with stent symmetry index < 0.7 were the sub-optimal (S) group (25 patients; 26 lesions, mean age 67 +/- 10 years). RESULTS: Angiographic follow up after 8 months showed no differences in target lesion revascularization (TLR) (O group: 3.1% vs S group: 3.8%, p = 0.833). Multivariate analysis identified the post minimal stent diameter as the independent predictor of TLR (p = 0.038). The stent symmetry index < 0.7 was not a predictor of TLR (p = 0.887). Clinical outcomes after 12 months showed both groups had 0% stent thrombosis and there were no differences in deaths (O group: 2.1% vs S group: 4.0%, p = 0.602). CONCLUSIONS: Highly asymmetric stent expansion after SES implantation may not have a negative impact on clinical outcomes at 12 months.

Study of the predictors and lesion characteristics of ischemic heart disease patients with false negative results in stress myocardial perfusion single-photon emission tomography.

BACKGROUND: The predictors and lesion morphology of patients with ischemic heart disease testing false negative results in stress myocardial perfusion single-photon emission computed tomography (SPECT) was investigated. METHODS AND RESULTS: Subjects were 58 consecutive patients who underwent coronary angiography (CAG), even though they showed normal findings in stress myocardial perfusion SPECT. Age, gender, methods of stress, perfusion agent, coronary risk factors, angina symptoms, and electrocardiographic changes were investigated as predictors by multivariate analysis. For lesion morphology, significant stenotic lesions were studied for morphological characteristics and reference diameter (RD), percentage diameter stenosis (%DS), minimum lumen diameter (MLD), and lesion length (LL) were measured. CAG revealed 30 significant stenotic lesions in 18 patients. Logistic regression analysis revealed significant predictors to be age (odds ratio (OR) 1.118, p<0.05), typical anginal pain (OR 21.09, p<0.01), and hypertension (OR 8.336, p<0.05). For lesion morphology, there were only 2 diffuse lesions and the mean RD, %DS, MLD, and LL were 3.03+/-0.9 mm, 63.1 +/-9.3%, 1.13+/-0.49 mm, and 13.2+/-7.0 mm, respectively. CONCLUSION: Sufficient caution is believed necessary in the interpretation of normal findings of stress myocardial perfusion SPECT when the patient is elderly, complains of typical anginal pain, or has hypertension. In regard to characteristics of lesion morphology, there were hardly any diffuse lesions.

Relationship between lesion vessel area and myocardial salvage assessed by myocardial single photon emission computed tomography in acute myocardial infarction with stenting after thrombectomy.

OBJECTIVES: To study the relationship between lesion vessel area and myocardial salvage assessed by myocardial single photon emission computed tomography (SPECT) in acute myocardial infarction with stenting after thrombectomy. METHODS: This study included 71 patients who underwent stenting after thrombectomy for acute myocardial infarction. Intravascular ultrasound (IVUS) was performed after thrombectomy. Patients were classified into two groups: the High group with external elastic membrane cross-sectional area (EEM-CSA) of the lesion > or = 18 mm2 (34 patients) and the Low group with EEM-CSA < 18 mm2 (37 patients). Dual isotope myocardial SPECT imaging was undertaken by perfusion SPECT (201Tl or 99mTc-MIBI) and 123I-15-(p-iodophenyl)-3-(R,-S)-methylpentadecanoic acid (BMIPP). The image of the left ventricular myocardium was divided into 17 segments to calculate total defect score using a 5-grade assessment (0: normal-4: defect). Differences in total defect score of perfusion SPECT and 123I-BMIPP was defined as mismatch. RESULTS: Culprit lesion morphology was assessed by IVUS. A higher incidence of lipid pool-like images (47% vs 5%, p < 0.01) was observed in the High group. The results of myocardial SPECT study revealed no difference in the total defect score of 123I-BMIPP (18.3 +/- 5.5 vs 17.3 +/- 6.3 points) but the mismatch in total defect score of perfusion SPECT and 123I-BMIPP was significantly lower in the High group (3.8 +/- 3.9 vs 7.7 +/- 4.2 points, p < 0.05). CONCLUSIONS: Patients with a high culprit lesion vessel area show fewer beneficial effects in myocardial salvage compared with those with low vessel area as assessed by myocardial SPECT in acute myocardial infarction with stenting after thrombectomy.