Taishi Hirai1, J Aaron Grantham2,3, James Sapontis4, David J Cohen2,3, Steven P Marso5, William Lombardi6, Dimitri Karmpaliotis7, Jeffrey Moses7, William J Nicholson8, Ashish Pershad9, R Michael Wyman10, Anthony Spaedy11, Stephen Cook12, Parag Doshi13, Robert Federici14, Karen Nugent3, Kensey L Gosch3, John A Spertus2,3, Adam C Salisbury2,3. 1. University of Chicago Medical Center, Chicago, Illinois. 2. Saint Luke's Mid America Heart Institute, Kansas City, Missouri. 3. University of Missouri Kansas City, Kansas City, Missouri. 4. Monash Heart, Melbourne, Australia. 5. Research Medical Center, Kansas City, Missouri. 6. University of Washington, Seattle, Washington. 7. Columbia University, New York Presbyterian Hospital, New York, New York. 8. York Hospital, York, Pennsylvania. 9. Banner Good Samaritan Medical Center, Phoenix, AZ and Banner Heart, Mesa, Arizona. 10. Torrance Medical Center, Torrance, California. 11. Boone County Hospital, Columbia, Missouri. 12. Peacehealth Sacred Heart Medical Center, Springfield, Oregon. 13. Alexian Brothers Medical Center, Chicago, Illinois. 14. FHS, Albuquerque, New Mexico.
Abstract
OBJECTIVES: We sought to determine the impact of subintimal plaque modification (SPM) on early health status following unsuccessful chronic total occlusion (CTO) PCI. BACKGROUND: Intentionally dilating the subintimal space during unsuccessful CTO PCI to facilitate flow through dissection planes and improve success of repeat PCI attempts is a technique used by some hybrid operators, and may improve health status by restoring distal vessel flow despite unsuccessful CTO PCI. METHODS: We studied 138 patients who underwent unsuccessful CTO PCI in a 12-center CTO PCI registry. Safety was assessed by comparing in-hospital outcomes of patients undergoing unsuccessful CTO PCI with and without SPM. The association between SPM and health status was quantified using the Seattle Angina Questionnaire Summary Score (SAQ SS), and the association between SPM and SAQ SS was determined using multivariable regression. RESULTS: SPM was performed in 59 patients (42.8%). Complication rates were similar comparing those with and without SPM. At 1-month, patients treated with SPM had larger increases in SAQ SS compared to patients who were not (28.3 ± 21.7 vs. 16.8 ±20.2, P = 0.012), and SPM was associated with an adjusted mean 10.5 point (95% CI 1.4-19.7, P = 0.02) greater SAQ SS improvement through 30 days. CONCLUSION: SPM was performed in almost half of unsuccessful CTO PCIs and was not associated with increased procedural complications. SPM was independently associated with better patient-reported health status at 30 days. Further studies are needed to assess the necessity of subsequent PCI in patients with significant health status improvements after SPM.
OBJECTIVES: We sought to determine the impact of subintimal plaque modification (SPM) on early health status following unsuccessful chronic total occlusion (CTO) PCI. BACKGROUND: Intentionally dilating the subintimal space during unsuccessful CTO PCI to facilitate flow through dissection planes and improve success of repeat PCI attempts is a technique used by some hybrid operators, and may improve health status by restoring distal vessel flow despite unsuccessful CTO PCI. METHODS: We studied 138 patients who underwent unsuccessful CTO PCI in a 12-center CTO PCI registry. Safety was assessed by comparing in-hospital outcomes of patients undergoing unsuccessful CTO PCI with and without SPM. The association between SPM and health status was quantified using the Seattle Angina Questionnaire Summary Score (SAQ SS), and the association between SPM and SAQ SS was determined using multivariable regression. RESULTS:SPM was performed in 59 patients (42.8%). Complication rates were similar comparing those with and without SPM. At 1-month, patients treated with SPM had larger increases in SAQ SS compared to patients who were not (28.3 ± 21.7 vs. 16.8 ±20.2, P = 0.012), and SPM was associated with an adjusted mean 10.5 point (95% CI 1.4-19.7, P = 0.02) greater SAQ SS improvement through 30 days. CONCLUSION:SPM was performed in almost half of unsuccessful CTO PCIs and was not associated with increased procedural complications. SPM was independently associated with better patient-reported health status at 30 days. Further studies are needed to assess the necessity of subsequent PCI in patients with significant health status improvements after SPM.
Authors: Poghni A Peri-Okonny; John A Spertus; J Aaron Grantham; Kensey Gosch; Ajay Kirtane; James Sapontis; William Lombardi; Dimitri Karmpaliotis; Jeffrey Moses; William Nicholson; Adam C Salisbury Journal: J Am Heart Assoc Date: 2019-04-02 Impact factor: 5.501
Authors: Leszek Bryniarski; Maksymilian P Opolski; Jarosław Wójcik; Maciej Lesiak; Tomasz Pawłowski; Jakub Drozd; Wojciech Wojakowski; Sławomir Surowiec; Maciej Dąbrowski; Adam Witkowski; Dariusz Dudek; Marek Grygier; Stanisław Bartuś Journal: Postepy Kardiol Interwencyjnej Date: 2021-03-27 Impact factor: 1.426