27 results on '"Kostantinis, Spyridon"'
Search Results
2. Activated Clotting Time and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry
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Simsek, Bahadir, primary, Rempakos, Athanasios, additional, Kostantinis, Spyridon, additional, Alexandrou, Michaella, additional, Gorgulu, Sevket, additional, Alaswad, Khaldoon, additional, Frizzell, Jarrod, additional, Yildirim, Ufuk, additional, Poommipanit, Paul, additional, Aygul, Nazif, additional, Abi Rafeh, Nidal, additional, Bagur, Rodrigo, additional, Davies, Rhian, additional, Goktekin, Omer, additional, Choi, James, additional, Reddy, Niranjan, additional, Dattilo, Philip, additional, Kerrigan, Jimmy, additional, Haddad, Elias, additional, Mastrodemos, Olga, additional, Rangan, Bavana, additional, Karacsonyi, Judit, additional, Allana, Salman, additional, Kearney, Kathleen, additional, Sandoval, Yader, additional, Burke, M. Nicholas, additional, Brilakis, Emmanouil, additional, and Azzalini, Lorenzo, additional
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- 2023
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3. Lesion Complexity and Procedural Outcomes Associated With Ostial Chronic Total Occlusions: Insights From the PROGRESS-CTO Registry
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Allana, Salman, primary, Kostantinis, Spyridon, additional, Simsek, Bahadir, additional, Karacsonyi, Judit, additional, Rempakos, Athanasios, additional, Alaswad, Khaldoon, additional, Krestyaninov, Oleg, additional, Khelimskii, Dmitrii, additional, Karmpaliotis, Dimitrios, additional, Jaffer, Farouc, additional, Khatri, Jaikirshan, additional, Poommipanit, Paul, additional, Patel, Mitul, additional, Mahmud, Ehtisham, additional, Koutouzis, Michael, additional, Tsiafoutis, Ioannis, additional, Gorgulu, Sevket, additional, Elbarouni, Basem, additional, Nicholson, William, additional, Jaber, Wissam, additional, Rinfret, Stephane, additional, Abi Rafeh, Nidal, additional, Goktekin, Omer, additional, Elguindy, Ahmed, additional, Sandoval, Yader, additional, Burke, M. Nicholas, additional, Rangan, Bavana, additional, and Brilakis, Emmanouil, additional
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- 2023
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4. Equipment Utilization in Chronic Total Occlusion Percutaneous Coronary Interventions: Update From the PROGRESS-CTO Registry
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Kostantinis, Spyridon, primary, Simsek, Bahadir, additional, Karacsonyi, Judit, additional, Rempakos, Athanasios, additional, Alaswad, Khaldoon, additional, Jaffer, Farouc, additional, Khatri, Jaikirshan, additional, Poommipanit, Paul, additional, Davies, Rhian, additional, Rinfret, Stephane, additional, Nicholson, William, additional, Jaber, Wissam, additional, Choi, James, additional, Patel, Mitul, additional, Koutouzis, Michael, additional, Tsiafoutis, Ioannis, additional, Gorgulu, Sevket, additional, Patel, Taral, additional, Jefferson, Brian, additional, Kerrigan, Jimmy, additional, Elbarouni, Basem, additional, Abi Rafeh, Nidal, additional, Goktekin, Omer, additional, ElGuindy, Ahmed, additional, Allana, Salman, additional, Mastrodemos, Olga, additional, Rangan, Bavana, additional, Sandoval, Yader, additional, Burke, M. Nicholas, additional, and Brilakis, Emmanouil, additional
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- 2023
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5. Adverse Events With Intravascular Lithotripsy After Coronary Use: A Report From the FDA MAUDE Database
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Rempakos, Athanasios, primary, Simsek, Bahadir, additional, Kostantinis, Spyridon, additional, Alexandrou, Michaella, additional, Karacsonyi, Judit, additional, Rangan, Bavana, additional, Mastrodemos, Olga, additional, Allana, Salman, additional, Sandoval, Yader, additional, Burke, M., additional, and Brilakis, Emmanouil, additional
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- 2023
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6. Outcomes of Patients With Acute Coronary Syndromes Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention
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Simsek, Bahadir, primary, Kostantinis, Spyridon, additional, Karacsonyi, Judit, additional, Gorgulu, Sevket, additional, Alaswad, Khaldoon, additional, Jaffer, Farouc, additional, Doshi, Darshan, additional, Khatri, Jaikirshan, additional, Poommipanit, Paul, additional, Aygul, Nazif, additional, Abi Rafeh, Nidal, additional, Krestyaninov, Oleg, additional, Khelimskii, Dmitrii, additional, Uretsky, Barry, additional, Davies, Rhian, additional, Goktekin, Omer, additional, ElGuindy, Ahmed, additional, Jefferson, Brian, additional, Patel, Taral, additional, Patel, Mitul, additional, Mastrodemos, Olga, additional, Rangan, Bavana, additional, Sandoval, Yader, additional, Allana, Salman, additional, Burke, M. Nicholas, additional, and Brilakis, Emmanouil, additional
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- 2022
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7. A Systematic Review and Meta-Analysis of Clinical Outcomes of Patients Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention.
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Simsek, Bahadir, Kostantinis, Spyridon, Karacsonyi, Judit, Alaswad, Khaldoon, Megaly, Michael, Karmpaliotis, Dimitrios, Masoumi, Amirali, Jaber, Wissam A., Nicholson, William, Rinfret, Stephane, Mashayekhi, Kambis, Werner, Gerald S., McEntegart, Margaret, Seung-Whan Lee, Khatri, Jaikirshan J., Harding, Scott A., Avran, Alexandre, Jaffer, Farouc A., Doshi, Darshan, and Hsien-Li Kao
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- 2022
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8. Primary vs Secondary Retrograde Approach in Chronic Total Occlusion Percutaneous Coronary Interventions.
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Kostantinis, Spyridon, Alaswad, Khaldoon, Karmpaliotis, Dimitri, Jaffer, Farouc, Jaber, Wissam, Nicholson, William, Rinfret, Stephane, Khatri, Jaikirshan, Poommipanit, Paul, Karacsonyi, Judit, Simsek, Bahadir, Vemmou, Evangelia, Nikolakopoulos, Ilias, Koutouzis, Michalis, Tsiafoutis, Ioannis, Riley, Robert, Sheikh, Abdul, Patel, Mitul, Gorgulu, Sevket, and ElGuindy, Ahmed M.
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- 2022
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9. Association of Annual Operator Volume With the Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention.
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Karacsonyi, Judit, Tsiafoutis, Ioannis, Alaswad, Khaldoon, Karmpaliotis, Dimitrios, Choi, James W., Khatri, Jaikirshan, Jaffer, Farouc A., Poommipanit, Paul, Patel, Mitul, Gorgulu, Sevket, Yeh, Robert, Elbarouni, Basem, ElGuindy, Ahmed, Krestyaninov, Oleg, Vemmou, Evangelia, Nikolakopoulos, Ilias, Kostantinis, Spyridon, Simsek, Bahadir, Rangan, Bavana V., and Ungi, Imre
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- 2022
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10. Incidence, Treatment, and Outcomes of Coronary Artery Perforation During Percutaneous Coronary Intervention.
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Avula, Vennela, Karacsonyi, Judit, Kostantinis, Spyridon, Simsek, Bahadir, Rangan, Bavana V., Gutierrez, Alessandra A., Burke, M. Nicholas, Garcia, Santiago, Mooney, Michael, Sorajja, Paul, Traverse, Jay H., Poulose, Anil, Chavez, Ivan, Wang, Yale, Goessl, Mario, and Brilakis, Emmanouil S.
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- 2022
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11. Temporal Trends in Retrograde Crossing of Epicardial Collaterals in Chronic Total Occlusion Percutaneous Coronary Intervention.
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Simsek, Bahadir, Kostantinis, Spyridon, Karacsonyi, Judit, Basir, Mir Babar, Megaly, Michael, Masoumi, Amirali, Jaffer, Farouc A., Gorgulu, Sevket, Brilakis, Emmanouil S., and Alaswad, Khaldoon
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- 2022
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12. Perceptions of interventional cardiologists on diversity and discrimination.
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Rempakos A, Alexandrou M, Simsek B, Kostantinis S, Karacsonyi J, Mutlu D, Hall A, Seto AH, Danek B, Shah B, Baechler C, Thomas D, Choi JW, Rier J, Kearney KE, Park K, Bennett M, Garcia S, Duong T, Kerrigan J, Al-Ogaili A, Rangan BV, Mastrodemos OC, Allana SS, Sandoval Y, Burke MN, and Brilakis ES
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- 2024
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13. Burnout in cardiology: a narrative review.
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Alexandrou M, Simsek B, Rempakos A, Kostantinis S, Karacsonyi J, Rangan BV, Mastrodemos OC, Allana SS, Rao SV, Linzer M, Egred M, Milkas A, Sandoval Y, Burke MN, and Brilakis ES
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- Humans, Cardiologists psychology, Workload psychology, Burnout, Professional psychology, Burnout, Professional epidemiology, Burnout, Professional etiology, Cardiology
- Abstract
The frequency of burnout is rising among cardiologists, affecting not only their well-being but also the quality of patient care. Computerization of practice, bureaucracy, excessive workload, lack of control/autonomy, hostile and hectic work environments, insufficient income, and work life imbalance are the main categories listed as contributing factors to cardiologists' burnout. Organization- and physician-directed interventions can be impactful; however, the effectiveness and feasibility of these interventions have rarely been assessed in cardiology. This review summarizes recent publications on burnout in cardiology, discusses the contributing factors and implications of burnout on physicians' health and patient safety, and explores possible interventions.
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- 2024
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14. Sex differences in the well-being of interventional cardiologists.
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Alexandrou M, Simsek B, Rempakos A, Kostantinis S, Karacsonyi J, Rangan BV, Mastrodemos OC, Kirtane AJ, Bortnick AE, Jneid H, Azzalini L, Milkas A, Alaswad K, Linzer M, Egred M, Rao SV, Allana SS, Sandoval Y, and Brilakis ES
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- Humans, Male, Female, Middle Aged, Sex Characteristics, Surveys and Questionnaires, Cardiologists, Burnout, Professional epidemiology, Burnout, Professional prevention & control
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Several studies suggest differences in burnout and coping mechanisms between female and male physicians. We conducted an international, online survey exploring sex-based differences in the well-being of interventional cardiologists. Of 1251 participants, 121 (9.7%) were women. Compared with men, women were more likely to be single and under 50 years old, and they asked more often for development opportunities and better communication with administration. Overall burnout was similar between women and men, but women interventional cardiology attendings were more likely to think that they were achieving less than they should. Improved communication with administration and access to career development opportunities may help prevent or mitigate burnout in women interventional cardiologists.
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- 2024
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15. Impact of target vessel on the procedural techniques and outcomes of chronic total occlusion percutaneous coronary intervention.
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Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Allana SS, Alaswad K, Basir MB, Davies RE, Benton SM Jr, Krestyaninov O, Khelimskii D, Jaber WA, Rinfret S, Nicholson W, Frizzell J, Jaffer FA, Khatri JJ, Poommipanit P, Choi JW, Chandwaney R, Jefferson BK, Patel TN, Al-Azizi KM, Potluri S, Aygul N, ElGuindy AM, Abi Rafeh N, Goktekin O, Alexandrou M, Mastrodemos OC, Rangan BV, Sandoval Y, Burke MN, Brilakis ES, and Gorgulu S
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- Humans, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Angiography, Percutaneous Coronary Intervention adverse effects, Vascular Diseases
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Background: There is limited information on the impact of the target vessel on the procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Methods: We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 11,580 CTO PCIs performed between 2012 and 2022 at 44 centers., Results: The most common CTO target vessel was the right coronary artery (RCA) (53.1%) followed by the left anterior descending artery (LAD) (26.0%) and the left circumflex artery (LCX) (19.8%). RCA CTOs were longer and more complex, with a higher Japanese CTO score compared with LAD or LCX CTOs. Technical success was higher among LAD (88.8%) lesions when compared with RCA (85.7%) or LCX (85.8%) lesions (P less than .001). The incidence of major adverse cardiovascular events (MACE) was overall 1.9% (n = 220) and was similar among target vessels (P=.916). There was a tendency toward more frequent utilization of the retrograde approach for more proximal occlusions in all 3 target vessels. When compared with all other RCA lesions combined, distal RCA lesions had higher technical success (87.7% vs 85.3%; P=.048). Technical success was similar between various locations of LAD CTOs (P=.704). First/second/third obtuse marginal branch had lower technical success when compared with all other LCX lesion locations (82.7% vs 86.8%; P=.014). There was no association between MACE and CTO location in all 3 target vessels., Conclusions: LAD CTO PCIs had higher technical and procedural success rates among target vessels. The incidence of MACE was similar among target vessels and among various locations within the target vessel.
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- 2023
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16. Atrial fibrillation and chronic total occlusion percutaneous coronary intervention outcomes: insights from the Progress-CTO registry.
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Alexandrou M, Rempakos A, Kostantinis S, Simsek B, Karacsonyi J, Choi JW, Poommipanit P, Khatri JJ, Young L, Davies R, Benton S, Jaffer FA, Chandwaney R, Azzalini L, ElGuindy AM, Rafeh NA, Koutouzis M, Tsiafoutis I, Goktekin O, Gorgulu S, Rangan BV, Mastrodemos OC, Allana SS, Sandoval Y, Burke MN, and Brilakis ES
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- Humans, Stroke Volume, Ventricular Function, Left, Atrial Fibrillation epidemiology, Atrial Fibrillation surgery, Percutaneous Coronary Intervention adverse effects, Peripheral Arterial Disease
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Background: We examined the effect of atrial fibrillation on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Methods: We examined the baseline characteristics and procedural outcomes of 9,166 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023., Results: Atrial fibrillation was present in 1122 (12%) patients. These patients were older and had a higher incidence of comorbidities, such as hypertension, dyslipidemia, heart failure, cerebrovascular disease, and peripheral arterial disease, lower left ventricular ejection fraction, and lower eGFR. Their CTOs were more likely to have moderate to severe calcification and longer lesion length. They also had higher mean J-CTO and PROGRESS-CTO complications (Acute MI, MACE, Mortality, Perforation, and Pericardiocentesis) scores. Patients with atrial fibrillation had higher prevalence of uncrossable and undilatable CTO lesions and required longer procedure (107 vs 119 min; P less than .001) and fluoroscopy (40 vs 43 min; P=.005) time. Technical success and MACE, including procedural/in-hospital bleeding, were similar in patients with and without atrial fibrillation. Although the crude incidence of MACE on follow-up (median 61 days) was significantly higher in patients with atrial fibrillation, the latter was not independently associated with adverse events on Cox proportional hazards analysis., Conclusions: Patients with atrial fibrillation undergoing CTO PCI are older, have more comorbidities, higher lesion complexity, and longer procedure time, but similar technical success and in-hospital MACE. They have higher MACE and mortality during follow-up, but the difference is not significant after adjusting for potential confounding variables.
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- 2023
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17. Incidence, treatment and outcomes of coronary artery dissection during percutaneous coronary intervention.
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Page E, Kostantinis S, Karacsonyi J, Allana SS, Walser-Kuntz E, Rangan BV, Simsek B, Rynders B, Mastrodemos OC, Stanberry L, Avula V, Rempakos A, Burke N, Sandoval Y, Mooney M, Sorajja P, Traverse JH, Poulose A, Chavez I, Wang Y, Gössl M, and Brilakis ES
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- Male, Humans, Female, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Incidence, Treatment Outcome, Coronary Angiography, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Myocardial Infarction etiology, Aortic Dissection
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Background: Coronary artery dissection is a feared and potentially life-threatening complication of percutaneous coronary intervention (PCI)., Methods: We examined the clinical, angiographic, and procedural characteristics, and outcomes of coronary dissection at a tertiary care institution., Results: Between 2014 and 2019, unplanned coronary dissection occurred in 141 of 10,278 PCIs (1.4%). Median patient age was 68 (60, 78) years, 68% were men, and 83% had hypertension. The prevalence of diabetes (29%), and prior PCI (37%) was high. Most target vessels were significantly diseased: 48% had moderate/severe tortuosity and 62% had moderate/severe calcification. The most common cause of dissection was guidewire advancement (30%), followed by stenting (22%), balloon angioplasty (20%), and guide-catheter engagement (18%). TIMI flow was 0 in 33% and 1-2 in 41% of cases. Intravascular imaging was used in 17% of the cases. Stenting was used to treat the dissection in 73% of patients. There was no consequence of dissection in 43% of patients. Technical and procedural success was 65% and 55%, respectively. In-hospital major adverse cardiovascular events occurred in 23% of patients: 13 (9%) had an acute myocardial infarction (MI), 3 (2%) had emergency coronary artery bypass graft surgery, and 10 (7%) died. During a mean follow up of 1612 days, 28 (20%) patients died, and the rate of target lesion revascularization was 11.3% (n=16)., Conclusion: Coronary artery dissection is an infrequent complication of PCI, but is associated with adverse clinical outcomes, such as death and acute MI.
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- 2023
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18. Frequency and outcomes of ad hoc chronic total occlusion percutaneous coronary intervention: insights from the progress-cto registry.
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Simsek B, Rempakos A, Kostantinis S, Karacsonyi J, Rinfret S, Jaber W, Nicholson W, Gorgulu S, Alaswad K, Khatri J, Poommipanit P, Aygul N, Krestyanino O, Khelimskii D, Uretsky B, Goktekin O, Dattilo P, Potluri S, Al-Azizi K, Mastrodemos OC, Rangan BV, Allana SS, Sandoval Y, Burke MN, and Brilakis ES
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- Humans, Treatment Outcome, Prospective Studies, Coronary Angiography methods, Registries, Chronic Disease, Risk Factors, Percutaneous Coronary Intervention methods, Coronary Occlusion diagnosis, Coronary Occlusion epidemiology, Coronary Occlusion surgery
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Background: Although discouraged, ad hoc chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is occasionally performed., Methods: We examined the clinical, angiographic characteristics, and procedural outcomes of patients who underwent ad hoc CTO PCI in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436)., Results: Of the 10,998 patients included in the registry, 899 (8.2%) underwent ad hoc CTO PCI. The incidence of ad hoc CTO PCI decreased from 18% in 2016 to 3% in 2022. Ad hoc CTO PCI patients had a lower prevalence of comorbidities and less complex angiographic characteristics demonstrated by lower J-CTO score (1.9±1.2 vs 2.4±1.3, P < .001). In these patients, PROGRESS-CTO major adverse cardiovascular events (MACE) (1.9±1.4 vs 2.5±1.7), mortality (1.2±1.0 vs 1.6±1.1), and perforation (1.5±1.2±2.2 vs 1.5) scores were lower (P < .001). Technical success was similar between the groups (86%). MACE were lower in the ad hoc CTO PCI group (.8% vs 2.0%, P=.009). Ad hoc CTO PCI was not associated with MACE after adjusting for potential confounders, odds ratio: .69 (95% confidence interval, .30-1.57). In patients with higher J-CTO scores, planned CTO PCI was associated with higher technical success (P < .001)., Conclusion: Approximately 8% of CTO PCI procedures are performed ad hoc, usually in less complex lesions and patients with lower complication risk. While ad hoc CTO PCI might be appropriate for carefully selected cases, a staged approach is recommended for most CTO PCI.
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- 2023
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19. Assessment of the ERCTO Score for Predicting Success in Retrograde Chronic Total Occlusion Percutaneous Coronary Interventions in the PROGRESS-CTO Registry.
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Rempakos A, Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, Mastrodemos OC, Allana S, Sandoval Y, Kalyanasundaram A, and Brilakis ES
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- Humans, Risk Factors, Treatment Outcome, Prospective Studies, Coronary Angiography, Chronic Disease, Registries, Percutaneous Coronary Intervention methods, Coronary Occlusion diagnosis, Coronary Occlusion surgery
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Background: The retrograde strategy is a common approach used in complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The ERCTO Retrograde score is a tool that aims to predict the likelihood of technical success for retrograde CTO PCI procedures by evaluating 5 parameters: calcification, distal opacification, proximal tortuosity, collateral connection classification, and operator volume., Methods: We evaluated the performance of the ERCTO Retrograde score using data from 2341 patients enrolled in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) at 35 centers between 2013 and 2023., Results: Retrograde CTO PCI was the primary crossing strategy in 871 cases (37.2%) and a secondary crossing strategy in 1467 cases (62.8%). Technical success was achieved in 1,810 cases (77.3%). The technical success rate was higher for primary retrograde cases compared with secondary retrograde cases (79.8% vs 75.9%; P=.031). The ERCTO Retrograde score was positively associated with the likelihood of procedural success. The c-statistic of the ERCTO retrograde score was 0.636 (95% confidence intervals [CI]: .610-.662) for all cases and 0.651 (95% CI: .607-.695) for primary retrograde cases., Conclusions: The ERCTO Retrograde score has modest predictive capacity for technical success in retrograde CTO PCI.
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- 2023
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20. Intravascular Imaging Use in Percutaneous Coronary Interventions of Chronic Total Occlusions.
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Karacsonyi J, Kostantinis S, Simsek B, Basir M, Megaly M, Ali Z, Kirtane A, McEntegart M, Brilakis ES, and Alaswad K
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- Humans, Coronary Angiography methods, Ultrasonography, Interventional methods, Stents, Chronic Disease, Treatment Outcome, Registries, Percutaneous Coronary Intervention methods, Coronary Occlusion etiology
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Background: Intravascular ultrasound (IVUS) can assist percutaneous coronary intervention (PCI) of chronic total occlusions (CTO)., Methods: We analyzed 8,983 CTO PCIs performed in 8,771 patients between 2012 and 2022 at 39 centers., Results: Overall, IVUS was used in 44.5% of the cases, for crossing in 11.5% and for stent optimization in 33.1%. IVUS for stent optimization was used more often for complex lesions with higher prevalence of calcification (51.2% vs 34.3%; P<.001); was associated with lower air kerma radiation dose (1.78 [1.00, 3.09] vs 2.30 (1.35, 3.91) min, P<.001) and contrast volume (190 [138, 258] vs 220 [160, 300] ml, P<.001). Among cases with successful guidewire crossing, those that used IVUS for stent optimization had higher technical (99.3% vs 96.3%; P<.001) and procedural (96.1% vs 94.6%, P=.002) success rates and similar major adverse complication event rates (2.04% vs 1.62%; P=.176). The use of IVUS for stent optimization significantly increased over time., Conclusion: In a contemporary, multicenter registry, IVUS was used in 44.5% and its use for stent optimization significantly increased over time. Cases where IVUS was used for stent optimization had higher technical and procedural success and similar risk of complications compared with cases where IVUS was not used for stent optimization.
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- 2023
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21. Coronary Angiography Within 30 Days From Coronary Artery Bypass Graft Surgery: Indications, Findings, and Outcomes.
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Simsek B, Rynders BD, Okeson BK, Rangan BV, Rempakos A, Kostantinis S, Karacsonyi J, Page E, Cahnbley M, Stanberry L, Mastrodemos OC, Allana S, Palmer S, Steffen R, Lodewyks C, Beckmann E, Sun B, Bapat V, Sandoval Y, Burke MN, and Brilakis ES
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- Humans, Middle Aged, Aged, Coronary Angiography, Coronary Artery Bypass, Treatment Outcome, Percutaneous Coronary Intervention, Coronary Artery Disease surgery
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Background: The incidence, indications, and outcomes of coronary angiography (CAG) performed within 30 days following coronary artery bypass graft surgery (CABG) have received limited study., Methods: We reviewed patients who underwent CAG within 30 days following CABG between April 2018 and September 2021 at a large quaternary healthcare system., Results: Of 2209 patients who underwent CABG during the study, 111 (5%) underwent CAG within 30 days following CABG. Mean age was 65 ± 10 years and they had high prevalence of comorbidities. Graft utilization was as follows: left internal mammary artery (LIMA) (84%); saphenous vein graft(s) (SVG) (81%); and right internal mammary artery (RIMA) (22%). The most common presentations/indications for angiography were cardiogenic shock (41%), ST-segment-elevation myocardial infarction (32%), and achieving complete revascularization by percutaneous coronary intervention (PCI) (16%). The LIMA, RIMA, and SVGs were completely/partially occluded in 41 (44%), 10 (42%), and 11 (50%) of patients, respectively. Of the 111 patients who underwent CAG, 55 (50%) underwent PCI, including 47 (85%) to the native vessel and 8 (15%) to the bypass graft, and 19 (17%) underwent repeat sternotomy. Overall, 29 patients (26%) required 30-day readmission following CAG and 19 (17%) died., Conclusion: The incidence of CAG within 30 days following CABG is approximately 5%. Patients who need CAG following CABG have high complication rates (26% readmission and 17% mortality, respectively, at 30 days).
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- 2023
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22. Update on Chronic Total Occlusion Percutaneous Coronary Intervention.
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Rempakos A, Kostantinis S, Simsek B, Karacsonyi J, Yamane M, Alaswad K, Basir M, Davies R, Benton SM Jr, Choi J, Gorgulu S, Khatri JJ, Nicholson W, Rinfret S, Jaber W, Egred M, Milkas A, Rangan BV, Mastrodemos OC, Sandoval Y, Allana S, Burke MN, and Brilakis ES
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- Humans, Treatment Outcome, Chronic Disease, Coronary Angiography methods, Risk Factors, Registries, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Coronary Occlusion diagnosis, Coronary Occlusion surgery
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Background: Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) lesions can be challenging to perform. In the present review we summarize recent publications in this rapidly evolving area grouped according to indications, outcomes, technique, and complications.
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- 2023
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23. Radial Artery Spasm, Excision of Avulsed Fragment and Uncompromised Flow: An Oxymoron in Invasive Cardiology.
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Karelas D, Kostantinis S, Papanikolaou J, and Platogiannis N
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- Humans, Coronary Angiography, Spasm etiology, Catheters, Radial Artery surgery, Cardiology
- Abstract
Transradial access may lead to anatomical and functional changes on the vessel wall due to puncture or material-associated trauma, inflammation and loss of endothelium's nitric oxide vasodilatory response. Despite the superficial and palpable radial artery course, caution and dexterity are important assets when puncturing, wiring, inserting the sheath, or maneuvering the catheters. Radial artery anatomic variations, tortuosity, and radial artery spasm are related with femoral access switch. The outer diameter of sheaths and catheters needs to match radial artery internal diameter; otherwise, friction or vascular stretch will occur, activating the surface endothelium and the coagulation cascade. Friction between the arterial wall and the equipment worsens endothelial function and precipitates patient discomfort, radial artery spasm, and ultimately, radial artery occlusion.
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- 2023
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24. Use of Bivalirudin for Chronic Total Occlusion Percutaneous Intervention: Insights From the PROGRESS-CTO Registry.
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Verreault-Julien L, Simsek B, Kostantinis S, Rempakos A, Karacsonyi J, Patel TN, Jefferson BK, Patel M, Poommipanit PB, Uretsky BF, Alaswad K, Gorgulu S, Goktekin O, Khatri J, Khelimskii D, Krestyaninov O, Allana S, Rinfret S, Nicholson WJ, Brilakis ES, and Jaber WA
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- Humans, Heparin adverse effects, Risk Factors, Prospective Studies, Treatment Outcome, Registries, Chronic Disease, Coronary Angiography, Coronary Occlusion diagnosis, Coronary Occlusion surgery, Percutaneous Coronary Intervention adverse effects
- Abstract
Background: There are limited data on the use of bivalirudin for chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Methods: We compared CTO-PCIs performed using bivalirudin vs unfractionated heparin in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO; NCT02061436). The primary endpoint was net adverse cardiac events (NACE), defined as major adverse cardiac events (MACE) and vascular complications., Results: Between 2012 and 2022, a total of 73 of 9723 procedures (0.75%) were performed using bivalirudin. The J-CTO score (2.4 ± 1.2 vs 2.4 ± 1.3; P=.73) and the PROGRESS-CTO score (1.4 ± 0.9 vs 1.2 ± 1.0; P=.31) were similar in both groups, and the retrograde approach was used less often in the bivalirudin group (15% vs 30%; P<.01). Procedural success (89% vs 85%; P=.35), in-hospital NACE (1.4% vs 2.1%; P>.99), incidence of MACE (0% vs 0.76%; P=.64), and vascular access complications (1.4% vs 0.9%; P=.48) were not different between the 2 groups. On multivariable analysis, use of bivalirudin was not associated with an increased risk of NACE (odds ratio, 0.99; 95% confidence interval, 0.13-7.27)., Conclusion: Bivalirudin is infrequently used during retrograde CTO-PCI. While the incidence of adverse events was similar with unfractionated heparin, larger studies are needed to assess the safety of bivalirudin.
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- 2023
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25. Body Mass Index and Chronic Total Occlusion Percutaneous Coronary Intervention Outcomes: Is Overweight the New Normal?
- Author
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Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, Davies RE, Jaffer FA, Doshi D, Azzalini L, Khatri J, and Brilakis ES
- Subjects
- Humans, Overweight complications, Body Mass Index, Treatment Outcome, Risk Factors, Chronic Disease, Registries, Coronary Angiography, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Coronary Occlusion diagnosis, Coronary Occlusion surgery, Coronary Occlusion etiology
- Abstract
Background: Although high body mass index (BMI) is a known risk factor for the development of cardiovascular diseases, people who are overweight or obese often have better outcomes after cardiac procedures. Whether this "obesity paradox" is observed in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is unknown. Therefore, we examined the association of BMI with the outcomes of CTO-PCI in patients from the large, multicenter PROGRESS-CTO registry after stratifying patients into 3 BMI groups.
- Published
- 2023
- Full Text
- View/download PDF
26. Outcomes of Patients With Acute Coronary Syndromes Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention.
- Author
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Simsek B, Kostantinis S, Karacsonyi J, Gorgulu S, Alaswad K, Jaffer FA, Doshi D, Khatri J, Poommipanit P, Aygul N, Abi Rafeh N, Krestyaninov O, Khelimskii D, Uretsky B, Davies R, Goktekin O, ElGuindy A, Jefferson BK, Patel TN, Patel M, Mastrodemos OC, Rangan BV, Allana S, Sandoval Y, Burke MN, and Brilakis ES
- Subjects
- Humans, Chronic Disease, Prospective Studies, Registries, Risk Factors, ST Elevation Myocardial Infarction, Stroke Volume, Treatment Outcome, Ventricular Function, Left, Middle Aged, Aged, Acute Coronary Syndrome surgery, Coronary Occlusion surgery, Percutaneous Coronary Intervention adverse effects
- Abstract
Background: The prevalence and outcomes of patients who presented with an acute coronary syndrome (ACS) and underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study., Methods: We examined the clinical characteristics and procedural outcomes of ACS patients who underwent CTO-PCI in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO; NCT02061436)., Results: Of the 8826 patients who underwent CTO-PCI between 2012 and 2022 at 38 centers, 558 (6.3%) presented with ACS. ACS presentation was with non-ST-segment elevation myocardial infarction (MI) in 54%, unstable angina in 33%, and ST-segment elevation MI in 6.5%. ACS patients were older (66 ± 11 years vs 64 ± 10 years; P<.001) and had higher prevalence of comorbidities such as diabetes mellitus (48% vs 42%; P=.02), prior MI (52% vs 45%; P<.01), and lower left ventricular ejection fraction (49 ± 14% vs 51 ± 13%; P<.01). While the PROGRESS-CTO score (1.4 ± 1.0 vs 1.2 ± 1.0; P<.001) was higher in the ACS group, the J-CTO score was comparable (2.3 ± 1.2 vs 2.4 ± 1.3; P=.68). Technical success (88% vs 86%; P=.12) and the incidence of in-hospital major adverse cardiovascular event (MACE) (0.9% vs 2.1%; P=.06) and adverse events at 3-month follow-up (3.4% vs 7.2%; Kaplan-Meier log-rank P=.16) were similar between ACS and non-ACS patients, respectively., Conclusion: Approximately 6% of patients who underwent CTO-PCI presented with an ACS. Technical success, in-hospital MACE, and the incidence of adverse events up to 3 months were similar between patients who presented with vs without an ACS.
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- 2023
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27. Saphenous Vein Graft Occlusion Following Native Vessel Chronic Total Occlusion Percutaneous Coronary Intervention.
- Author
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Kostantinis S, Simsek B, Karacsonyi J, Alaswad K, Megaly M, Jaffer FA, Khatri JJ, Poommipanit P, Davies RE, Rinfret S, Elbarouni B, Ybarra LF, Sheikh AM, Toma C, Chandwaney R, Abi Rafeh N, Goktekin O, El Guindy AM, Allana S, Mastrodemos OC, Rangan BV, Sandoval Y, Burke MN, and Brilakis ES
- Subjects
- Humans, Middle Aged, Aged, Saphenous Vein, Percutaneous Coronary Intervention adverse effects
- Abstract
Background: Whether saphenous vein grafts (SVGs) should be occluded after successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of the corresponding native vessel remains controversial., Methods: We analyzed the clinical and angiographic characteristics and procedural outcomes of 51 patients who underwent SVG occlusion following successful CTO-PCI of the corresponding native vessel between 2015 and 2022 at 14 centers., Results: Mean patient age was 71 ± 8 years and 80% were men. The most common CTO target vessel was the right coronary artery (41%), followed by the left circumflex (37%). Retrograde crossing through the SVG was the successful crossing strategy in 40 cases (78%). SVG occlusion was achieved with coils (1.9 ± 1.0) in 35 of 51 patients (69%) and vascular plugs in the other 16 cases (31%). All procedures were technically successful and the SVG was occluded completely (TIMI 0 flow) in 38 of the cases (75%), with the remaining cases having TIMI 1 flow. Follow-up was available for 37 patients (73%); during a mean follow-up of 312 days from CTO-PCI, the incidence of target-lesion failure due to restenosis was 5.4% (n = 2) with no other major events reported., Conclusion: Following native vessel CTO-PCI, SVG occlusion is often performed and is associated with favorable mid-term outcomes.
- Published
- 2022
- Full Text
- View/download PDF
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