26 results on '"Kostantinis, Spyridon"'
Search Results
2. Iso-osmolar vs low-osmolar contrast agents for coronary optical coherence tomography: a blinded prospective randomized controlled study.
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Kostantinis S, Mastrodemos O, Stanberry L, Sandoval Y, Allana SS, Mutlu D, Simsek B, Rempakos A, Karacsonyi J, Alexandrou M, Okeson BK, Burke MN, Rangan BV, and Brilakis ES
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- Humans, Male, Female, Aged, Prospective Studies, Middle Aged, Coronary Artery Disease diagnosis, Single-Blind Method, Percutaneous Coronary Intervention methods, Tomography, Optical Coherence methods, Contrast Media adverse effects, Contrast Media administration & dosage, Cross-Over Studies, Coronary Vessels diagnostic imaging
- Abstract
Background: The impact of contrast type on coronary optical coherence tomography (OCT) imaging has received limited research., Methods: We conducted a blinded, prospective, single-center, randomized, controlled crossover study comparing iso-osmolar contrast media (IOCM) with low-osmolar contrast media (LOCM) in patients undergoing clinically indicated coronary OCT imaging. Patients were randomly assigned to undergo OCT imaging with either IOCM or LOCM as the initial contrast medium. Following a washout period, a second run of OCT imaging of the same coronary vessel was performed using the other contrast medium., Results: A total of 62 patients were randomized to IOCM first (n = 31) or LOCM first (n = 31). Mean patient age was 65.9 ± 11.2 years and 74.2% were male, with high prevalence of dyslipidemia (82.3%) and prior myocardial infarction (41.9%). Percutaneous coronary intervention was performed in 60 cases (96.8%) and the left anterior descending artery was the most common target vessel (53.3%). The contrast volume used for OCT imaging was similar for IOCM and LOCM (8.0 [6.9, 9.0] mL vs 8.0 [6.7, 9.0] mL; P = .89), as was the length of clear OCT images (70.0 [62.8, 74.0] mm for IOCM vs 70.0 [64.0, 74.0] mm for LOCM; P = .65). Electrocardiographic changes were observed in 11 runs with IOCM (ventricular repolarization changes in 9 runs and premature ventricular contractions [PVCs] in 2 runs) vs 12 runs with LOCM (ventricular repolarization changes in 9 runs and PVCs in 3 runs)., Conclusions: The use of IOCM in coronary OCT is associated with similar contrast volume and clear imaging length when compared with LOCM.
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- 2024
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3. 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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4. 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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5. Activated clotting time and outcomes of chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-CTO Registry.
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Simsek B, Rempakos A, Kostantinis S, Alexandrou M, Gorgulu S, Alaswad K, Frizzell JD, Yildirim U, Poommipanit P, Aygul N, Abi Rafeh N, Bagur R, Davies R, Goktekin O, Choi JW, Reddy N, Dattilo P, Kerrigan J, Haddad EV, Mastrodemos OC, Rangan BV, Karacsonyi J, Allana SS, Kearney KE, Sandoval Y, Burke MN, Brilakis ES, and Azzalini L
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- Humans, Prospective Studies, Registries, Hospitals, Percutaneous Coronary Intervention adverse effects, Vascular Diseases
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Background: The optimal range of activated clotting time (ACT) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study., Methods: We examined the association between ACT and in-hospital ischemic and bleeding outcomes in patients who underwent CTO PCI in the Prospective Global Registry for the Study of CTO Intervention., Results: ACT values were available for 4377 patients who underwent CTO PCI between 2012 and 2023 at 29 centers. The mean ACT distribution was less than 250 seconds (19%), 250 to 349 seconds (50%), and greater than or equal to 350 seconds (31%). The incidence of ischemic events, bleeding events, and net adverse cardiovascular events (NACE) was 0.8%, 3.0%, and 3.8%, respectively. In multiple logistic regression analysis, increasing nadir ACT was associated with decreasing ischemic events (adjusted odds ratio [aOR] per 50-second increments: 0.69 [95% confidence interval (CI), 0.50-0.94; P=.017]; and increasing peak ACT was associated with increasing bleeding events (aOR per 50-second increments: 1.17 [95% CI ,1.01-1.36; P=.032]). A U-shaped association was seen between mean ACT and NACE, where restricted cubic spline analysis demonstrated that patients with a low ( less than 200 seconds) or high ( greater than 400 seconds) ACT had increasing NACE risk compared with an ACT of 200 to 400 seconds (aOR 2.06, 95% CI 1.18-3.62; P=.012)., Conclusions: Among patients who underwent CTO PCI, mean ACT had a U-shaped relationship with NACE, where patients with a low ( less than 200 seconds) ACT (driven by ischemic events) or high ( greater than 400 seconds) ACT (driven by bleeding) had higher NACE compared with an ACT of 200 to 400 seconds.
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- 2023
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6. Lesion complexity and procedural outcomes associated with ostial chronic total occlusions: Insights from the PROGRESS-CTO Registry.
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Allana SS, Kostantinis S, Simsek B, Karacsonyi J, Rempakos A, Alaswad K, Krestyaninov O, Khelimskii D, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Patel MP, Mahmud E, Koutouzis M, Tsiafoutis I, Gorgulu S, Elbarouni B, Nicholson W, Jaber W, Rinfret S, Abi Rafeh N, Goktekin O, ElGuindy AM, Sandoval Y, Burke MN, Rangan BV, and Brilakis ES
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- Humans, Hospital Mortality, Registries, Percutaneous Coronary Intervention adverse effects, Stroke epidemiology, Stroke etiology, Myocardial Infarction
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Objectives: Ostial CTOs can be challenging to revascularize. We aim to describe the outcomes of ostial chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Methods: We examined the clinical and angiographic characteristics and procedural outcomes of 8788 CTO PCIs performed at 35 US and non-US centers between 2012 and 2022. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target-vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke., Results: Ostial CTOs constituted 12% of all CTOs. Patients with ostial CTOs had higher J-CTO score (2.9 ± 1.2 vs 2.3 ± 1.3; P less than .01). Ostial CTO PCI had lower technical (82% vs. 86%; P less than .01) and procedural (81% vs. 85%; P less than .01) success rates compared with non-ostial CTO PCI. Ostial location was not independently associated with technical success (OR 1.03, CI 95% 0.83-1.29 P =.73). Ostial CTO PCI had a trend towards higher incidence of MACE (2.6% vs. 1.8%; P =.06), driven by higher incidence of in-hospital death (0.9% vs 0.3% P less than.01) and stroke (0.5% vs 0.1% P less than .01). Ostial lesions required more often use of the retrograde approach (30% vs 9%; P less than .01). Ostial CTO PCI required longer procedure time (149 [103,204] vs 110 [72,160] min; P less than .01) and higher air kerma radiation dose (2.3 [1.3, 3.6] vs 2.0 [1.1, 3.5] Gray; P less than .01)., Conclusions: Ostial CTOs are associated with higher lesion complexity and lower technical and procedural success rates. CTO PCI of ostial lesions is associated with frequent need for retrograde crossing, higher incidence of death and stroke, longer procedure time and higher radiation dose.
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- 2023
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7. Adverse events with intravascular lithotripsy after coronary use: A report from the FDA MAUDE database.
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Rempakos A, Simsek B, Kostantinis S, Alexandrou M, Karacsonyi J, Rangan BV, Mastrodemos OC, Allana SS, Sandoval Y, Burke MN, and Brilakis ES
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- Humans, Catheters, Databases, Factual, Heart, Percutaneous Coronary Intervention adverse effects, Lithotripsy adverse effects
- Abstract
Percutaneous coronary intervention (PCI) on heavily calcified lesions has been associated with more complications.1 Intravascular lithotripsy (IVL) was recently approved for treating de novo calcified coronary lesions based on excellent safety and efficacy on several studies, but there are limited "real world" outcomes. We conducted a comprehensive search of the MAUDE database between February 12, 2021, and February 28, 2023 using the manufacturer and brand name tabs with the keywords "Shockwave Medical" and "Shockwave," respectively. Given that a single IVL catheter can fail or cause multiple adverse events through different mechanisms, we considered all possible outcomes. The MAUDE database is freely accessible and de-identified, obviating the need for institutional review board approval.
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- 2023
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8. 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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9. 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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10. 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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11. 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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12. 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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13. 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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14. 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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15. 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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16. 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
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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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17. 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
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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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18. Body Mass Index and Chronic Total Occlusion Percutaneous Coronary Intervention Outcomes: Is Overweight the New Normal?
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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
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- 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.
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- 2023
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19. Equipment Utilization in Chronic Total Occlusion Percutaneous Coronary Interventions: Update From the PROGRESS-CTO Registry.
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Kostantinis S, Simsek B, Karacsonyi J, Rempakos A, Alaswad K, Jaffer FA, Khatri JJ, Poommipanit P, Davies RE, Rinfret S, Nicholson W, Jaber W, Choi JW, Patel MP, Koutouzis M, Tsiafoutis I, Gorgulu S, Patel TN, Jefferson BK, Kerrigan JL, Elbarouni B, Abi Rafeh N, Goktekin O, ElGuindy AM, Allana S, Mastrodemos OC, Rangan BV, Sandoval Y, Burke MN, and Brilakis ES
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- Humans, United States, Treatment Outcome, Equipment and Supplies Utilization, Coronary Angiography, Registries, Chronic Disease, Percutaneous Coronary Intervention methods, Coronary Occlusion diagnosis, Coronary Occlusion surgery
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Background: Guidewires and microcatheters are critical to the success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Methods: We examined equipment utilization in 11,202 CTO-PCIs performed in 10,952 patients at 42 United States (US) and non-US centers between 2012 and 2022., Results: Antegrade-only crossing was attempted in 7628 CTO-PCIs (68%) and the retrograde approach was used in 3574 CTO-PCIs (32%). The median number of guidewires used during antegrade wiring increased with lesion complexity from 3 (interquartile range [IQR], 2-4) for J-CTO score of 0 to 5 (IQR, 4-7) for J-CTO score of 5 (P<.001). Antegrade-only procedures had higher technical (90% vs 79%; P<.001) and procedural success (89% vs 77%; P<.001) compared with retrograde procedures. In antegrade-only cases, Pilot 200 (28%; Abbott Vascular) and Fielder XT (24%; Asahi Intecc) were the most frequently used guidewires, while Corsair (21%; Asahi Intecc) and Turnpike Spiral (20%; Vascular Solutions) were the most commonly used microcatheters. In retrograde cases, Sion (32%; Asahi Intecc) was the most common guidewire used, followed by Sion Black (22%; Asahi Intecc), Pilot 200 (22%), and Suoh 03 (19%; Asahi Intecc), while Corsair (16%) and Turnpike LP (11%) were the most commonly used microcatheters. The most successful guidewire for collateral crossing was the Sion (32%), followed by Sion Black (15%) and Suoh 03 (11%)., Conclusion: Polymer-jacketed guidewires are the most commonly used guidewires for antegrade wiring, while non-polymer-jacketed, torquable guidewires are the most frequently used guidewires for retrograde techniques. Turnpike and Corsair are the most commonly used microcatheters in CTO-PCI.
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- 2023
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20. Outcomes of Patients With Acute Coronary Syndromes Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention.
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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
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- 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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21. Saphenous Vein Graft Occlusion Following Native Vessel Chronic Total Occlusion Percutaneous Coronary Intervention.
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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
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- 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.
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- 2022
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22. A Systematic Review and Meta-Analysis of Clinical Outcomes of Patients Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention.
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Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, Megaly M, Karmpaliotis D, Masoumi A, Jaber WA, Nicholson W, Rinfret S, Mashayekhi K, Werner GS, McEntegart M, Lee SW, Khatri JJ, Harding SA, Avran A, Jaffer FA, Doshi D, Kao HL, Sianos G, Yamane M, Milkas A, Azzalini L, Garbo R, Tammam K, Abi Rafeh N, Nikolakopoulos I, Vemmou E, Rangan BV, Burke MN, Garcia S, Croce KJ, Wu EB, Tsuchikane E, Di Mario C, Galassi AR, Gagnor A, Knaapen P, Jang Y, Kim BK, Poommipanit PB, and Brilakis ES
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- Humans, Treatment Outcome, Odds Ratio, Randomized Controlled Trials as Topic, Observational Studies as Topic, Coronary Occlusion surgery, Percutaneous Coronary Intervention adverse effects, Myocardial Infarction etiology
- Abstract
Objectives: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms, but it remains controversial whether it impacts subsequent clinical outcomes., Methods: In this systematic review and meta-analysis, we queried PubMed, ScienceDirect, Cochrane Library, Web of Science, and Embase databases (last search: September 15, 2021). We investigated the impact of CTO-PCI on clinical events including all-cause mortality, cardiovascular death, myocardial infarction (MI), major adverse cardiovascular event (MACE), stroke, subsequent coronary artery bypass surgery, target-vessel revascularization, and heart failure hospitalizations. Pooled analysis was performed using a random-effects model., Results: A total of 58 publications with 54,540 patients were included in this analysis, of which 33 were observational studies of successful vs failed CTO-PCI, 19 were observational studies of CTO-PCI vs no CTO-PCI, and 6 were randomized controlled trials (RCTs). In observational studies, but not RCTs, CTO-PCI was associated with better clinical outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) for all-cause mortality, MACE, and MI were 0.52 (95% CI, 0.42-0.64), 0.46 (95% CI, 0.37-0.58), 0.66 (95% CI, 0.50-0.86), respectively for successful vs failed CTO-PCI studies; 0.38 (95% CI, 0.31-0.45), 0.57 (95% CI, 0.42-0.78), 0.65 (95% CI, 0.42-0.99), respectively, for observational studies of CTO-PCI vs no CTO-PCI; 0.72 (95% CI, 0.39-1.32), 0.69 (95% CI, 0.38-1.25), and 1.04 (95% CI, 0.46-2.37), respectively for RCTs., Conclusions: CTO-PCI is associated with better subsequent clinical outcomes in observational studies but not in RCTs. Appropriately powered RCTs are needed to conclusively determine the impact of CTO-PCI on clinical outcomes.
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- 2022
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23. Association of Annual Operator Volume With the Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention.
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Karacsonyi J, Tsiafoutis I, Alaswad K, Karmpaliotis D, Choi JW, Khatri J, Jaffer FA, Poommipanit P, Patel M, Gorgulu S, Yeh R, Elbarouni B, ElGuindy A, Krestyaninov O, Vemmou E, Nikolakopoulos I, Kostantinis S, Simsek B, Rangan BV, Ungi I, Tammam K, Abi Rafeh N, Goktekin O, Brilakis ES, and Koutouzis M
- Subjects
- Aged, Chronic Disease, Coronary Angiography, Female, Humans, Male, Middle Aged, Registries, Risk Factors, Treatment Outcome, Coronary Occlusion diagnosis, Coronary Occlusion etiology, Coronary Occlusion surgery, Percutaneous Coronary Intervention adverse effects
- Abstract
Objectives: There are limited data on the association of operator volume with the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Methods: We analyzed the association between operator volume and procedural outcomes of 7035 CTO-PCIs performed between 2012 and February 2021 at 30 centers., Results: The study population was divided into 3 groups based on annual operator CTO-PCI volume: low-volume operators (LVO: <30 cases/year; 39.7% of the cases); medium-volume operators (MVO: 30-60 cases/year; 25.7% of the cases); and high-volume operators (HVO: >60 cases/ year; 34.6% of the cases). Mean patient age was 64.4 ± 10 years and 82% were men. Cases performed by HVOs were more complex, with higher J-CTO score compared with cases performed by MVOs and LVOs (2.72 ± 1.27 vs 2.39 ± 1.19 vs 2.12 ± 1.27, respectively; P<.001). Moderate/severe proximal vessel tortuosity (35% vs 23% vs 20%; P<.001) and proximal cap ambiguity (44% vs 34% vs 32%; P<.001) was also more common in the HVO group. Cases performed by HVOs had higher technical success rates (87.9% vs 86.9% vs 82.6%; P<.001), but also higher rates of periprocedural major cardiac adverse events compared with MVOs and LVOs (3.08% vs 2.71% vs 1.50%; P<.01). On multivariable analyses, HVOs and MVOs were associated with higher technical success., Conclusions: In a contemporary, multicenter registry, 40% of CTO-PCI cases are performed by LVOs performing <30 cases per year. Cases performed by HVOs were associated with higher technical and procedural success, but also higher periprocedural major complication rates, potentially due to higher lesion complexity.
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- 2022
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24. Primary vs Secondary Retrograde Approach in Chronic Total Occlusion Percutaneous Coronary Interventions.
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Kostantinis S, Alaswad K, Karmpaliotis D, Jaffer F, Jaber W, Nicholson W, Rinfret S, Khatri J, Poommipanit P, Karacsonyi J, Simsek B, Vemmou E, Nikolakopoulos I, Koutouzis M, Tsiafoutis I, Riley R, Sheikh A, Patel M, Gorgulu S, ElGuindy AM, Goktekin O, Abi Rafeh N, Rangan BV, Garcia S, Burke MN, and Brilakis ES
- Subjects
- Chronic Disease, Coronary Angiography methods, Humans, Registries, Risk Factors, Stroke Volume, Treatment Outcome, Ventricular Function, Left, Coronary Occlusion diagnosis, Coronary Occlusion etiology, Coronary Occlusion surgery, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods
- Abstract
Background: The retrograde approach to coronary chronic total occlusions (CTOs) can be used as the initial crossing strategy (primary retrograde) or after failure of antegrade crossing attempts (secondary retrograde)., Methods: We compared baseline clinical and angiographic characteristics and procedural outcomes of primary vs secondary retrograde crossing for CTO percutaneous coronary intervention (PCI) among 2789 procedures performed at 34 centers between 2012 and 2021., Results: Retrograde CTO-PCI was performed as the primary crossing strategy in 1086 cases (38.9%) and as a secondary approach in 1703 cases (61.1%). Patients in the primary group had slightly lower left ventricular ejection fraction (49.1% vs 50.4%; P=.02), were more likely to have had prior coronary artery bypass graft surgery (52.9% vs 38.4%; P<.001), and had higher J-CTO (3.31 ± 0.98 vs 2.99 ± 1.09; P<.001) and PROGRESS-CTO scores (1.47 ± 0.92 vs 1.29 ± 0.99; P<.001). Technical (81.4% vs 77.3%; P=.01) and procedural success rates (78.6% vs 74.1%; P<.01) were higher in the primary retrograde group, with no difference between in-hospital major adverse event rates (4.3% vs 4.0%; P=.66). Contrast volume (250 mL [interquartile range (IQR), 176-347] vs 270 mL [IQR, 190-367]; P<.001) and procedure time (175 minutes [IQR, 127-233] vs 180 minutes [IQR, 142-236]; P<.001) were lower in the primary group., Conclusions: Use of retrograde approach as the primary crossing strategy is associated with higher rates of technical and procedural success and similar rates of in-hospital major adverse cardiac events compared with secondary retrograde CTO-PCI.
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- 2022
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25. Incidence, Treatment, and Outcomes of Coronary Artery Perforation During Percutaneous Coronary Intervention.
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Avula V, Karacsonyi J, Kostantinis S, Simsek B, Rangan BV, Gutierrez AA, Burke MN, Garcia S, Mooney M, Sorajja P, Traverse JH, Poulose A, Chavez I, Wang Y, Goessl M, and Brilakis ES
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- Aged, Aged, 80 and over, Coronary Angiography, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Female, Humans, Incidence, Male, Middle Aged, Treatment Outcome, Heart Injuries diagnosis, Heart Injuries epidemiology, Heart Injuries etiology, Percutaneous Coronary Intervention adverse effects, Vascular System Injuries diagnosis, Vascular System Injuries epidemiology, Vascular System Injuries etiology
- Abstract
Objectives: To examine the incidence, treatment and outcomes of perforation during percutaneous coronary intervention (PCI)., Background: Coronary perforation is a potentially life-threatening PCI complication., Methods: We examined the clinical, angiographic, and procedural characteristics, management, and outcomes of coronary perforation at a tertiary care institution., Results: Between 2014 and 2019, perforation occurred in 70 of 10,278 PCIs (0.7%). Patient age was 71 ± 12 years, 66% were men, and 30% had prior coronary artery bypass graft surgery. Among perforation cases, the prevalence of chronic total occlusions was 33%, moderate/severe calcification was 66% and moderate/severe tortuosity was 41%. The frequency of Ellis class 1, 2, and 3 perforations was 14%, 50%, and 36%, respectively. Most (n = 51; 73%) were large vessel perforations, 16 (23%) were distal vessel perforations and 3 (4%) were collateral vessel perforations (1 septal and 2 epicardial). Hypotension occurred in 26%, pericardial effusion in 36% and tamponade in 13%; 47% of perforations did not have clinical consequences. Perforations were most often treated with prolonged balloon inflation (63%), reversal of anticoagulation (39%), and covered stent implantation (33%). Technical and procedural success were 73% and 60%, respectively, and major periprocedural adverse cardiac events occurred in 21% of the patients. Three patients (4%) required emergent CABG surgery and four (6%) died., Conclusions: Coronary perforation is an infrequent complication of PCI. Most perforations are large vessel perforations and often require further intervention. The incidence of death or emergent cardiac surgery is low.
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- 2022
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26. Temporal Trends in Retrograde Crossing of Epicardial Collaterals in Chronic Total Occlusion Percutaneous Coronary Intervention.
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Simsek B, Kostantinis S, Karacsonyi J, Basir MB, Megaly M, Masoumi A, Jaffer FA, Gorgulu S, Brilakis ES, and Alaswad K
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- Chronic Disease, Coronary Angiography methods, Humans, Registries, Risk Factors, Treatment Outcome, Coronary Occlusion diagnosis, Coronary Occlusion etiology, Coronary Occlusion surgery, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods
- Abstract
Background: The use of retrograde crossings in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) provides higher technical success rates in CTO-PCI. However, the use of epicardial collaterals carries a higher complication risk., Methods and Results: In this study, we aimed to investigate the temporal trends in retrograde crossing of epicardial collaterals, introduction of new guidewires, in-hospital major adverse cardiovascular events (MACE), and technical success rates in a large, multinational registry. We demonstrate that technical success rates increased substantially from about 5%-10% to 76% in the past decade without a concomitant increase in MACE rate (~3% to 4%), likely associated with increased operator experience and introduction of new guidewires. In addition, we show that while high-volume centers have higher technical success, they also have higher perforation rates.
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- 2022
- Full Text
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