W M Wilson1, S J Walsh2, A T Yan3, C G Hanratty2, A J Bagnall4, M Egred4, E Smith5, K G Oldroyd6, M McEntegart6, J Irving7, J Strange8, H Douglas2, J C Spratt9. 1. Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia. 2. Belfast Health and Social Care Trust, Belfast, UK. 3. St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 4. Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. 5. The London Chest Hospital (Barts Health Centre, Barts Health NHS Trust), London, UK. 6. Golden Jubilee National Hospital, Glasgow, UK. 7. Ninewells Hospital, Dundee, UK. 8. Bristol Heart Institute, Bristol, UK. 9. Golden Jubilee National Hospital, Glasgow, UK Edinburgh Heart Centre, Edinburgh, UK Forth Valley Acute Hospitals, Larbert, UK.
Abstract
OBJECTIVES: Treatment options for coronary chronic total occlusions (CTO) are limited, with low historical success rates from percutaneous coronary intervention (PCI). We report procedural outcomes of CTO PCI from 7 centres with dedicated CTO operators trained in hybrid approaches comprising antegrade/retrograde wire escalation (AWE/RWE) and dissection re-entry (ADR/RDR) techniques. METHODS: Clinical and procedural data were collected from consecutive unselected patients with CTO between 2012 and 2014. Lesion complexity was graded by the Multicentre CTO Registry of Japan (J-CTO) score, with ≥2 defined as complex. Success was defined as thrombolysis in myocardial infarction 3 flow with <30% residual stenosis, subclassified as at first attempt or overall. Inhospital complications and 30-day major adverse cardiovascular events (MACEs, death/myocardial infarction/unplanned target vessel revascularisation) were recorded. RESULTS: 1156 patients were included. Despite high complexity (mean J-CTO score 2.5±1.3), success rates were 79% (first attempt) and 90% (overall) with 30-day MACE of 1.6%. AWE was highly effective in less complex lesions (J-CTO ≤1 94% success vs 79% in J-CTO score ≥2). ADR/RDR was used more commonly in complex lesions (J-CTO≤1 15% vs J-CTO ≥2 56%). Need for multiple approaches during each attempt increased with lesion complexity (17% J-CTO ≤1 vs 48% J-CTO ≥2). Lesion modification ('investment procedures') at the end of unsuccessful first attempts increased the chance of subsequent success (96% vs 71%). CONCLUSIONS: Hybrid-trained operators can achieve overall success rates of 90% in real world practice with acceptable MACE. Use of dissection re-entry and investment procedures maintains high success rates in complex lesions. The hybrid approach represents a significant advance in CTO treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
OBJECTIVES: Treatment options for coronary chronic total occlusions (CTO) are limited, with low historical success rates from percutaneous coronary intervention (PCI). We report procedural outcomes of CTO PCI from 7 centres with dedicated CTO operators trained in hybrid approaches comprising antegrade/retrograde wire escalation (AWE/RWE) and dissection re-entry (ADR/RDR) techniques. METHODS: Clinical and procedural data were collected from consecutive unselected patients with CTO between 2012 and 2014. Lesion complexity was graded by the Multicentre CTO Registry of Japan (J-CTO) score, with ≥2 defined as complex. Success was defined as thrombolysis in myocardial infarction 3 flow with <30% residual stenosis, subclassified as at first attempt or overall. Inhospital complications and 30-day major adverse cardiovascular events (MACEs, death/myocardial infarction/unplanned target vessel revascularisation) were recorded. RESULTS: 1156 patients were included. Despite high complexity (mean J-CTO score 2.5±1.3), success rates were 79% (first attempt) and 90% (overall) with 30-day MACE of 1.6%. AWE was highly effective in less complex lesions (J-CTO ≤1 94% success vs 79% in J-CTO score ≥2). ADR/RDR was used more commonly in complex lesions (J-CTO≤1 15% vs J-CTO ≥2 56%). Need for multiple approaches during each attempt increased with lesion complexity (17% J-CTO ≤1 vs 48% J-CTO ≥2). Lesion modification ('investment procedures') at the end of unsuccessful first attempts increased the chance of subsequent success (96% vs 71%). CONCLUSIONS: Hybrid-trained operators can achieve overall success rates of 90% in real world practice with acceptable MACE. Use of dissection re-entry and investment procedures maintains high success rates in complex lesions. The hybrid approach represents a significant advance in CTO treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Lei Song; Akiko Maehara; Matthew T Finn; Sanjog Kalra; Jeffrey W Moses; Manish A Parikh; Ajay J Kirtane; Michael B Collins; Tamim M Nazif; Khady N Fall; Raja Hatem; Ming Liao; Tiffany Kim; Philip Green; Ziad A Ali; Candido Batres; Martin B Leon; Gary S Mintz; Dimitri Karmpaliotis Journal: JACC Cardiovasc Interv Date: 2017-05-22 Impact factor: 11.195
Authors: Peter Tajti; Iosif Xenogiannis; Dimitris Karmpaliotis; Khaldoon Alaswad; Farouc A Jaffer; M Nicholas Burke; Imre Ungi; Emmanouil S Brilakis Journal: Curr Cardiol Rep Date: 2018-10-22 Impact factor: 2.931