Purchase Manual of Coronary Chronic Total Occlusion Interventions - 1st Edition. Print Book & E-Book. ISBN 9780124201293, 9780128004326
Increased interest focusing on coronary chronic total occlusions has emerged since several studies have proven improved cardiovascular outcomes and quality of life after successful chronic total occlusion (CTO) revascularization. CTO of an epicardial coronary artery is one of the leading challenging complex lesion type when percutaneous coronary intervention (PCI) is indicated.
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BACKGROUND: Coronary chronic total occlusions (CTO) are the most challenging lesions to treat percutaneously. Thus, consistent efforts are made to develop new approaches to treat CTO. OBJECTIVE: To explore the key points of a novel ``crowbar effect
Background: With the improved lifestyle of people, the incidence of coronary artery disease is gradually increasing. Approximately 15% - 20% of patients undergoing diagnostic catheterization had one or more chronically occluded coronary arteries. Method: The patients who were diagnosed with chronic total occlusion (CTO) in our hospital within one year period have been included. They were initially divided into two groups based on angiographic reports: single vessel disease (SVD) and non-single vessel disease (non-SVD) group, then into optimal medical therapy (OMT) group, percutaneous coronary intervention (PCI) group and coronary artery bypass graft (CABG) group. Finally, PCI group is further divided into PCI of CTO lesion (CTO PCI group) and PCI of non-CTO lesion (non-CTO PCI group). Results: A total of 261 patients were enrolled as CTO patients, mean age was 62.83 years, 70.1% were male patients. The incidence rate of common risk factors was hypertension (64.4%), followed by smoking (48.3%), diabetes
AbstractBackgroundThe benefits of chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) are being questioned. The aim of this study was to assess the effects of CTO PCI on absolute myocardial perfusion, as compared with PCI of hemodynamically significant non ‐CTO lesions.MethodsConsecutive patients with a preserved left ventricular ejection fraction ( ≥50%) and a CTO...
The reverse CART technique provides the potential to modify the retrograde procedure by improving the controlled movement of the retrograde wire and improve the success rates of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Development of interventricular hematoma is a rare complication of CTO PCI. A 63-year-old man with effort angina with a right coronary artery CTO lesion underwent PCI by retrograde approach from the LAD to a septal branch. A contrast "stain" was demonstrated surrounding the septal collateral channel used for the retrograde approach at the end of the procedure without symptom ...
TY - JOUR. T1 - Coronary Computed Tomography Angiography Predicts Guidewire Crossing and Success of Percutaneous Intervention for Chronic Total Occlusion. AU - Yu, Cheol Woong. AU - Lee, Hyun Jong. AU - Suh, Jon. AU - Lee, Nae Hee. AU - Park, Sang Min. AU - Park, Taek Kyu. AU - Yang, Jeong Hoon. AU - Song, Young Bin. AU - Hahn, Joo Yong. AU - Choi, Seung Hyuk. AU - Gwon, Hyeon Cheol. AU - Lee, Sang Hoon. AU - Choe, Yeon Hyeon. AU - Kim, Sung Mok. AU - Choi, Jin Ho. PY - 2017/4/1. Y1 - 2017/4/1. N2 - Background - We developed a model that predicts difficulty of percutaneous coronary intervention for coronary chronic total occlusion (CTO) using coronary computed tomographic angiography. Methods and Results - A total of 684 CTO lesions with preprocedural computed tomographic angiography were enrolled from 4 centers. Data were randomly divided into derivation and validation datasets at 2:1 ratio. The end point was successful guidewire crossing ≤30 minutes, which was met in 50%. The KCCT (Korean ...
A 73-year-old man with unstable angina was found to have a severely calcified chronic total occlusion (CTO) of the mid left anterior descending coronary artery (LAD). Diagnostic coronary angiography confirmed the CTO to be complex, with a "flush" occlusion occurring in a segment associated with proximal septal and diagonal branches. Retrograde filling of the distal LAD occurred via 2 large septal perforators from the right coronary artery (RCA). Cardiac magnetic resonance imaging demonstrated preserved left ventricular systolic function with viability.. After discussion, the patient opted for percutaneous coronary intervention. Intervention was performed by 2 high-volume CTO operators with extensive experience of retrograde CTO percutaneous coronary intervention. An initial antegrade approach failed to negotiate the calcific CTO lesion (Figure 1A). A subsequent attempt was made to treat the CTO via … ...
Contributors All authors have read and approved the manuscript. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Each author has contributed significantly to the submitted work and namely: CG, AG, AS and FM started the study and did the final validation of the results; LB, CAP, AM and AB were responsible for the collection analysis and interpretation of the data. AC, MC, GFrag and LA revised the manuscript for intellectual content. GBZ and GFrat revised the manuscript for the statistical methods; the paper received an important input from MC, MM, AM and AC. CG is responsible for the overall content as guarantor. ...
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Since data from the 2 landmark studies, the BENESTENT and STRESS studies, showed that coronary stenting significantly decreases restenosis as compared with conventional balloon angioplasty, this treatment modality has shown to be superior in an increasing number of indications. Percutaneous coronary intervention of chronic total occlusions (CTO), however, is still limited by high restenosis rates. Although coronary stenting using bare metal stents significantly decreases restenosis in CTO, restenosis rates still reach 32% to 55%.. In 200 patients with CTO randomized in the PRISON I study, we demonstrated a restenosis rate of 22% after bare metal stent implantation as compared with 33% after conventional balloon angioplasty. During the past few years, sirolimus (rapamycin), a cytostatic macrocyclic lactone with anti-inflammatory and antiproliferative properties, delivered from a polymer-encapsulated stent was shown to almost eliminate the risk of restenosis in selected groups of patients.. In ...
Chronic total coronary occlusions (CTO) still remain one of the most technically challenging clinical scenarios in which to perform interventions. Although the antegrad..
Purpose: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still one of the challenging procedures. Multislice computed tomographic coronary angiography (CTCA) allows reliable non-invasive evaluation of coronary artery by visualizing calcium deposit, vessel tortuosity, distal flow, etc. even in the occluded site. The aim of this study is to determine the morphological predictors of procedural success in PCI for CTO using CTCA, and to estimate the value of CTCA to predict procedural outcome.. Methods: Using Somatom Sensation Cardiac 64, we performed CTCA in 91 patients who have CTO prior to PCI, and 93 CTO lesions were scanned. CTO was defined as complete occlusion of a major coronary artery on catheter coronary angiography, which was deemed to be of , 3 months duration. Procedural success was defined as complete cross of the guidewire to the occluded site. Retrograde approach, in which the guidewire was advanced from the distal end of the occluded site through the ...
First, a 5-F catheter was inserted via a femoral vein and advanced to the right atrium to record mean right atrial pressure (PRA). This catheter also served as central venous line. Then the donor artery was visualized by a 6-F guiding catheter, and a pressure wire (PressureWire, RADI Medical Systems, Uppsala, Sweden) was advanced into artery. The pressure sensor was positioned exactly at the takeoff of the collateral, and the local pressure (PD) together with the mean aortic root pressure (PAo) were recorded during 3 min of maximum peripheral vasodilation induced by central venous infusion of adenosine (140 μg/kg/min). The pressure difference along the epicardial donor artery segment was measured as: PAo− PD. Before and during adenosine infusion, PRAwas recorded. The FFRDwas calculated as: (PD− PRA)/(PAo− PRA) (17,18). After stopping adenosine and returning to baseline pressures, the wire was advanced further distal into the donor artery in order to assess the CFRDusing the recently ...
The main finding from this large prospective, observational, multicenter registry of consecutive CTO recanalizations across all U.K. PCI centers between 2005 and 2009 is the strong association between successful CTO revascularization and improved survival over a median follow-up of 2.65 years (interquartile range: 1.59 to 3.83 years). This is important because a recent large observational study found an association between successful CTO intervention and fewer cardiovascular deaths but did not demonstrate an increase in absolute survival (9). The improvement in survival remained after multivariate analysis, suggesting that it is independent of measurable confounding factors. The survival outcome of successful revascularization did not vary between the different epicardial vessels.. Increasing age, diabetes, heart failure, smoking, and renal disease were confirmed as factors associated with increased all-cause mortality, whereas increasing age, smoking history, increasing body mass index, ...
Chronic total occlusions (CTO) are encountered in almost one-fourth of patients undergoing coronary angiography. The presence of an untreated CTO has been related to adverse clinical prognosis, both in stable angina and acute myocardial infarction, and is often associated with persistent symptomatic angina. Depending on their symptomatic and functional status as well as anatomical complexity, CTO can be treated by optimal medical therapy only or therapy combined with coronary revascularization.. The potential benefits of percutaneous coronary intervention (PCI) in CTO include symptom relief, improved left ventricular function, and potentially a survival advantage associated with success when compared with failed revascularization. Of note, marked advances in endovascular techniques and device technology have resulted in substantial improvements of procedural success rates of PCI in CTO.. In spite of these advances, the vast majority of patients with CTO are still being managed medically or ...
OBJECTIVE: Chronic total occlusion (CTO) of coronary arteries represents a challenge for percutaneous treatment. Although ameroid constrictors have been used to create CTOs from extrinsic compression of coronary arteries, this model is not suitable f
The prevalence of heart failure depends on the definition used, but it is estimated that it affects approximately 1% to 2% of the general population and approximately 10% of those ,70 years of age, with coronary artery disease being the most common etiology (1). Chronic total occlusions (CTO) are found in ∼20% of patients without prior surgical revascularization undergoing nonurgent coronary angiography (2). This incidence is even higher in selected subgroups of patients such as those presenting with an acute coronary syndrome (47%), prior surgical bypass (coronary artery bypass grafting [CABG]) (89%), or in implantable cardioverter defibrillator recipients due to ischemic cardiomyopathy (∼50%) (3-6). It has largely been shown that the presence of a CTO confers a negative impact on long-term prognosis in several clinical scenarios. In the setting of acute coronary syndrome (with or without cardiogenic shock), a coexisting CTO is associated with worse early and late mortality (3,7,8). In ...
Percutaneous revascularisation of chronic total occlusions (CTO) is limited by failure of guidewire crossing. Neovascularisation within the proximal CTO segment may be important for guidewire crossing and dramatically declines in CTO beyond six weeks
OBJECTIVE: This study aimed to examine predictors and clinical outcomes of periprocedural myocardial infarction (PMI) after chronic total occlusion (CTO) intervention. BACKGROUND: There are limited data on the clinical implications of PMI after CTO intervention in the new-generation drug-eluting stent (DES) era. METHODS: We enrolled 337 patients who underwent CTO intervention and met the study criteria. We evaluated the incidence and predictors of PMI, defined as an increase in creatine kinase-MB ≥3× the upper limit of normal (ULN) after intervention and compared the occurrence rates of major adverse cardiac and cerebrovascular events (MACCE, defined as the composite of cardiac death, myocardial infarction, stent thrombosis, target-vessel revascularization, or cerebrovascular accidents) between the PMI and non-PMI groups ...
The study is the largest in the United States to examine the safety and effectiveness of a so-called retrograde approach to angioplasty and stenting of chronic total occlusions (CTOs). Using this innovative technique, interventional cardiologists at three medical centers were successful in tunneling through the obstruction, opening the blocked artery and restoring blood flow to the heart in about 80 percent of patients, many of whom had no alternative treatment options.. "Patients with chronic total occlusions experience chest pain, shortness of breath and other disabling symptoms," said Tesfaldet T. Michael, MD, a cardiology research fellow at the University of Texas Southwestern Medical Center inDallas. "When medical therapy fails, percutaneous coronary intervention (PCI) may be the last resort. It really helps patients to have a better quality of life.". Up to one-third of patients who undergo diagnostic angiography have cholesterol plaque that completely blocks a coronary artery. If they ...
Several large studies (2,5) have reported on the clinical impact of successful percutaneous CTO revascularization. In particular, studies have shown that successful PCI of a CTO lesion reduces the incidence of MI, cardiac death, and bypass surgery, resulting in enhanced 1-year survival. From this point of view, the influence of the immediate result of a CTO procedure on long-term outcomes is an important factor. In recent contemporary series, procedural success rates have ranged from 55% to 80%, with the variability reflecting differences in operator technique and experience, availability of advanced guidewires, CTO definitions, and case selection (2,15). Recent procedural outcomes after PCI for CTO lesions have increased significantly due to improved device technology, as well as technique and experience, such that successful recanalization of true CTOs may now be achieved in approximately 80% of attempted lesions (2,5,16). We reported that technical success was achieved in 207 (92.4%) of 224 ...
Expertise, Disease and Conditions: Acute Myocardial Infarction (AMI), Cardiac Catheterization, Cardiovascular Diseases, Cardiovascular Interventions, Carotid Artery Disease, Carotid Artery Stenosis, Carotid Artery Stenting, Chronic Total Coronary Occlusion, Chronic Total Occlusions, Circulatory Support Devices, Coronary Angiography, Coronary Artery Disease, Coronary Artery Stenting, Coronary Care Unit, Emboli-Protection Devices, Endovascular Therapies, Fractional Flow Reserve, Heart Disease, Hypertension, Interventional Cardiology, Intravascular Ultrasound (IVUS), Invasive Cardiology, Laser Atherectomy, Lower Extremity Revascularization, Pericardiocentesis, Peripheral Angiography, Peripheral Arterial Disease (PAD), Peripheral Vascular Disease, Renal Artery Disease, Restenosis, Rotational Atherectomy, Trans-Radial Intervention, Valvular Heart Disease, Valvuloplasty for Valvular ...
PCI was successful in a total of 582 (69.6%) procedures. Stents were implanted in 97.0% of successful procedures and drug-eluting stents were used in 73%. Procedural complications, including coronary dissection, were more frequent in unsuccessful cases (20.5% vs. 4.9%; p < 0.0001), but there was no difference in in-hospital major adverse cardiac events (3% vs. 2.1%; p = not significant). All-cause mortality at 5 years was significantly higher in patients with failed recanalization (17.2% vs. 4.5%; p < 0.0001). The need for coronary artery bypass grafting was significantly lower following successful CTO PCI (3.1% vs. 22.1%; p < 0.0001). After adjusting for the differences in baseline variables, successful PCI of a CTO was independently associated with a lower mortality (hazard ratio, 0.32; 95% confidence interval, 0.18-0.58).. ...
Expertise, Disease and Conditions: Acute Coronary Care, Acute Coronary Syndrome (ACS), Acute Myocardial Infarction (AMI), Adult Congenital Heart Disease, Angina, Angioplasty, Atherosclerosis, Atherosclerosis Imaging, Cardiac Catheterization, Cardiac Disease, Cardiac Imaging, Cardiology, Cardiomyopathy, Cardiovascular Computed Tomography, Cardiovascular Disease in Women, Cardiovascular Disease with Chronic Renal Disease, Cardiovascular Diseases, Cardiovascular Interventions, Cardiovascular Medicine, Cardioversion, Chest Pain, Chronic Total Coronary Occlusion, Chronic Total Occlusions, Clinical Cardiology, Congenital Heart Disease, Congestive Heart Failure (CHF), Coronary Angiography, Coronary Artery Disease, Coronary Artery Stenting, Coronary CT Angiography, Coronary Endothelial Function, CT Angiography, General Cardiology, Heart Attack, Heart Conditions, Heart Disease, Heart Disease Prevention and Treatment in Women, Hypertrophic Cardiomyopathy, Interventional Cardiology, Intravascular ...
The data were statistically analyzed by SPSS Statistics version 24 (IBM, Armonk, NY, USA) and Medcalc 11.1 statistical program (Medcalc, Gent, Belgium). Continuous values are expressed as means±standard deviation. Categorical data are presented as frequencies and percentages. Normality was evaluated by the Shapiro-Wilk test. Normally distributed values were compared by an unpaired t test, and non‐normally distributed values were compared by the Kruskal-Wallis rank test or the Mann-Whitney U test. Categorical data were compared by the χ2 test or Fisher exact test. We used logistic regression models to identify predictors of technical failure in overall CTO‐PCI by univariate and multivariate analysis with a forward stepwise algorithm and forced inclusion models. However, logistic regression analyses are sometimes difficult to apply directly to patients in daily clinical practice because of variation in the number, type, and severity of their comorbidities. Therefore, recursive partitioning ...
The procedural success rates of percutaneous intervention for chronic total coronary occlusions (CTOs) over the past decade have been increasing, driven by the development of specialized guidewires and microcatheters and the introduction of new technical strategies, including antegrade subintimal re-entry and the retrograde transcollateral approach. An ongoing challenge is to select the most promising strategy early to reduce total procedure time, to reduce radiation and contrast exposure, and to further improve complication-free procedural success rates. In this regard, procedural planning is typically based on the angiographic assessment of the occluded lesion, including features of the proximal cap, the extent of calcification, and the apparent length of the lesion (1). Pre-procedural coronary computed tomographic angiography (CTA) with modern high-resolution scanners may provide incremental information about the features of the coronary occlusion, which might enhance procedural planning and ...
Philips, in collaboration with Radcliffe Cardiology, are pleased to present an in-depth interview with Prof. Gerald Werner (Darmstadt, DE) discussing the important role that IVUS imaging plays in his CTO procedures
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The ESC congress in Vienna heard that drug eluting stents are highly effective in chronically occluded arteries, when compared with bare metal stents. Derek Thorne got more on this German study from Gerald Werner, of Klinikum Darmstadt in Germany ...
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by Physicians Weekly , Aug 23, 2012. The Occluded Artery Trial (OAT) was a large, randomized controlled study funded by the National Heart, Lung, and Blood Institute that tested routine percutaneous recanalization of persistently totally occluded infarct-related arteries identified a minimum of 24 hours after myocardial infarction (MI) in stable patients who did not have triple vessel disease or severe inducible ischemia. In 2006, results from OAT were released, showing that there appears to be no benefit to routinely using PCI for persistently totally occluded infarct-related arteries in this patient population. Routine PCI for these arteries did not reduce mortality, reinfarction, or class IV heart failure. These results subsequently led to updates of guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) on unstable angina/non-STEMI, STEMI, and PCI in 2007. The revised guidelines recommended that PCI not be performed in this context. Prior to OAT data ...
by Physicians Weekly , Aug 23, 2012. The Occluded Artery Trial (OAT) was a large, randomized controlled study funded by the National Heart, Lung, and Blood Institute that tested routine percutaneous recanalization of persistently totally occluded infarct-related arteries identified a minimum of 24 hours after myocardial infarction (MI) in stable patients who did not have triple vessel disease or severe inducible ischemia. In 2006, results from OAT were released, showing that there appears to be no benefit to routinely using PCI for persistently totally occluded infarct-related arteries in this patient population. Routine PCI for these arteries did not reduce mortality, reinfarction, or class IV heart failure. These results subsequently led to updates of guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) on unstable angina/non-STEMI, STEMI, and PCI in 2007. The revised guidelines recommended that PCI not be performed in this context. Prior to OAT data ...
A method and systems for treating chronic total occlusions, particularly those that are difficult to treat, is disclosed. In this approach, recanalizing the CTO is achieved using a combined antegrade and retrograde approach. The proximal end of the occlusion is penetrated using an antegrade wire, using a traditional approach. Using collateral vessels, the distal end of the occlusion is crossed in a retrograde fashion. By appropriately maneuvering each member and applying radiofrequency energy between the proximal and distal ends of the occlusion, a continuous channel is created.
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A dual lumen guidewire support catheter for accurately crossing a chronic total occlusion in a vessel is disclosed. The dual lumen guidewire support catheter includes a first lumen portion and a second lumen portion sharing a common side and a common distal end. The first lumen portion can be a rapid exchange or over-the-wire portion, while the second lumen portion is an over the wire portion. One or both of the portions can include a discontinuity to enable removal of a guidewire following placement through or at an occlusion or lesion.
Avinger has received FDA clearance to market its Wildcat catheter for crossing chronic total occlusions (CTOs) to help treat peripheral artery disease (PAD).
The trial aims to investigate the safety and tolerability of acute intracoronary injected collagenase in patients with chronic total coronary artery occlusions
About Spectranetics. The Spectranetics Corporation develops, manufactures, markets and distributes medical devices used in minimally invasive procedures within the cardiovascular system. The Companys products are available in over 65 countries and are used to treat arterial blockages in the heart and legs and in the removal of pacemaker and defibrillator leads.. The Companys Vascular Intervention (VI) products include a range of laser catheters for ablation of blockages in arteries above and below the knee, the AngioSculpt scoring balloon used in both peripheral and coronary procedures, and the Stellarex drug-coated balloon peripheral angioplasty platform, which received European CE mark approval in December 2014. The Company also markets support catheters to facilitate crossing of peripheral and coronary arterial blockages, and retrograde access and guidewire retrieval devices used in the treatment of peripheral arterial blockages, including chronic total occlusions. The Company markets ...
News and information on minimally invasive coronary disease therapies, covering valvular, structural, radial access, chronic total occlusion, and imaging issues.
PGOcclsion is dedicated to the toughtful discussion of concept of Posterior Guided Occlusion, this page provides a subset of the papers that form the basis of the idea.
SAN DIEGO, CA-One-fifth of patients undergoing PCI for a chronic total occlusion (CTO) have chronic kidney disease (CKD), according to new registry data. However, while the incidence of contrast-induced acute kidney injury (CI-AKI) was almost doubled for patients with CKD, this did not lead to higher rates of new dialysis or target lesion failure over follow-up.. Lorenzo Azzalini, MD, PhD (San Raffaele Scientific Institute, Milan, Italy), who presented the results Friday at TCT 2018, told TCTMD that these results should encourage dedicated CTO operators in that they "should not be scared" to perform this procedure in patients with CKD. Rather, good results can be achieved by paying attention to identifying high-risk patients, using intravenous hydration, avoiding ad hoc procedures, setting a maximum contrast level, and defaulting to a retrograde approach, he stressed.. The study, also appearing in the October 2018 issue of the Canadian Journal of Cardiology, included 1,092 patients-19.6% with ...
Abstract To define the prevalence of total coronary occlusion in the hours after transmural myocardial infarction, we used coronary arteriography to study the degree of coronary obstruction in 322 patients admitted within 24 hours of infarction. Total coronary occlusion was observed in 110 of 126 patients (87 per cent) who were evaluated within four hours of the onset of symptoms; this proportion decreased significantly, to 37 of 57 (65 per cent), when patients were studied 12 to 24 hours after the onset of symptoms. Among 59 patients with angiographic features of coronary thrombosis, the thrombus was retrieved by Fogarty catheter in 52 (88 per cent) but was absent in seven (12 per cent false positive). Among an additional 20 patients without angiographic features of thrombosis, a thrombus was discovered in five (25 per cent false negative). Thus, total coronary occlusion is frequent during the early hours of transmural infarction and decreases in frequency during the initial 24 hours, ...
1 Kavteladze Z. Retrograde recanalization of tibial CTOs. Presented at: TCT 2010; September 21-25, 2010; Washington, DC.. 2 Montero-Baker M, Schmidt A, Bräunlich S, et al. Retrograde approach for complex popliteal and tibioperoneal occlusions. J Endovasc Ther. 2008;15(5):594-604.. 3 Belch JJ, Topol EJ, Agnelli G, et al. Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med. 2003;163(8):884-892.. 4 Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33(suppl 1):S1-S75.. 5 Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes. In: Harris MI, Cowie CC, Stern MP, et al., eds. Diabetes in America. 2nd ed. Washington, DC: National Institute of Diabetes and Digestive and Kidney Diseases, 1995:409-428.. ABOUT COOK MEDICAL. A global pioneer in medical breakthroughs, Cook Medical is committed to creating effective ...
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December 1, 2016-A prospective, multicenter, observational study evaluated the safety and effectiveness of tibiopedal access and retrograde crossing in the treatment of infrainguinal chronic total occlusions (CTOs). The study demonstrated that tibiopedal access appears to be safe and can be used effectively for the crossing of infrainguinal lesions in patients with severe lower limb ischemia. Craig M. Walker, MD, et al published the studys findings in the Journal of Endovascular Therapy (JEVT; 2016;23:839-846).. The study was conducted at 12 sites around the world from May 2012 to July 2013. Investigators prospectively enrolled 197 patients (mean age, 71 ± 11 years; range, 41-93 years; 129 men) who met the inclusion criterion of at least one CTO for which a retrograde crossing procedure was planned or became necessary. The study population was composed of 64 (32.5%) claudicants (Rutherford categories 2/3) and 133 (67.5%) patients with critical limb ischemia (Rutherford category ≥ 4).. The ...
A new study found that intravascular ultrasound (IVUS)-guided intervention in patients with chronic total occlusion (CTO) could improve outcomes compared to a conventional angiography-guided approach during percutaneous coronary intervention. The IVUS-CTO study is the first randomized trial to examine the clinical impact of IVUS guidance for CTO intervention.
Coronary CT angiography (CCTA) has revealed the presence of well-developed distal collaterals in patients with chronic total occlusion and the extent of downstream myocardial infarction, according to a study published online Feb. 19 by Radiology.
This program is geared toward the interventionalist seeking to increase their knowledge on the evaluation and comprehensive management of complex and higher-risk patients undergoing coronary revascularization. Emphasizing a case-based presentation format with audience interactivity, participants will learn how to assess and plan indicated procedures from access through post-procedural care, tackling issues such as revascularization of complex lesions (calcified lesions, bifurcations, chronic total occlusions, in-stent restenosis, and lesions in the post-CABG setting), and when and how to use hemodynamic support. The use of simulator training will further enhance the learning experience for interventionalists and fellows. Expert faculty will offer insights into selecting devices and patients, optimizing technique, and overcoming difficult anatomy. The latest clinical data and guidelines for complex, higher-risk procedures also will be reviewed. ...