30 results on '"Rempakos, Athanasios"'
Search Results
2. Peripheral artery disease in chronic total occlusion percutaneous coronary intervention.
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Alexandrou M, Rempakos A, Mutlu D, Al Ogaili A, Carvalho PEP, Strepkos D, Choi JW, Poommipanit P, Alaswad K, Basir MB, Davies R, Jaffer FA, Dattilo P, Doing AH, Azzalini L, Aygul N, Chandwaney RH, Jefferson BK, Gorgulu S, Khatri JJ, Young LD, Krestyaninov O, Khelimskii D, Frizzell J, Goktekin O, Flaherty JD, Schimmel DR, Benzuly KH, Uluganyan M, Ozdemir R, Ahmad Y, Rangan BV, Mastrodemos OC, Burke MN, Voudris K, Sandoval Y, and Brilakis ES
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- 2024
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3. Guide catheter extension use in chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS CTO registry.
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Al-Ogaili A, Mutlu D, Alexandrou M, Rempakos A, Rangan BV, Mastrodemos OC, Sandoval Y, Burke MN, and Brilakis ES
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- 2024
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4. Interventional cardiologists' perspectives and knowledge towards artificial intelligence.
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Alexandrou M, Rempakos A, Mutlu D, Al Ogaili A, Rangan BV, Mastrodemos OC, Voudris K, Milkas A, Burke MN, Sandoval Y, Chatzizisis YS, Siontis KC, and Brilakis ES
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- Humans, Female, Male, Middle Aged, Adult, Surveys and Questionnaires, Cardiology, Health Knowledge, Attitudes, Practice, Attitude of Health Personnel, United States, Artificial Intelligence, Cardiologists
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Background: Artificial intelligence (AI) is increasingly utilized in interventional cardiology (IC) and holds the potential to revolutionize the field., Methods: We conducted a global, web-based, anonymous survey of IC fellows and attendings to assess the knowledge and perceptions of interventional cardiologists regarding AI use in IC., Results: A total of 521 interventional cardiologists participated in the survey. The median age range of participants was 36 to 45 years, most (51.5%) practice in the United States, and 7.5% were women. Most (84.7%) could explain well or somehow knew what AI is about, and 63.7% were optimistic/very optimistic about AI in IC. However, 73.5% believed that physicians know too little about AI to use it on patients and most (46.1%) agreed that training will be necessary. Only 22.1% were currently implementing AI in their personal clinical practice, while 60.6% estimated implementation of AI in their practice during the next 5 years. Most agreed that AI will increase diagnostic efficiency, diagnostic accuracy, treatment selection, and healthcare expenditure, and decrease medical errors. The most tried AI-powered tools were image analysis (57.3%), ECG analysis (61.7%), and AI-powered algorithms (45.9%). Interventional cardiologists practicing in academic hospitals were more likely to have AI tools currently implemented in their clinical practice and to use them, women had a higher likelihood of expressing concerns regarding AI, and younger interventional cardiologists were more optimistic about AI integration in IC., Conclusions: Our survey suggests a positive attitude of interventional cardiologists regarding AI implementation in the field of IC.
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- 2024
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5. 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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6. 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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7. Predictors of successful primary antegrade wiring in chronic total occlusion percutaneous coronary intervention.
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Rempakos A, Alexandrou M, Mutlu D, Choi JW, Poommipanit P, Khatri JJ, Young L, Dattilo P, Sadek Y, Davies R, Gorgulu S, Jaffer FA, Chandwaney R, Jefferson B, Elbarouni B, Azzalini L, Kearney KE, Alaswad K, Basir MB, Krestyaninov O, Khelimskii D, Aygul N, Abi-Rafeh N, Elguindy A, Goktekin O, Rangan BV, Mastrodemos OC, Al-Ogaili A, Sandoval Y, Burke MN, Brilakis ES, and Kalyanasundaram A
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- Humans, Male, Female, Middle Aged, Aged, Chronic Disease, Treatment Outcome, Prospective Studies, Follow-Up Studies, Coronary Occlusion surgery, Coronary Occlusion diagnosis, Percutaneous Coronary Intervention methods, Coronary Angiography methods, Registries, Coronary Vessels diagnostic imaging, Coronary Vessels surgery
- Abstract
Background: Antegrade wiring is the most commonly used chronic total occlusion (CTO) crossing technique., Methods: Using data from the PROGRESS CTO registry (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; Clinicaltrials.gov identifier: NCT02061436), we examined the clinical and angiographic characteristics and procedural outcomes of CTO percutaneous coronary interventions (PCIs) performed using a primary antegrade wiring strategy., Results: Of the 13 563 CTO PCIs performed at 46 centers between 2012 and 2023, a primary antegrade wiring strategy was used in 11 332 (83.6%). Upon multivariable logistic regression analysis, proximal cap ambiguity (odds ratio [OR]: 0.52; 95% CI, 0.46-0.59), side branch at the proximal cap (OR: 0.85; 95% CI, 0.77-0.95), blunt/no stump (OR: 0.52; 95% CI: 0.47-0.59), increasing lesion length (OR [per 10 mm increase]: 0.79; 95% CI, 0.76-0.81), moderate to severe calcification (OR: 0.73; 95% CI, 0.66-0.81), moderate to severe proximal tortuosity (OR: 0.67; 95% CI, 0.59-0.75), bifurcation at the distal cap (OR: 0.66; 95% CI, 0.59-0.73), left anterior descending artery CTO (OR [vs right coronary artery]: 1.44; 95% CI, 1.28-1.62) and left circumflex CTO (OR [vs right coronary artery]: 1.22; 95% CI, 1.07-1.40), non-in-stent restenosis lesion (OR: 0.56; 95% CI, 0.49-0.65), and good distal landing zone (OR: 1.18; 95% CI, 1.06-1.32) were independently associated with primary antegrade wiring crossing success., Conclusions: The use of antegrade wiring as the initial strategy was high (83.6%) in our registry. We identified several parameters associated with primary antegrade wiring success.
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- 2024
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8. Geographic diversity in chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-CTO registry.
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Alexandrou M, Rempakos A, Mutlu D, Al Ogaili A, Choi JW, Poommipanit P, Alaswad K, Basir MB, Davies R, Jaffer FA, Chandwaney RH, Azzalini L, Aygul N, ElGuindy AM, Jefferson BK, Gorgulu S, Khatri JJ, Krestyaninov O, Khelimskii D, Frizzell J, Elbarouni B, Goktekin O, McEntegart MB, Rangan BV, Mastrodemos OC, Burke MN, Sandoval Y, and Brilakis ES
- Abstract
Background: There is variability in clinical and lesion characteristics as well as techniques in chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Methods: We analyzed patient and lesion characteristics, techniques, and outcomes in 11 503 CTO-PCI procedures performed in North America (NA) and in the combined regions of Europe, Asia, and Africa from 2017 to 2023 as documented in the PROGRESS-CTO registry., Results: Eight thousand four hundred seventy-nine (74%) procedures were performed in NA. Compared with non-NA patients, NA patients were older, with higher body mass index and higher prevalence of diabetes, hypertension, dyslipidemia, family history of coronary artery disease, prior history of PCI, coronary artery bypass graft surgery and heart failure, cerebrovascular disease, and peripheral arterial disease. Their CTOs were more complex, with higher J-CTO (2.56 ± 1.22 vs 1.81 ± 1.24; P less than .001) and PROGRESS-CTO (1.29 ± 1.01 vs 1.07 ± 0.95; P less than .001) scores, longer length, and higher prevalence of proximal cap ambiguity, blunt/no stump, moderate to severe calcification, and proximal tortuosity. Retrograde (31.0% vs 22.1%; P less than .001) and antegrade dissection and re-entry (ADR) (21.2% vs 9.2%; P less than .001) were more commonly used in NA centers, along with intravascular ultrasound (69.0% vs 10.1%; P less than .001). Procedure and fluoroscopy times were longer in NA, while contrast volume and radiation dose were lower. Technical (86.7% vs 86.8%; P > .90) and procedural (85.4% vs 85.8%; P = .70) success and in-hospital major adverse cardiovascular events (MACE) (1.9% vs 1.7%; P = .40) were similar in NA and non-NA centers., Conclusions: Compared with non-NA patients, NA patients undergoing CTO PCI have more comorbidities, higher CTO lesion complexity, are more likely to undergo treatment with retrograde and ADR, and have similar technical success and MACE.
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- 2024
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9. Validation of the J-Channel Score for retrograde channel crossing in the PROGRESS-CTO registry.
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Mutlu D, Rempakos A, Alexandrou M, Al-Ogaili A, Khatri JJ, Alaswad K, Gorgulu S, Sandoval Y, Burke MN, and Brilakis ES
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- Humans, Male, Female, Aged, Middle Aged, Prospective Studies, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Treatment Outcome, Collateral Circulation physiology, Japan, Chronic Disease, Registries, Coronary Occlusion diagnosis, Coronary Occlusion surgery, Percutaneous Coronary Intervention methods, Coronary Angiography
- Abstract
Successful collateral channel (CC) crossing is essential for the success of retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Based on the Japanese CTO PCI expert registry, the J-Channel score was developed to predict CC crossing. We examined the performance of the J-Channel score in patients who underwent retrograde CTO-PCI at 31 centers between 2013-2023 as part of the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO). We observed an association between successful CC crossing and the J-Channel score, its predictive efficacy was modest for both wire and microcatheter crossing.
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- 2024
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10. 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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11. Ranolazine in chronic total occlusion percutaneous coronary intervention.
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Alexandrou M, Mutlu D, Rempakos A, Al Ogaili A, Choi JW, Poommipanit P, Alaswad K, Basir MB, Davies R, Jaffer FA, Dattilo P, Azzalini L, Aygul N, Reddy N, Jefferson BK, Gorgulu S, Khatri JJ, Young LD, Krestyaninov O, Khelimskii D, Frizzell J, Elbarouni B, Rangan BV, Mastrodemos OC, Burke MN, Sandoval Y, and Brilakis ES
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Ranolazine is an anti-anginal medication given to patients with chronic angina and persistent symptoms despite medical therapy. We examined 11 491 chronic total occlusion (CTO) percutaneous coronary interventions (PCI) that were performed at 41 US and non-US centers between 2012 and 2023 in the PROGRESS-CTO Registry. Patients on ranolazine at baseline had more comorbidities, more complex lesions, lower procedural and technical success (based on univariable but not multivariable analysis), and higher incidence of major adverse cardiac events (MACE) (on both univariable and multivariable analysis).
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- 2024
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12. Equipment entrapment/loss during chronic total occlusion percutaneous coronary intervention.
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Alexandrou M, Rempakos A, Mutlu D, Al Ogaili A, Choi JW, Poommipanit P, Alaswad K, Basir MB, Davies R, Jaffer FA, Chandwaney RH, Azzalini L, Aygul N, Dattilo P, Jefferson BK, Gorgulu S, Khatri JJ, Krestyaninov O, Frizzell J, Elbarouni B, Rangan BV, Mastrodemos O, Burke MN, Sandoval Y, and Brilakis ES
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- Humans, Treatment Outcome, Risk Factors, Coronary Angiography methods, Registries, Chronic Disease, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Coronary Occlusion diagnosis, Coronary Occlusion surgery, Coronary Occlusion etiology
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Background: There is limited data on equipment loss or entrapment during chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Methods: We analyzed the baseline clinical and angiographic characteristics and outcomes of equipment loss/entrapment at 43 US and non-US centers between 2017 and 2023., Results: Equipment loss/entrapment was reported in 40 (0.4%) of 10 719 cases during the study period. These included guidewire entrapment/fracture (n = 21), microcatheter entrapment/fracture (n = 11), stent loss (n = 8) and balloon entrapment/fracture/rupture (n = 5). The equipment loss/entrapment cases were more likely to have moderate to severe calcification, longer lesion length, higher J-CTO and PROGRESS-CTO complications scores, and use of the retrograde approach compared with the remaining cases. Retrieval was attempted in 71.4% of the guidewire, 90.9% of the microcatheter, 100% of the stent loss, and 100% of the balloon cases, and was successful in 26.7%, 30.0%, 50%, and 40% of the cases, respectively. Procedures complicated by equipment loss/entrapment had higher procedure and fluoroscopy time, contrast volume and patient air kerma radiation dose, lower procedural (60.0% vs 85.6%, P less than .001) and technical (75.0% vs 86.8%, P = .05) success, and higher incidence of major adverse cardiac events (MACE) (17.5% vs 1.8%, P less than .001), acute MI (7.5% vs 0.4%, P less than .001), emergency coronary artery bypass graft (CABG) (2.5% vs 0.1%, P = .03), perforation (20.0% vs 4.9%, P less than .001), and death (7.5% vs 0.4%, P less than .001)., Conclusions: Equipment loss is a rare complication of CTO PCI; it is more common in complex CTOs and is associated with lower technical success and higher MACE.
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- 2024
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13. Radiation dose during contemporary percutaneous coronary interventions for chronic total occlusion: insights from the PROGRESS-CTO registry.
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Mutlu D, Rempakos A, Alexandrou M, Al-Ogaili A, Rangan BV, Mastrodemos OC, Sandoval Y, Burke MN, and Brilakis ES
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- Humans, Prospective Studies, Chronic Disease, Treatment Outcome, Registries, Radiation Dosage, Risk Factors, Coronary Angiography, Percutaneous Coronary Intervention adverse effects, Coronary Occlusion diagnosis, Coronary Occlusion surgery
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Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with high radiation doses. In this manuscript, we examined the contemporary trends and determinants of radiation dose in the PROGRESS CTO (Prospective Global Registry for the Study of CTO Intervention; Clinicaltrials.gov identifier: NCT02061436) registry. Radiation dose during CTO PCI did not change significantly since 2020, highlighting the need for innovation and operator education to further maintain radiation safety.
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- 2024
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14. Use of plaque modification microcatheters during percutaneous coronary interventions for chronic total occlusion: insights from the PROGRESS-CTO Registry.
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Mutlu D, Rempakos A, Alexandrou M, Al-Ogaili A, Jaffer FA, Alaswad K, Khatri JJ, Young L, Basir MB, Krestyaninov O, Khelimskii D, Gorguluu S, Goktekin O, Choi JW, Chandwaney RH, Potluri S, Poommipanit P, Uretsky B, Kandzari DE, Aygul N, Azzalini L, Rangan BV, Mastrodemos OC, Sandoval Y, Burke MN, and Brilakis ES
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Plaque modification microcatheters (PM) (Tornus [Asahi] and Turnpike Gold [Teleflex]) are devices that are mainly used to modify the cap or lesion and maintain good support in chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI). We evaluated the frequency of use and outcomes of plaque modification microcatheters in an international multicenter registry. Plaque modification microcatheters were utilized in 242 cases (1.6%: Tornus in 51% and Turnpike Gold in 49%) with decreasing frequency over time (P-for-trend: 0.007 and 0.035, respectively). Technical and procedural success and the incidence of major cardiac adverse events were similar with Tornus and Turnpike Gold use. PM are infrequently utilized in CTO-PCI and are associated with high success and acceptable complication rates.
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- 2024
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15. Racial disparities in chronic total occlusion percutaneous coronary interventions: insights from the PROGRESS-CTO registry.
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Allana SS, Rempakos A, Alexandrou M, Mutlu D, Alaswad K, Azzalini L, Kearney K, Krestyaninov O, Khelimskii D, Gorgulu S, Chandwaney R, Jaffer FA, Khatri JJ, Davies R, Benton S, Choi JW, Karmpaliotis D, Poommipanit P, Nicholson W, Jaber W, Rinfret S, Frizzell J, Patel T, Jefferson B, Aygul N, Goktekin O, ElGuindy A, Abi-Rafeh N, Rangan BV, Murad B, Burke MN, Sandoval Y, and Brilakis ES
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- Humans, Heart, Registries, Percutaneous Coronary Intervention adverse effects, Myocardial Infarction, Stroke
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Objectives: There is limited data on race and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The authors sought to evaluate CTO PCI techniques and outcomes in different racial groups., Methods: We examined the baseline characteristics and procedural outcomes of 11 806 CTO PCIs performed at 44 US and non-US centers between 2012 and March 2023. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, repeat target-vessel revascularization, pericardiocentesis, cardiac surgery, and stroke prior to discharge., Results: The most common racial group was White (84.5%), followed by Black (5.7%), "Other" (3.9%), Hispanic (2.9%), Asian (2.4%), and Native American (0.7%). There were significant differences in the baseline characteristics between different racial groups. When compared with non-White patients, the retrograde approach and antegrade dissection re-entry were more likely to be the successful crossing strategies in White patients without any significant differences in technical success (86.4% vs 86.4%; P = .93), procedural success (84.8% vs 85.0%; P = .79), and in-hospital MACE (2.0% vs 1.5%; P = .15) between the 2 groups. The technical success rate was significantly higher in the "Other" racial group (91.0% vs 86.4% in White, 86.9% in Asian, 84.5% in Black, 84.5% in Hispanic, and 83.3% in Native American; P = .03) without any significant differences in procedural success or in-hospital MACE rates between the groups., Conclusions: Despite differences in baseline characteristics and procedural techniques, the procedural success and in-hospital MACE of CTO PCI were not significantly different between most racial groups.
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- 2024
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16. Update on chronic total occlusion percutaneous coronary intervention.
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Mutlu D, Rempakos A, Alexandrou M, Al-Ogaili A, Yamane M, Alaswad K, Basir M, Davies R, Choi J, Gagnor A, Garbo R, Goktekin O, Gorgulu S, Khatri JJ, Nicholson W, Rinfret S, Jaber W, Egred M, Milkas A, Di Mario C, Mashayekhi K, Sandoval Y, Burke MN, and Brilakis ES
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- Humans, Percutaneous Coronary Intervention adverse effects, Vascular Diseases
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Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) continues to evolve. This review summarizes recent publications categorized by outcomes, techniques, complications, and ongoing studies in this rapidly growing area.
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- 2024
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17. 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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18. 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
- Abstract
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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19. 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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20. Impact of coronary collaterals on the outcomes of chronic total occlusion percutaneous coronary intervention.
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Rempakos A, Alexandrou M, Mutlu D, Forouzandeh F, Rangan BV, Mastrodemos OC, Al-Ogaili A, Sandoval Y, Burke MN, Brilakis ES, and Poommipanit P
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- Humans, Treatment Outcome, Risk Factors, Coronary Angiography, Chronic Disease, Registries, Time Factors, Percutaneous Coronary Intervention adverse effects, Coronary Occlusion diagnosis, Coronary Occlusion surgery, Coronary Occlusion etiology
- Abstract
This study aims to evaluate the impact that the presence of interventional collaterals has on the outcomes of CTO PCI. We examined the clinical and angiographic characteristics and procedural outcomes of 11 205 patients who underwent 11 444 CTO PCIs at 45 US and non-US centers between 2012 and 2023.
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- 2023
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21. 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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22. 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
- Subjects
- Humans, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Angiography, Percutaneous Coronary Intervention adverse effects, Vascular Diseases
- Abstract
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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23. 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
- Abstract
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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24. 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
- Abstract
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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25. 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
- Abstract
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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26. 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
- Abstract
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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27. 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
- Abstract
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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28. 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
- Subjects
- 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
- Abstract
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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29. 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
- Subjects
- 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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30. 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
- Abstract
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
- Full Text
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