51 results on '"Azzalini, Lorenzo"'
Search Results
2. Use of dual-lumen microcatheter pullback injection in complex percutaneous coronary intervention.
- Author
-
Le Q, Hirai T, Lombardi WL, and Azzalini L
- Abstract
Dual-lumen microcatheters (DLMC) are utilized in challenging wiring scenarios as well as for contrast and medication injections. Nonetheless, lesion characterization remains extremely challenging in many cases. We describe a DLMC-facilitated technique which can assist in locating the distal anastomosis while navigating an occluded bypass graft during retrograde chronic total occlusion recanalization, as well as in the differential diagnosis of abrupt vessel closure. This "DLMC Pullback Injection" technique is performed by injecting contrast through the over-the-wire port of the DLMC, while the latter is quickly pulled back across the region of interest in a dynamic fashion. We believe this technique has the potential to solve challenging scenarios and to enrich the complex percutaneous coronary intervention operator's armamentarium., (© 2024 Wiley Periodicals LLC.)
- Published
- 2024
- Full Text
- View/download PDF
3. Optimal timing of staged percutaneous coronary intervention after subintimal tracking and re-entry: Rationale and design of the subintimal tracking and re-entry with deferred stenting study.
- Author
-
Hirai T, Kearney K, Azzalini L, Salisbury AC, Stone N, Gosch KL, Pershad A, Nicholson W, Lombardi W, Wyman RM, Davies R, and Grantham JA
- Abstract
Background: Ten to fifteen percent of chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) are unsuccessful in contemporary practice. Subintimal tracking and re-entry (STAR) (one form of "investment procedure") with staged reattempt and stenting may further increase the ultimate success and safety of CTO as a bailout strategy. The optimal timing for staged stenting after STAR is unknown., Methods and Results: We designed a six-center, prospective randomized trial with a planned enrollment of 150 patients where STAR is utilized in case of impending failure. The primary aim is to evaluate the optimal timing of the staged PCI after STAR by randomizing the timing to earlier (5-7 weeks) versus later (12-14 weeks) staged PCI. The primary endpoint of the study is the technical success rate of the staged procedure. The secondary endpoints include: (1) the rate of thrombolysis in myocardial infarction 3 flow at the start of staged intervention, (2) rate of partial technical and procedural success of the staged procedure, (3) rate of in-hospital and 12-month major cardiac and cerebrovascular adverse events, and (4) change in patient-reported quality at 30 days, 6 months, and 12 months assessed by Seattle Angina Questionnaire., Conclusion: This study will ascertain the optimal timing of staged stenting after bail-out STAR approach in contemporary CTO PCI (ClinicalTrials.gov NCT05089864)., (© 2024 Wiley Periodicals LLC.)
- Published
- 2024
- Full Text
- View/download PDF
4. Validation of the BCIS CHIP Score in chronic total occlusion percutaneous coronary intervention.
- Author
-
Rempakos A, Alexandrou M, Mutlu D, Choi JW, Poommipanit P, Khatri JJ, Young L, Jefferson B, Gorgulu S, Jaffer FA, Chandwaney R, Davies R, Benton S, Alaswad K, Azzalini L, Kearney KE, Krestyaninov O, Khelimskii D, Dattilo P, Reddy N, Abi-Rafeh N, Elguindy A, Goktekin O, Rangan BV, Mastrodemos OC, Al-Ogaili A, Sandoval Y, Burke NM, Brilakis ES, and Basir MB
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Chronic Disease, Reproducibility of Results, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Coronary Occlusion diagnostic imaging, Coronary Occlusion therapy, Decision Support Techniques, Percutaneous Coronary Intervention adverse effects, Predictive Value of Tests, Registries
- Abstract
Background: The complex high-risk indicated percutaneous coronary intervention (CHIP) score is a tool developed using the British Cardiovascular Intervention Society (BCIS) database to define CHIP cases and predict in-hospital major adverse cardiac or cerebrovascular events (MACCE)., Aim: To assess the validity of the CHIP score in chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Methods: We evaluated the performance of the CHIP score on 8341 CTO PCIs from the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) performed at 44 centers between 2012 and 2023., Results: In our cohort, 7.8% (n = 647) of patients had a CHIP score of 0, 50.2% (n = 4192) had a CHIP score of 1-2, 26.2% (n = 2187) had a CHIP score of 3-4, 11.7% (n = 972) had a CHIP score of 5-6, 3.3% (n = 276) had a CHIP score of 7-8, and 0.8% (n = 67) had a CHIP score of 9+. The incidence of MACCE for a CHIP score of 0 was 0.6%, reaching as high as 8.7% for a CHIP score of 9+, confirming that a higher CHIP score is associated with a higher risk of MACCE. The estimated increase in the risk of MACCE per one score unit increase was 100% (95% confidence interval [CI]: 65%-141%). The AUC of the CHIP score model for predicting MACCE in our cohort was 0.63 (95% CI: 0.58-0.67). There was a positive correlation between the CHIP score and the PROGRESS-CTO MACE score (Spearman's correlation: 0.37; 95% CI: 0.35-0.39; p < 0.001)., Conclusions: The CHIP score has modest predictive capacity for MACCE in CTO PCI., (© 2024 Wiley Periodicals LLC.)
- Published
- 2024
- Full Text
- View/download PDF
5. Retrograde chronic total occlusion percutaneous coronary intervention via ipsilateral collaterals.
- Author
-
Al-Ogaili A, Alexandrou M, Rempakos A, Mutlu D, Choi JW, Poommipanit P, Khatri JJ, Alaswad K, Basir MB, Chandwaney RH, Gorgulu S, ElGuindy AM, Elbarouni B, Jaber W, Rinfret S, Nicholson W, Jaffer FA, Aygul N, Azzalini L, Kearney KE, Frizzell J, Davies R, Goktekin O, Rangan BV, Mastrodemos OC, Sandoval Y, Nicholas Burke M, and Brilakis ES
- Subjects
- Humans, Male, Treatment Outcome, Chronic Disease, Female, Aged, Middle Aged, Time Factors, Risk Factors, Coronary Occlusion diagnostic imaging, Coronary Occlusion therapy, Coronary Occlusion physiopathology, Registries, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention instrumentation, Collateral Circulation, Coronary Circulation, Coronary Angiography
- Abstract
Background: There is limited data on retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) via ipsilateral epicardial collaterals (IEC)., Aims: To compare the clinical and angiographic characteristics, and outcomes of retrograde CTO PCI via IEC versus other collaterals in a large multicenter registry., Methods: Observational cohort study from the Prospective Global registry for the study of Chronic Total Occlusion Intervention (PROGRESS-CTO)., Results: Of 4466 retrograde cases performed between 2012 and 2023, crossing through IEC was attempted in 191 (4.3%) cases with 50% wiring success. The most common target vessel in the IEC group was the left circumflex (50%), in comparison to other retrograde cases, where the right coronary artery was most common (70%). The Japanese CTO score was similar between the two groups (3.13 ± 1.23 vs. 3.06 ± 1.06, p = 0.456); however, the IEC group had a higher Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) score (1.95 ± 1.02 vs. 1.27 ± 0.92, p < 0.0001). The most used IEC guidewire was the SUOH 03 (39%), and the most frequently used microcatheter was the Caravel (43%). Dual injection was less common in IEC cases (66% vs. 89%, p < 0.0001). Technical (76% vs. 79%, p = 0.317) and procedural success rates (74% vs. 79%, p = 0.281) were not different between the two groups. However, IEC cases had a higher procedural complications rate (25.8% vs. 16.4%, p = 0.0008), including perforations (17.3% vs. 9.0%, p = 0.0001), pericardiocentesis (3.1% vs. 1.2%, p = 0.018), and dissection/thrombus of the donor vessel (3.7% vs. 1.2%, p = 0.002)., Conclusion: The use of IEC for retrograde CTO PCI was associated with similar technical and procedural success rates when compared with other retrograde cases, but higher incidence of periprocedural complications., (© 2024 Wiley Periodicals LLC.)
- Published
- 2024
- Full Text
- View/download PDF
6. Intracoronary snaring of the retrograde guidewire: A novel method to solve compartment mismatch in complex retrograde CTO PCI.
- Author
-
Moscardelli S, Condos G, Lombardi WL, and Azzalini L
- Subjects
- Humans, Treatment Outcome, Coronary Angiography methods, Chronic Disease, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Coronary Occlusion therapy, Coronary Occlusion surgery
- Abstract
The retrograde approach has allowed a remarkable improvement in the success rate of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). After collateral channel crossing, the most crucial aspect of retrograde CTO PCI is creating the connection between the antegrade and retrograde system. Currently, the most common technique to achieve this is reverse controlled antegrade and retrograde subintimal tracking. However, this maneuver sometimes fails due to compartment mismatch (intraplaque situation of one wire and extraplaque situation of the other). New approaches are therefore needed to overcome challenges in this important step of the procedure. Here we present an innovative solution to this problem, which involved capturing the retrograde guidewire (advanced into a side branch at the distal cap) with a microsnare that had been advanced antegradely: this severed the dissection flap separating the antegrade and retrograde system, thus allowing us to successfully recanalize the CTO., (© 2024 Wiley Periodicals LLC.)
- Published
- 2024
- Full Text
- View/download PDF
7. International survey of chronic total occlusion percutaneous coronary intervention operators.
- Author
-
Simsek B, Rempakos A, Kostantinis S, Alexandrou M, Karacsonyi J, Rangan BV, Mastrodemos OC, Mutlu D, Abi Rafeh N, Alaswad K, Avran A, Azzalini L, ElGuindy A, Egred M, Goktekin O, Gorgulu S, Jaber W, Kearney KE, Kirtane AJ, Lombardi WL, Mashayekhi K, McEntegart M, Nicholson W, Rinfret S, Allana SS, Sandoval Y, Nicholas Burke M, and Brilakis ES
- Subjects
- Male, Humans, United States, Female, Treatment Outcome, Chronic Disease, Time Factors, Registries, Coronary Angiography methods, Risk Factors, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Coronary Occlusion diagnostic imaging, Coronary Occlusion therapy, Heart Injuries
- Abstract
Background: Contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) practice has received limited study., Aim: To examine the contemporary CTO PCI practice., Methods: We performed an online, anonymous, international survey of CTO PCI operators., Results: Five hundred forty-five CTO PCI operators and 190 interventional cardiology fellows with an interest in CTO PCI participated in this survey. Almost half were from the United States (41%), most (93%) were men, and the median h/week spent in the hospital was 58. Median annual case numbers were 205 (150-328) for PCIs and 20 (5-50) for CTO PCIs. Almost one-fifth (17%) entered CTO cases into registries, such as PROGRESS-CTO (55%) and EuroCTO (20%). More than one-third worked at academic institutions (39%), 31% trained dedicated CTO fellows, and 22% proctored CTO PCI. One-third (34%) had dedicated CTO PCI days. Most (51%) never discharged CTO patients the same day, while 17% discharged CTO patients the same day >50% of the time. After successful guidewire crossing, 38% used intravascular imaging >90% of the time. Most used CTO scores including J-CTO (81%), PROGRESS-CTO (35%), and PROGRESS-CTO complications scores (30%). Coronary artery perforation was encountered within the last month by 19%. On a scale of 0-10, the median comfort levels in treating coronary artery perforation were: covered stents 8.8 (7.0-10), coil embolization 5.0 (2.1-8.5), and fat embolization 3.7 (0.6-7.3). Most (51%) participants had a complication cart/kit and 25% conducted regular complication drills with catheterization laboratory staff., Conclusion: Contemporary CTO PCI practices vary widely. Further research on barriers to following the guiding principles of CTO PCI may improve patient outcomes., (© 2023 Wiley Periodicals LLC.)
- Published
- 2024
- Full Text
- View/download PDF
8. Applicability of J-CTO channel score to predict microcatheter tracking during retrograde percutaneous coronary intervention of chronic total occlusions: Insights from the SURFING MICRO registry.
- Author
-
Piedimonte G, Azzalini L, Ferrarotto L, Mangione R, Cerrato E, Franzè A, Tomassini F, Rolfo C, Pavani M, Zanda G, Tamburino C, Varbella F, and La Manna A
- Subjects
- Humans, Treatment Outcome, Coronary Angiography, Chronic Disease, Collateral Circulation, Registries, Risk Factors, Percutaneous Coronary Intervention adverse effects, Coronary Occlusion diagnostic imaging, Coronary Occlusion therapy, Coronary Occlusion etiology
- Abstract
Background: The J-chronic total occlusion (CTO) channel score can predict guidewire tracking of the collateral channels (CCs), but its efficacy in predicting microcatheter tracking has never been tested in the setting of retrograde CTO-percutaneous coronary intervention (PCI)., Aims: Predicting microcatheter collateral tracking during retrograde CTO-PCIs., Methods: A total of 189 patients undergoing retrograde CTO-PCI from April 2017 to August 2021 were screened. The primary outcome of interest was a correlation between J-CTO channel score and microcatheter tracking failure (MTF) after successful CC tracking by the guidewire. The independent association between anatomical features of the J-CTO channel score and the primary outcome of interest was explored., Results: After adjustment, only small size (adjusted OR: 12.70, 95% confidence interval [CI]: 1.79-89.82; p = 0.01) and continuous bends (adjusted OR: 14.15, 95% CI: 2.77-72.34; p < 0.001) remained significantly associated with an increased risk of MTF for septal collaterals. The small size was the only predictor of the MTF for epicardial collaterals (OR: 6.39, 95% CI: 1.13-35.96; p = 0.020) at univariate analysis. Patients in the MTF group had a lower incidence of procedural success compared with patients in the microcatheter tracking success (MTS) group (40.0% vs. 93.9%, p < 0.001) and had a higher incidence of collateral perforations (20.0% vs. 3.0%, p < 0.001)., Conclusion: Small and tortuous septal collaterals, identified by a score ≥3, are associated with an increased risk of MTF, lower incidence of procedural success, and higher risk of procedural complications driven by collateral perforations., (© 2023 Wiley Periodicals LLC.)
- Published
- 2024
- Full Text
- View/download PDF
9. Balloon-assisted subintimal entry (BASE) in chronic total occlusion percutaneous coronary interventions.
- Author
-
Alexandrou M, Rempakos A, Al Ogaili A, Choi JW, Poommipanit P, Alaswad K, Basir MB, Davies R, Benton S, Jaffer FA, Chandwaney RH, Azzalini L, Kearney KE, ElGuindy AM, Abi Rafeh N, Goktekin O, Gorgulu S, Khatri JJ, Aygul N, Vo MN, Cincin A, Rangan BV, Mastrodemos OC, Allana SS, Sandoval Y, Burke MN, and Brilakis ES
- Subjects
- Male, Humans, Middle Aged, Aged, Female, Treatment Outcome, Prospective Studies, Coronary Angiography, Chronic Disease, Registries, Risk Factors, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Coronary Occlusion diagnostic imaging, Coronary Occlusion therapy, Coronary Occlusion etiology
- Abstract
Background: There is limited data on the use of the balloon-assisted subintimal entry (BASE) technique in chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Methods: We analyzed the baseline clinical and angiographic characteristics and outcomes of 155 CTO PCIs that utilized the BASE technique at 31 US and non-US centers between 2016 and 2023., Results: The BASE technique was used in 155 (7.9%) of 1968 antegrade dissection and re-entry (ADR) cases performed during the study period. The mean age was 66 ± 10 years, 88.9% of the patients were men, and the prevalence of diabetes (44.6%), hypertension (90.5%), and dyslipidemia (88.7%) was high. Compared with 1813 ADR cases that did not use BASE, the target vessel of the BASE cases was more commonly the RCA and less commonly the LAD. Lesions requiring BASE had longer occlusion length (42 ± 23 vs. 37 ± 23 mm, p = 0.011), higher Japanese CTO (J-CTO) (3.4 ± 1.0 vs. 3.0 ± 1.1, p < 0.001) and PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention chronic total occlusion) (1.8 ± 1.0 vs. 1.5 ± 1.0, p = 0.008) scores, and were more likely to have proximal cap ambiguity, side branch at the proximal cap, blunt/no stump, moderate to severe calcification, and proximal tortuosity. Technical (71.6% vs. 75.5%, p = 0.334) and procedural success (71.6% vs. 72.8%, p = 0.821), as well as major adverse cardiac events (MACE) (1.3% vs. 4.1%, p = 0.124), were similar in ADR cases that used BASE and those that did not., Conclusions: The BASE technique is used in CTOs with longer occlusion length, higher J-CTO score, and more complex angiographic characteristics, and is associated with moderate success but also low MACE., (© 2023 Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
10. Increased prescription dose for large vessel intravascular brachytherapy.
- Author
-
Wallner K, Kearney KE, Tiwana J, Pristera N, Kim EY, Azzalini L, Sandison G, Lombardi WL, Don C, and Kim M
- Subjects
- Humans, Treatment Outcome, Catheterization, Vascular Surgical Procedures, Stents, Brachytherapy adverse effects, Coronary Restenosis
- Abstract
Background: Most randomized studies testing the effectiveness of IVBT were limited to vessels less than 4 mm diameter. In fact, it is now common to treat vessels larger than 4 mm. Accordingly, the authors instituted a prescription dose increase to 34 Gy at 2 mm from source center for vessels greater than 4.0 mm. The increase in prescription dose to 34 Gy at 2 mm from center is substantial, being 50% higher than the conventional maximum of 23 Gy., Aim: To take a close look at group of patients treated to 34 Gy, and for whom follow-up angiograms are available., Methods: Ten patients treated for ISR with a prescription dose of 34 Gy and for whom follow-up angiograms were available were studied. Beta-radiation brachytherapy was performed with a Novoste Beta-Cath System using a strontium-90 (beta) source (Best Vascular, Springfield, VA). Source lengths of 40 or 60 mm were used. A dose of 34 Gy was prescribed at 2 mm from the source center., Results: Patients were re-catheterized from 2 to 21 months (median: 16 months) following IVBT, all for symptoms suggested of restenosis. All patients had some degree of ISR of the target vessel, but no IVBT-treated vascular segment showed angiographic signs of degeneration, dissection or aneurysm., Conclusion: The authors' clinical impression, along with detailed review of the 10 cases, suggest that using a 34 Gy prescription dose at 2 mm from source center does not result in increased toxicity., (© 2023 Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
11. Impact of preprocedural anemia on in-hospital and follow-up outcomes of chronic total occlusion percutaneous coronary intervention.
- Author
-
Rempakos A, Kostantinis S, Simsek B, Karacsonyi J, Alexandrou M, Choi JW, Poommipanit P, Khatri JJ, Young L, Davies R, Benton S, Jaffer FA, Chandwaney R, Azzalini L, Alaswad K, Jefferson B, Frizzell J, Abi-Rafeh N, Elguindy A, Goktekin O, Rangan BV, Mastrodemos OC, Allana SS, Sandoval Y, Burke NM, Brilakis ES, and Gorgulu S
- Subjects
- Male, Humans, Female, Treatment Outcome, Follow-Up Studies, Risk Factors, Chronic Disease, Time Factors, Coronary Angiography adverse effects, Hospitals, Registries, Coronary Occlusion diagnostic imaging, Coronary Occlusion therapy, Coronary Occlusion complications, Percutaneous Coronary Intervention, Anemia complications, Anemia diagnosis
- Abstract
Background: The impact of preprocedural anemia on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study., Methods: We examined the clinical and angiographic characteristics and procedural outcomes of 8633 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023. Anemia was defined as a hemoglobin level of <13 g/dL in men and <12 g/dL in women., Results: Anemia was present in 1652 (19%) patients undergoing CTO PCI. Anemic patients had a higher incidence of comorbidities, such as diabetes mellitus, hypertension, dyslipidemia, heart failure, cerebrovascular disease, and peripheral arterial disease. CTOs in anemic patients were more likely to have complex angiographic characteristics, including smaller diameter, longer length, moderate to severe calcification, and moderate to severe proximal tortuosity. Anemic patients required longer procedure (119 vs. 107 min; p < 0.001) and fluoroscopy (45 vs. 40 min; p < 0.001) times but received similar contrast volumes. Technical success was similar between the two groups. In-hospital major adverse cardiac events (MACE) rates were higher in patients with anemia; however, this association was no longer significant after adjusting for confounding factors. Baseline anemia was independently associated with follow-up MACE (adjusted hazard ratio [HR]: 1.63; 95% confidence interval [CI]: 1.07-2.49; p = 0.023) and all-cause mortality (adjusted HR: 3.03; 95% CI: 1.41-6.49; p = 0.004)., Conclusions: Preprocedural anemia is associated with more comorbidities, higher lesion complexity, longer procedure times, and higher follow-up MACE and mortality after CTO PCI., (© 2023 Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
12. STAR procedure becomes SAFER: First-in-man case series of a new antegrade dissection re-entry technique.
- Author
-
Carlino M, Uretsky BF, Azzalini L, Nascimbene A, Brilakis ES, Colombo A, Nakamura S, Godino C, Avran A, Rinfret S, and Faurie B
- Abstract
Introduction: Antegrade dissection and re-entry (ADR) is an integral part of the hybrid algorithm, which has allowed for improved outcomes in chronic total occlusion (CTO) coronary intervention (PCI)., Methods: A new ADR method, Subintimal Antegrade FEnestration and Re-entry (SAFER), is described. The results of a first-in-man series are presented., Results: SAFER was performed on seven consecutive patients with angiographic and clinical success in all patients., Conclusions: This first-in-man study has shown that the SAFER technique is feasible and effective with the possibility of improving the antegrade PCI CTO success rate., (© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
13. Electrocautery-assisted re-entry to resolve bilateral aorto-ostial chronic total occlusions due to leaflet obstruction following transcatheter aortic valve replacement.
- Author
-
Kane J, Kearney KE, Lombardi WL, and Azzalini L
- Subjects
- Humans, Treatment Outcome, Electrocoagulation adverse effects, Aortic Valve diagnostic imaging, Aortic Valve surgery, Risk Factors, Transcatheter Aortic Valve Replacement adverse effects, Coronary Occlusion diagnostic imaging, Coronary Occlusion etiology, Coronary Occlusion surgery, Percutaneous Coronary Intervention adverse effects, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Aortic Valve Stenosis complications
- Abstract
Coronary artery obstruction is a rare but life-threatening complication of transcatheter aortic valve replacement (TAVR). While urgent percutaneous coronary intervention has been described in cases of acute occlusion, little is known about the interventional management of obstruction once it has occurred in the chronic setting. We describe a case in which electrocautery-assisted re-entry was successfully utilized to manage the right coronary artery and left main chronic total occlusion due to leaflet-induced coronary artery obstruction after TAVR., (© 2023 Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
14. The contemporary role of protamine in the cardiac catheterization laboratory.
- Author
-
Danek BA, Kearney KE, Chung CJ, Steinberg Z, Lombardi WL, McCabe JM, and Azzalini L
- Subjects
- Humans, Treatment Outcome, Blood Coagulation, Cardiac Catheterization adverse effects, Protamines adverse effects, Hemorrhage chemically induced, Hemorrhage prevention & control
- Abstract
Access to the arterial circulation and full anticoagulation carries a risk of serious bleeding during and after percutaneous coronary intervention. Important sources of bleeding include the arterial access site and coronary artery perforation. Prompt and effective management of hemorrhagic complications is an essential interventional skill. Protamine sulfate is well-known as a heparin reversal agent. Despite this, there is heterogeneity in the use of protamine during interventional procedures. While protamine is generally well-tolerated, it is associated with a risk of hypersensitivity reaction, including anaphylaxis, among others. The purpose of this review is to summarize the existing evidence about and experience with the use of protamine sulfate in the setting of percutaneous coronary and structural interventional procedures., (© 2023 Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
15. Role of the retrograde Carlino technique for chronic total occlusion percutaneous coronary intervention.
- Author
-
Azzalini L, Boudou N, Avran A, Kane J, Lombardi WL, Kearney KE, and Carlino M
- Subjects
- Humans, Treatment Outcome, Coronary Angiography, Chronic Disease, Registries, Risk Factors, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Coronary Occlusion diagnostic imaging, Coronary Occlusion therapy, Coronary Occlusion etiology
- Abstract
Background: There is scarce data on the outcomes of the Carlino technique for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We aimed to investigate the indications and outcomes of the Carlino technique as performed in the context of the retrograde approach., Methods: We pooled CTO PCI cases where a retrograde Carlino technique was performed from high-volume operators at four centers. The Carlino technique was characterized according to its indication (achieving plaque/cap modification, clarifying microcatheter location within the vessel, resolving distal cap ambiguity) and was considered successful when it led to the desired outcome., Results: A total of 43 patients were included. Occlusion complexity was very high (mean J-CTO score 3.3 ± 0.8). The two most common indications were understanding the anatomy of the occlusion and clarifying gear location (37.2%) and impenetrable distal cap (34.9%). The Carlino technique was successful in 88.4% of cases. Overall technical and procedural success was 86.0%. The most common successful crossing technique was reverse controlled antegrade and retrograde subintimal tracking (70.3%). No complications were attributed to the Carlino technique., Conclusions: We observed a high success rate of the retrograde Carlino technique, as well as overall technical and procedural success rates. No Carlino technique-related complications were observed. Additional data from larger registries are warranted to further confirm the safety and efficacy of this technique., (© 2023 Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
16. Validation of the new PROGRESS-CTO complication risk scores in the OPEN-CTO registry.
- Author
-
Azzalini L, Hirai T, Salisbury A, Gosch K, Sapontis J, Nicholson WJ, Karmpaliotis D, Moses JW, Kearney KE, Lombardi WL, and Grantham JA
- Subjects
- Humans, Middle Aged, Aged, Coronary Angiography, Treatment Outcome, Risk Factors, Registries, Chronic Disease, Coronary Occlusion diagnostic imaging, Coronary Occlusion therapy, Coronary Occlusion etiology, Percutaneous Coronary Intervention, Myocardial Infarction etiology
- Abstract
Background: Risk stratification before chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is important to inform procedural planning as well as patients and their families. We sought to externally validate the PROGRESS-CTO complication risk scores in the OPEN-CTO registry., Methods: OPEN-CTO is a prospective registry of 1000 consecutive CTO PCIs performed at 12 experienced US centers using the hybrid algorithm. Endpoints of interest were in-hospital all-cause mortality, need for pericardiocentesis, acute myocardial infarction (MI), and major adverse cardiovascular events (MACE) (a composite of all-cause mortality, stroke, periprocedural MI, urgent repeat revascularization, and tamponade requiring pericardiocentesis). Model discrimination was assessed with the area under the curve (AUC) method, and calibration with the observed-versus-predicted probability method., Results: Mean age was 65.4 ± 10.3 year, and 36.5% of patients had prior coronary artery bypass graft. Overall, 41 patients (4.1%) suffered MACE, 9 (0.9%) mortality, 26 (2.6%) acute MI, and 11 (1.1%) required pericardiocentesis. Technical success was achieved in 86.3%. Patients who experienced MACE had higher anatomic complexity, and more often required antegrade dissection/reentry and the retrograde approach. Increasing PROGRESS-CTO MACE scores were associated with increasing MACE rates: 0.5% (score 0-1), 2.4% (score 2), 3.7% (score 3), 4.5% (score 4), 7.8% (score 5), 13.0% (score 6-7). The AUC were as follows: MACE 0.72 (95% confidence interval [CI]: 0.66-0.78), mortality 0.79 (95% CI: 0.66-0.95), pericardiocentesis 0.71 (95% CI: 0.60-0.82), and acute MI 0.57 (95% CI: 0.49-0.66). Calibration was adequate for MACE and mortality, while the models underestimated the risk of pericardiocentesis and acute MI., Conclusions: In a large external cohort of patients treated with the hybrid algorithm by experienced CTO operators, the PROGRESS-CTO MACE, mortality, and pericardiocentesis risk scores showed good discrimination, while the acute MI score had inferior performance., (© 2023 Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
17. External validation of the PROGRESS-CTO perforation risk score: Individual patient data pooled analysis of three registries.
- Author
-
Simsek B, Tajti P, Carlino M, Ojeda S, Pan M, Rinfret S, Vemmou E, Kostantinis S, Nikolakopoulos I, Karacsonyi J, Rempakos A, Dens JA, Agostoni P, Alaswad K, Megaly M, Avran A, Choi JW, Jaffer FA, Doshi D, Karmpaliotis D, Khatri JJ, Knaapen P, La Manna A, Spratt JC, Tanabe M, Walsh S, Mastrodemos OC, Allana S, Rangan BV, Goktekin O, Gorgulu S, Poommipanit P, Kearney KE, Lombardi WL, Grantham JA, Mashayekhi K, Brilakis ES, and Azzalini L
- Abstract
Background: Coronary artery perforation is one of the most feared and common complications of chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Methods: To assess the usefulness of the recently developed PROGRESS-CTO (NCT02061436) perforation risk score in independent cohorts. Individual patient-level data pooled analysis of three registries was performed., Results: Of the 4566 patients who underwent CTO PCI at 25 centers, 196 (4.2%) had coronary artery perforation. Patients with perforations were older (69 ± 10 vs. 65 ± 10, p < 0.001), more likely to be women (19% vs. 13%, p = 0.009), more likely to have a history of prior coronary artery bypass graft (34% vs. 20%, p < 0.001), and unfavorable angiographic characteristics such as blunt stump (62% vs. 48%, p < 0.001), proximal cap ambiguity (52% vs. 34%, p < 0.001), and moderate-severe calcification (60% vs. 49%, p = 0.002). Technical success was lower in patients with perforations (73% vs. 88%, p < 0.001). The area under the receiver operating characteristic curve of the PROGRESS-CTO perforation risk model was 0.76 (95% confidence interval [CI], 0.72-0.79), with good calibration (Hosmer-Lemeshow p = 0.97). We found that the CTO PCI perforation risk increased with higher PROGRESS-CTO perforation scores: 0.3% (score 0), 2.3% (score 1), 3.1% (score 2), 5.5% (score 3), 7.5% (score 4), 14.6% (score 5)., Conclusion: Given the good discriminative performance, calibration, and the ease of calculation, the PROGRESS-CTO perforation score may facilitate assessment of the risk of perforation in patients undergoing CTO PCI., (© 2023 Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
18. Chronic total occlusion percutaneous coronary intervention in heart transplant patients.
- Author
-
Azzalini L, Moroni F, Dawson KL, and Kearney KE
- Subjects
- Humans, Treatment Outcome, Ventricular Function, Left, Chronic Disease, Coronary Angiography, Risk Factors, Percutaneous Coronary Intervention, Coronary Occlusion diagnostic imaging, Coronary Occlusion etiology, Coronary Occlusion therapy, Heart Transplantation adverse effects
- Abstract
Cardiac allograft vasculopathy (CAV) is frequently observed after heart transplant (HT), and represents one of the main causes of chronic rejection, graft loss, and death. While the role of percutaneous coronary intervention (PCI) is well established in the management of CAV in cases of nonocclusive stenoses, the outcomes and technical aspects of this procedure in chronic total occlusions (CTOs) are unknown. We describe our experience with three cases in which CTO PCI was indicated to treat CAV in HT recipients, and we discuss the peculiarities and therapeutic approach to this challenging patient population. In particular, all patients were asymptomatic for angina, and CTO PCI was indicated to promote recovery of left ventricular function, extend graft survival, and/or protect from future ischemic events. CTO PCI was performed using hybrid techniques and was successful in all three cases. Intravascular imaging was used in all cases to maximize the durability of the procedure., (© 2022 Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
19. Extraplaque versus intraplaque tracking in chronic total occlusion percutaneous coronary intervention.
- Author
-
Megaly M, Buda K, Karacsonyi J, Kostantinis S, Simsek B, Basir MB, Mashayekhi K, Rinfret S, McEntegart M, Yamane M, Azzalini L, Alaswad K, and Brilakis ES
- Subjects
- Humans, Treatment Outcome, Risk Factors, Time Factors, Chronic Disease, Coronary Angiography adverse effects, Observational Studies as Topic, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Coronary Occlusion diagnostic imaging, Coronary Occlusion therapy, Coronary Occlusion complications, Myocardial Infarction etiology
- Abstract
Objective: To compare the clinical outcomes after extraplaque (EP) versus intraplaque (IP) tracking in chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Background: The impact of modern dissection and reentry (DR) techniques on the long-term outcomes of CTO PCI remains controversial., Methods: We performed a systematic review and meta-analysis of studies that compared EP versus IP tracking in CTO PCI. Odds ratios (ORs) with 95% confidence intervals (CIs) are calculated using the Der-Simonian and Laird random-effects method., Results: Our meta-analysis included seven observational studies with 2982 patients. Patients who underwent EP tracking had significantly more complex CTOs with higher J-CTO score, longer lesion length, and more severe calcification and had significantly longer stented segments. During a median follow-up of 12 months (range 9-12 months), EP tracking was associated with a higher risk of major adverse cardiovascular events (MACE) (OR 1.50, 95% CI (1.10-2.06), p = 0.01) and target vessel revascularization (TVR) (OR 1.69, 95% CI (1.15-2.48), p = 0.01) compared with IP tracking. There was no difference in the incidence of all-cause death (OR 1.37, 95% CI (0.67-2.78), p = 0.39), myocardial infarction (MI) (OR 1.48, 95% CI (0.82-2.69), p = 0.20), stent thrombosis (OR 2.09, 95% CI (0.69-6.33), p = 0.19), or cardiac death (OR 1.10, 95% CI (0.39-3.15), p = 0.85) between IP and EP tracking., Conclusion: EP tracking is utilized in more complex CTOs and requires more stents. EP tracking is associated with a higher risk of MACE, driven by a higher risk of TVR at 1 year, but without an increased risk of death or MI compared with IP tracking. EP tracking is critically important for contemporary CTO PCI., (© 2022 Wiley Periodicals LLC.)
- Published
- 2022
- Full Text
- View/download PDF
20. Grade 3 coronary artery perforations in chronic total occlusion-percutaneous coronary intervention: Mechanisms, locations, and outcomes from the G3CAP Registry.
- Author
-
Pavani M, Cerrato E, Franzè A, Colombo F, Ryan N, Durante A, Bellini B, Calcagno S, Montorfano M, Gonzalo N, Azzalini L, Escaned J, and Varbella F
- Subjects
- Chronic Disease, Coronary Angiography, Hospital Mortality, Humans, Registries, Risk Factors, Treatment Outcome, Coronary Artery Disease, Coronary Occlusion diagnostic imaging, Coronary Occlusion therapy, Heart Injuries diagnostic imaging, Heart Injuries etiology, Heart Injuries therapy, Percutaneous Coronary Intervention, Vascular System Injuries diagnostic imaging, Vascular System Injuries etiology, Vascular System Injuries therapy
- Abstract
Aim: The impact of Grade III coronary perforations (G3-CP) in the setting of CTO-PCI is not well assessed., Methods and Results: We reviewed 7773 CTO-PCI and 98,819 non CTO-PCI performed in 10 European centers: G3 perforation occurred in 87 patients (1.1%) during CTO PCI and 224 patients (0.22%) during non CTO-PCI (p < 0.001). G3-CP involved the CTO segment in 68% of patients and the retrograde channels in 14% of cases. In the CTO PCI group, wire induced G3-CP (50.5% vs. 32.5%, p = 0.02) occurred predominantly when dedicated CTO tapered and highly penetrative wires were used. Intra-procedural and in-hospital death rates were 4.6% vs. 5.8% and 3.6% vs. 7.5% respectively for CTO PCI and non-CTO PCI groups (p = NS). At a median follow up of 24 months, the overall mortality and MAE were respectively 7.8% and MAE 19% without difference among groups., Conclusions: We showed similar in-hospital and long-term outcomes when G3 perforations occurred during CTO PCI and non CTO-PCI., (© 2022 Wiley Periodicals LLC.)
- Published
- 2022
- Full Text
- View/download PDF
21. Iso-osmolar versus low-osmolar contrast media and outcomes after percutaneous coronary intervention: Insights from the VA CART Program.
- Author
-
Jovin IS, Warsavage TJ, Plomondon ME, Grunwald GK, Waldo SW, Rao SV, Brilakis ES, and Azzalini L
- Subjects
- Acute Kidney Injury epidemiology, Cohort Studies, Humans, Myocardial Infarction epidemiology, Stroke epidemiology, Treatment Outcome, Veterans Health Services, Contrast Media adverse effects, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods
- Abstract
Objectives: To assess whether contrast media type is associated with outcomes in veterans undergoing percutaneous coronary intervention (PCI)., Background: There is uncertainty about the impact of iso-osmolar contrast medium (IOCM) versus low-osmolar contrast medium (LOCM) on acute kidney injury (AKI) and other major adverse renal or cardiovascular events (MARCE) after PCI. We assessed the association between contrast media type and MARCE in patients who underwent PCI within the Veterans Administration Healthcare System., Methods: We reviewed PCIs performed between 2009 and 2019 using data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. The primary endpoint was MARCE, a composite of myocardial infarction, stroke, all-cause death, AKI, and dialysis onset at 30 days., Results: The analysis cohort consisted of 50,389 patients of whom 25,555 received LOCM and 24,834 received IOCM. There was significant variation in contrast type across sites. After adjustment for comorbidities, no significant association between contrast media type and MARCE was observed in both site-unadjusted (odds ratio [OR] for IOCM: 0.99; 95% confidence interval [CI]: 0.92-1.08; p = 0.97) and site-adjusted (OR: 1.06; 95% CI: 0.95-1.18; p = 0.30) analyses. Similar results were obtained when contrast volume was imputed or the data was subset to individuals with available contrast volume., Conclusion: In a large cohort of veterans undergoing PCI, we found considerable site variation in the type of contrast media used but no significant association between contrast media type and the incidence of MARCE, both before and after adjustment for the site., (© 2022 Wiley Periodicals LLC.)
- Published
- 2022
- Full Text
- View/download PDF
22. International percutaneous coronary intervention complication survey.
- Author
-
Simsek B, Kostantinis S, Karacsonyi J, Hall A, Rangan BV, Croce KJ, Azzalini L, McEntegart M, Shishehbor M, Egred M, Mastrodemos OC, Sorajja P, Banerjee S, Lombardi W, Sandoval Y, and Brilakis ES
- Subjects
- Humans, Middle Aged, Surveys and Questionnaires, Treatment Outcome, United States epidemiology, Cardiologists, Heart Injuries, Percutaneous Coronary Intervention adverse effects
- Abstract
Objectives: To investigate the perceptions of interventional cardiologists (IC) regarding the frequency, impact, and management strategies of percutaneous coronary intervention (PCI) complications., Background: The perceptions and management strategies of ICs of PCI complications have received limited study., Methods: Online survey on PCI complications: 46 questions were distributed via email lists and Twitter to ICs., Results: Of 11,663 contacts, 821 responded (7% response rate): 60% were from the United States and the median age was 46-50 years. Annual PCI case numbers were <100 (26%), 100-199 (37%), 200-299 (21%), and ≥300 (16%); 42% do not perform structural interventions, others reported performing <40 (30%), or >100 (11%) structural cases annually. On a scale of 0-10, participating ICs were highly concerned about potential complications with a median score of 7.2 (interquartile range: 5.0-8.7). The most feared complication was death (39%), followed by coronary perforation (26%) and stroke (9%). Covered stents were never deployed by 21%, and 32% deployed at least one during the past year; 79% have never used fat to seal perforations; 64% have never used coils for perforations. Complications were attributed to higher patient/angiographic complexity by 68% and seen as opportunities for improvement by 70%; 97% of participants were interested in learning more about the management of PCI complications. The most useful learning methods were meetings (66%), webinars (48%), YouTube (32%), and Twitter (29%)., Conclusion: ICs who participated in the survey are highly concerned about complications. Following complication management algorithms and having access to more experienced operators might alleviate stress and optimize patient outcomes., (© 2022 Wiley Periodicals LLC.)
- Published
- 2022
- Full Text
- View/download PDF
23. Outcomes of chronic total occlusion percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Insights from the LATAM CTO registry.
- Author
-
Hernandez-Suarez DF, Azzalini L, Moroni F, Tinoco de Paula JE, Lamelas P, Campos CM, Harada Ribeiro M, Martins Filho E, Damas de Los Santos F, Padilla L, Alcantara-Melendez M, Abud MA, Almodóvar-Rivera IA, Moura Schmidt M, Echavarria M, Botelho AC, Del Rio V, Quadros A, and Santiago R
- Subjects
- Chronic Disease, Coronary Angiography, Coronary Artery Bypass adverse effects, Humans, Registries, Risk Factors, Stroke Volume, Time Factors, Treatment Outcome, Ventricular Function, Left, Coronary Occlusion diagnostic imaging, Coronary Occlusion surgery, Percutaneous Coronary Intervention adverse effects
- Abstract
Objectives: To evaluate the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with and without prior coronary artery bypass graft (CABG) surgery., Background: Data on the outcomes of CTO PCI in patients with versus without CABG remains limited and with scarce representation from developing regions like Latin America., Methods: We evaluated patients undergoing CTO PCI in 42 centers participating in the LATAM CTO registry between 2008 and 2020. Statistical analyses were stratified according to CABG status. The outcomes of interest were technical and procedural success and in-hospital major adverse cardiac and cerebrovascular events (MACCE)., Results: A total of 1662 patients were included (n = 1411 [84.9%] no-CABG and n = 251 [15.1%] prior-CABG). Compared with no-CABG, those with prior-CABG were older (67 ± 11 vs. 64 ± 11 years; p < 0.001), had more comorbidities and lower left ventricular ejection fraction (52.8 ± 12.8% vs. 54.4 ± 11.7%; p = 0.042). Anatomic complexity was higher in the prior-CABG group (J-CTO score 2.46 ± 1.19 vs. 2.10 ± 1.22; p < 0.001; PROGRESS CTO score 1.28 ± 0.89 vs. 0.91 ± 0.85; p < 0.001). Absence of CABG was associated with lower risk of technical and procedural failure (OR: 0.60, 95% CI: 0.43-0.85 and OR: 0.58, 95% CI: 0.40-0.83, respectively). No significant differences in the incidence of in-hospital MACCE (3.8% no-CABG vs. 4.4% prior-CABG; p = 0.766) were observed between groups., Conclusion: In a contemporary multicenter CTO-PCI registry from Latin America, prior-CABG patients had more comorbidities, higher anatomical complexity, lower success, and similar in-hospital adverse event rates compared with no-CABG patients., (© 2021 Wiley Periodicals LLC.)
- Published
- 2022
- Full Text
- View/download PDF
24. Excimer laser coronary atherectomy for uncrossable coronary lesions. A multicenter registry.
- Author
-
Ojeda S, Azzalini L, Suárez de Lezo J, Johal GS, González R, Barman N, Hidalgo F, Bellera N, Dangas G, Jurado-Román A, Kini A, Romero M, Moreno R, Garcia Del Blanco B, Mehran R, Sharma SK, and Pan M
- Subjects
- Coronary Angiography, Humans, Lasers, Excimer adverse effects, Registries, Treatment Outcome, Atherectomy, Coronary adverse effects
- Abstract
Objectives: To assess the efficacy and safety of excimer laser coronary atherectomy (ELCA), as well as, the long-term outcomes and the factors associated with ELCA failure in uncrossable lesions., Background: Uncrossable lesions constitute a challenge for percutaneous coronary intervention., Methods: This multicenter registry included 126 patients with 126 uncrossable lesions. Study endpoints were ELCA success, technical success and a composite of cardiac death, myocardial infarction (MI), and target-lesion revascularization (TLR) on follow-up. Predictors of ELCA failure were analyzed., Results: Moderate or severe calcification was present in 79 (62.7%) of the lesions and 58 (46%) were a chronic total occlusion. ELCA success was obtained in 103 (81.8%) patients. Rotational atherectomy was attempted as bailout in 21 out of 23 ELCA failure (91.3%), being successful in 14 (66.7%) of them. Finally, technical and procedural success were achieved in 114 (90.5%) and 110 (87.3%) of the patients. Severe calcification was independently associated with ELCA failure (OR: 3.73, 95% CI: 1.35-10.32; p = .011). Two (1.6%) patients died (one after a stroke and another patient because of heart failure), 4 (3.2%) developed a non-Q MI without clinical consequences and 1 (0.8%) patient had a Q-MI. Other complications were ventricular tachycardia/fibrillation (n = 2; 1.6%) and flow-limiting dissection (n = 1, 0.8%). At follow-up (median 424 days), 3 (2.4%) patients died (1 (0.8%) from cardiovascular cause) and 15 (11.9%) required TLR., Conclusions: In our multicenter experience, ELCA use demonstrated to be safe and reasonably effective with a rate of events on follow-up relatively low. Severe calcification was associated with ELCA failure., (© 2020 Wiley Periodicals LLC.)
- Published
- 2021
- Full Text
- View/download PDF
25. A new combined antegrade and retrograde approach for chronic total occlusion recanalization: Facilitated antegrade fenestration and re-entry.
- Author
-
Azzalini L and Carlino M
- Subjects
- Chronic Disease, Coronary Angiography, Humans, Treatment Outcome, Coronary Occlusion diagnostic imaging, Coronary Occlusion surgery, Percutaneous Coronary Intervention
- Abstract
While antegrade techniques remain the cornerstone of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), operators have often to resort to the retrograde approach in complex occlusions. In particular, lesions with proximal cap ambiguity, unclear vessel course and/or poor distal landing zone are difficult to tackle with either antegrade wiring or antegrade dissection and re-entry (ADR), and often require the retrograde approach. After collateral channel crossing, the retrograde approach usually culminates with either reverse controlled antegrade and retrograde subintimal tracking (CART) or retrograde true lumen crossing. Both techniques usually involve the use of an externalization wire, which requires keeping a higher activate clotting time to prevent thrombosis of the retrograde channel and is potentially associated with risk for donor vessel injury. In 2018, we described antegrade fenestration and re-entry (AFR), a targeted ADR technique in which fenestrations between the false and true lumen are created by antegrade balloon dilatation in the extraplaque space at the level of the distal cap, which are subsequently engaged by a polymer-jacketed wire to achieve re-entry. We hypothesized that AFR can also expedite antegrade crossing of the CTO after a wire has reached the distal vessel in a retrograde fashion. In this report, we present two cases in which we successfully achieved antegrade CTO crossing with AFR following retrograde advancement of a guidewire to the distal cap, in new variant of the technique, which we called "facilitated AFR"., (© 2021 Wiley Periodicals LLC.)
- Published
- 2021
- Full Text
- View/download PDF
26. One-year outcomes of patients undergoing complex percutaneous coronary intervention with three contemporary drug-eluting stents.
- Author
-
Azzalini L, Baber U, Johal GS, Farhan S, Barman N, Kapur V, Hasan C, Vijay P, Jhaveri V, Mehran R, Kini AS, and Sharma SK
- Subjects
- Everolimus adverse effects, Humans, Prosthesis Design, Treatment Outcome, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease surgery, Drug-Eluting Stents, Myocardial Infarction, Percutaneous Coronary Intervention adverse effects
- Abstract
Objectives: We aimed to evaluate the 1-year outcomes of three everolimus-eluting stents (EES) for complex percutaneous coronary intervention (PCI)., Background: It is controversial whether contemporary bioresorbable-polymer drug-eluting stents (BP-DES) are associated with better outcomes compared with durable-polymer DES (DP-DES)., Methods: Patients undergoing PCI with cobalt-chromium (CoCr)-DP-EES (Xience), platinum-chromium (PtCr)-DP-EES (Promus), or PtCr-BP-EES (Synergy) at one high-volume institution between 2015 and 2017 were included. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of death, myocardial infarction, and target-vessel revascularization. Associations were also examined in patients undergoing complex PCI. Multivariable analysis was conducted to adjust for baseline differences across groups., Results: We included n = 5,446 patients (CoCr-DP-EES, n = 3,177; PtCr-DP-EES, n = 1,555; PtCr-BP-EES, n = 714). Patients treated with PtCr-BP-EES had higher comorbidity burden and procedural complexity. At 1 year, MACE rates were 8.9% for CoCr-DP-EES versus 8.9% for PtCr-DP-EES versus 8.6% for PtCr-BP-EES (p = .97). The incidence of definite/probable stent thrombosis (ST) was also similar (0.6 vs. 0.4 vs. 0.3%, p = .69). Complex PCI was performed in n = 2,894/5,446 (53.1%). At 1 year, MACE rates were 11.5 versus 10.7 versus 10.3%, respectively (p = .83). The incidence of definite/probable ST was also similar (0.9 vs. 0.3 vs. 0.3%, p = .22). On multivariable analysis, stent type was not an independent predictor of MACE either in the overall or in the complex PCI population., Conclusions: We observed comparable 1-year rates of MACE and definite/probable ST in patients undergoing PCI with CoCr-DP-EES, PtCr-DP-EES, and PtCr-BP-EES. Results were unchanged among patients undergoing complex PCI. Future multicenter randomized studies should confirm and extend our findings., (© 2020 Wiley Periodicals LLC.)
- Published
- 2021
- Full Text
- View/download PDF
27. Outcomes of Impella-supported high-risk nonemergent percutaneous coronary intervention in a large single-center registry.
- Author
-
Azzalini L, Johal GS, Baber U, Bander J, Moreno PR, Bazi L, Kapur V, Barman N, Kini AS, and Sharma SK
- Subjects
- Humans, Registries, Retrospective Studies, Risk Factors, Treatment Outcome, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease surgery, Heart-Assist Devices adverse effects, Percutaneous Coronary Intervention adverse effects
- Abstract
Objectives: We aimed to evaluate the early and one-year outcomes of Impella-supported high-risk nonemergent percutaneous coronary intervention (PCI)., Background: The evidence for the use of mechanical circulatory support (MCS) devices in high-risk nonemergent PCI is limited and nonconclusive., Methods: We performed a single-center retrospective study including all patients who underwent high-risk nonemergent PCI supported by Impella 2.5/CP at our institution between January 2009 and June 2018. This patient population was propensity score matched with subjects undergoing PCI with no MCS. The primary endpoint was major adverse cardiac events (MACE: all-cause death, myocardial infarction [MI], and target lesion revascularization) at one-year follow-up., Results: Two-hundred fifty patients undergoing Impella-supported nonemergent PCI were matched to 250 controls. The two groups were well balanced in terms of clinical and angiographic characteristics. Left main PCI was performed more frequently among Impella-supported patients (26% vs. 11%, p < .001), who also had numerically higher prevalence of rotational atherectomy use (44% vs. 37%, p = .10) and a higher number of vessels treated (1.8 ± 0.8 vs. 1.3 ± 0.6, p < .001), compared with controls. Impella-supported patients suffered a higher incidence of periprocedural MI (14.0% vs. 6.4%, p = .005), major bleeding (6.8% vs. 2.8%, p = .04), and need for blood transfusions (11.2% vs. 4.8%, p = .008). However, at one-year follow-up there were no differences in the rates of MACE (31.2% vs. 27.4%, p = .78) or any of its individual components between Impella-supported patients and controls., Conclusions: Although Impella-supported patients suffer a higher incidence of periprocedural adverse events (partially linked to more aggressive PCI), the incidence of one-year MACE was similar between the Impella and control group., (© 2020 Wiley Periodicals, Inc.)
- Published
- 2021
- Full Text
- View/download PDF
28. Multicenter experience with the antegrade fenestration and reentry technique for chronic total occlusion recanalization.
- Author
-
Azzalini L, Alaswad K, Uretsky BF, Agostoni P, Galassi AR, Harada Ribeiro M, Filho EM, Morales-Victorino N, Attallah A, Gupta A, Zivelonghi C, Montorfano M, Bellini B, and Carlino M
- Subjects
- Chronic Disease, Coronary Angiography, Humans, Registries, Treatment Outcome, Coronary Occlusion diagnostic imaging, Coronary Occlusion surgery, Percutaneous Coronary Intervention
- Abstract
Objectives: We aimed to evaluate the efficacy and safety of antegrade fenestration and reentry (AFR) for chronic total occlusion (CTO) recanalization in a multicenter registry., Background: Adoption of antegrade dissection/reentry (ADR) for CTO recanalization has been limited, and novel ADR techniques are needed., Methods: AFR involves the balloon-induced creation of multiple fenestrations between the false and true lumen. A targeted true lumen reentry is subsequently achieved with a low tip-load polymer-jacketed guidewire. Following the initial description and dissemination of AFR, patients undergoing AFR-based CTO recanalization at nine centers were included in the present registry. Study endpoints were AFR success, procedural success, and target-lesion failure (TLF) on follow-up., Results: We included 41 patients. Mean J-CTO score was 2.5 ± 1.4. In 80.5% of cases, AFR was performed after failed antegrade wire escalation. Another ADR technique was used before AFR in one-third of cases. AFR achieved distal true lumen reentry in n = 27/41 (65.9%) cases. In n = 14/41 (34.1%) cases with AFR failure, use of alternative techniques led to successful CTO recanalization in eight additional patients. The overall technical and procedural success rates were 85.4% and 82.9%, respectively. No AFR-related complications were observed. One-year TLF rate was 8.3% overall, with no differences between successful and failed AFR., Conclusions: We report on AFR feasibility in a multicenter registry of patients undergoing CTO recanalization. We observed a moderate success rate, coupled with the absence of complications. Moreover, even a failed AFR attempt did not preclude the use of alternative techniques to achieve recanalization. Further studies should confirm and extend our findings., (© 2020 Wiley Periodicals, Inc.)
- Published
- 2021
- Full Text
- View/download PDF
29. Long-term clinical effects of recanalization of chronic coronary total occlusions in patients with left ventricular systolic dysfunction.
- Author
-
Pinto G, Fragasso G, Gemma M, Bertoldi L, Salerno A, Godino Md C, Colombo A, Azzalini L, Margonato A, and Carlino M
- Subjects
- Aged, Chronic Disease, Coronary Occlusion diagnostic imaging, Coronary Occlusion mortality, Coronary Occlusion physiopathology, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Assessment, Risk Factors, Systole, Time Factors, Treatment Outcome, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left mortality, Coronary Occlusion therapy, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Stroke Volume, Ventricular Dysfunction, Left physiopathology, Ventricular Function, Left
- Abstract
Objectives: The aim of the present analysis is to evaluate the clinical impact of chronic total occlusions (CTOs) recanalization in patients with left ventricular (LV) systolic dysfunction., Background: According to contemporary knowledge, patient selection for percutaneous CTO revascularization is not yet standardized. In particular, data on outcomes in patients with LV systolic dysfunction undergoing percutaneous coronary intervention (PCI) for CTO are scarce., Methods: From a total of 2,421 consecutive patients with at least one CTO, 436 patients with ejection fraction (EF) ≤45%, who were referred for coronary angiography between January 1998 and September 2014, were selected. Patients with successful recanalization of the target CTO were assigned to CTO-revascularized group and those with failed or not attempted recanalization to the CTO-not revascularized (CTO-NR) group. Study endpoints were all-cause death, cardiac death, and occurrence of myocardial infarction on follow-up., Results: Out of 436 CTO patients with reduced EF, 228 (52.3%) were successfully recanalized and 208 patients (47.7%) were not, either due to CTO-PCI failure (n = 106, 24.3%) or because CTO-PCI was not attempted (n = 102, 23.4%). At long-term follow-up, CTO-NR patients had significantly higher rate of overall (p = .021) and cardiac mortality (p = .035) compared to those successfully revascularized., Conclusion: In patients with systolic LV dysfunction (EF ≤ 45%), CTO revascularization was associated with significant lower rate of total and cardiac mortality compared to those with nonrevascularized CTO., (© 2020 Wiley Periodicals, Inc.)
- Published
- 2020
- Full Text
- View/download PDF
30. Conventional vascular access site approach versus fully trans-wrist approach for chronic total occlusion percutaneous coronary intervention: a multicenter registry.
- Author
-
Poletti E, Azzalini L, Ayoub M, Ojeda S, Zivelonghi C, La Manna A, Bellini B, Lostalo A, Luque A, Venuti G, Montorfano M, Agostoni P, Pan M, Carlino M, and Mashayekhi K
- Subjects
- Aged, Chronic Disease, Coronary Occlusion diagnostic imaging, Europe, Female, Hemorrhage etiology, Humans, Male, Middle Aged, Punctures, Registries, Retrospective Studies, Stents, Treatment Outcome, Vascular Diseases etiology, Catheterization, Peripheral adverse effects, Coronary Occlusion therapy, Femoral Artery, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention instrumentation, Wrist blood supply
- Abstract
Objectives: To evaluate the incidence of vascular complication and major bleeding in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with a fully trans-wrist access (TWA) approach versus a conventional approach based on trans-femoral access (TFA)., Background: TFA is the preferred vascular access in CTO PCI, but it has been associated with a non-negligible risk of complications., Methods: This retrospective registry included all patients undergoing CTO PCI at five institutions between July 2011 and October 2018. Patients were divided into two groups: Conventional (patients treated with at least one TFA) and Fully TWA (subjects exclusively treated with one or two TWA). The primary safety endpoint was a composite of vascular complications and major bleeding. The primary efficacy endpoint was procedural success., Results: We included 1,900 patients (Conventional n = 1,496 and Fully TWA n = 404). Conventional patients showed higher occlusion complexity (J-CTO score 2.1 ± 1.2 vs. 1.5 ± 1.1, p < .001). Procedural success showed no significant difference between both groups (85.7 vs. 83.0%, p = .17). The primary safety endpoint occurred more frequently in the Conventional group (10.3 vs. 4.5%, p < .001), driven by vascular complications (9.4 vs. 3.7%, p < .001). On multivariate analysis, not using a Fully TWA approach was an independent predictor of the study endpoint, after adjusting for age, sex, diabetes, body mass index, chronic kidney disease, prior coronary artery bypass graft, and J-CTO score., Conclusions: Embracing a Fully TWA approach for CTO PCI might be associated with lower incidence of a composite endpoint of vascular complications and major bleeding, compared with a Conventional approach., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2020
- Full Text
- View/download PDF
31. A "minimalistic hybrid algorithm" in coronary chronic total occlusion revascularization: Procedural and clinical outcomes.
- Author
-
Zivelonghi C, van Kuijk JP, Poletti E, Suttorp MJ, Eefting FD, Rensing BJ, Ten Berg JM, Colombo A, Azzalini L, and Agostoni P
- Subjects
- Aged, Chronic Disease, Coronary Occlusion diagnostic imaging, Coronary Occlusion physiopathology, Decision Trees, Equipment Design, Female, Humans, Male, Middle Aged, Registries, Retrospective Studies, Risk Factors, Treatment Outcome, Vascular Access Devices, Algorithms, Catheterization, Peripheral adverse effects, Catheterization, Peripheral instrumentation, Clinical Protocols, Coronary Occlusion therapy, Femoral Artery, Percutaneous Coronary Intervention adverse effects, Radial Artery
- Abstract
Background: Percutaneous recanalization of coronary chronic total occlusions (CTOs) traditionally relies on the use of dual-access and large bore catheters, with trans-femoral approach adoption in most cases., Objectives: Aim of this manuscript is to describe the outcomes of an alternative hybrid algorithm, called "Minimalistic Hybrid Algorithm," which has the purpose to minimize the use of double access, large bore catheters, and femoral approach in order to minimize the risk of vascular complications and patient's discomfort, without compromising efficacy., Methods: In this single-center registry, a "minimalistic" approach was attempted in consecutive patients undergoing CTO PCI between March 2016 and October 2017. Data regarding the applicability of this algorithm and the related procedural success rates were collected, together with common demographic and angiographic characteristics., Results: Of the 100 CTO PCI performed in the study period, 91(91%) were successfully approached according to the novel algorithm. Mean J-CTO score of all minimalistic procedures was 1.9 ± 1.2, with 31(34%) patients presenting with J-CTO score ≥3. In 52 procedures, the approach consisted of single-catheter access, 49(94.2%) of which were trans-radial. Out of the 39 patients approached with dual-catheters, 26(69.2%) were biradial, and 8(21%) radial-femoral. Procedural success in patients approached with the minimalistic algorithm was 89%, in line with the results of large-multicenter experiences nowadays available., Conclusions: Our results show that an alternative algorithm limiting the routine use of large bore catheters and trans-femoral approach is feasible in the clinical practice and yields good procedural outcomes., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2020
- Full Text
- View/download PDF
32. Long-term follow-up of covered stent implantation for various coronary artery diseases.
- Author
-
Hachinohe D, Latib A, Laricchia A, Iannopollo G, Demir OM, Ancona MB, Mangieri A, Regazzoli D, Giannini F, Azzalini L, Mitomo S, Chieffo A, Montorfano M, Carlino M, and Colombo A
- Subjects
- Aged, Aged, 80 and over, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality, Coronary Artery Disease physiopathology, Databases, Factual, Female, Follow-Up Studies, Humans, Italy, Male, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Prosthesis Design, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Coronary Artery Disease therapy, Percutaneous Coronary Intervention instrumentation, Stents
- Abstract
Objectives: The aims of this study were to evaluate the long-term clinical outcomes after coronary covered stent (CS) implantation and to compare the results according to the indications., Background: To date, data on the long-term follow-up of coronary CS are limited, and no studies have been conducted to compare outcomes on the basis of specific lesions treated., Methods: A total of 190 consecutive patients (212 lesions) implanted with CS and surviving until discharge between May 1997 and February 2017 were enrolled in this retrospective study. Clinical outcomes were evaluated and compared using the Gehan-Breslow-Wilcoxon test., Results: CS was mainly used for the treatment of a saphenous vein graft (SVG) (51.4%), followed by coronary artery perforation (CAP) (25.0%) and coronary artery aneurysm (CAA) (11.8%). The median follow-up duration was 6.0 (interquartile range: 1.6-13.5) years. Target vessel myocardial infarction (MI), target vessel occlusion, target lesion revascularization, and stent thrombosis, frequently occurred in the early follow-up period (7.3%, 16.6%, 21.5%, and 8.9% at 1 year, respectively) and continued to increase throughout the long-term follow-up (14.8%, 38.6%, 38.7%, and 17.8% at 10 years, respectively). Target vessel occlusion, target vessel MI, and ST were not identified in CAA with superiority to CAP (Gehan-Breslow-Wilcoxon p-value = 0.010, 0.047, and 0.046, respectively). SVG had a higher rate of target vessel occlusion than CAA (p = 0.004)., Conclusions: Clinical events after CS implantation frequently occurred in the early period and steadily increased in the long-term period. CS implantation in CAA was associated with fewer adverse cardiac events and may lead to safe and acceptable outcomes. However, CS implanted in CAP and SVG are associated with a high risk of long-term cardiac events., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2019
- Full Text
- View/download PDF
33. Algorithmic solutions to common problems encountered during chronic total occlusion angioplasty: The algorithms within the algorithm.
- Author
-
Riley RF, Walsh SJ, Kirtane AJ, Michael Wyman R, Nicholson WJ, Azzalini L, Spratt JC, Kalra S, Hanratty CG, Pershad A, DeMartini T, Karmpaliotis D, Lombardi WL, and Aaron Grantham J
- Subjects
- Chronic Disease, Clinical Decision-Making, Consensus, Coronary Angiography, Coronary Occlusion diagnostic imaging, Humans, Percutaneous Coronary Intervention instrumentation, Treatment Outcome, Algorithms, Coronary Occlusion therapy, Critical Pathways, Percutaneous Coronary Intervention adverse effects
- Abstract
Improved technical equipment, dissemination of best practices, and the importance of complete coronary revascularization have led to a renewed interest in coronary chronic total occlusion (CTO) PCI. In particular, the hybrid algorithm has been associated with increasing procedural success rates in the US. However, the hybrid algorithm only covers overarching strategies in the overall approach to these lesions. Several technical challenges can occur during execution of these approaches, each of which has several potential solutions. A systematic or algorithmic approach to dealing with these challenges could contribute to improved procedural efficiency and higher procedural success. While there have been isolated attempts in the past to codify approaches to each of these situations, there has not been a contemporary, comprehensive review of the potential solutions to these problems. We present 10 common problems encountered during CTO PCI and a consensus hierarchical approach to them., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2019
- Full Text
- View/download PDF
34. Contrast modulation in chronic total occlusion percutaneous coronary intervention.
- Author
-
Azzalini L, Uretsky B, Brilakis ES, Colombo A, and Carlino M
- Subjects
- Chronic Disease, Contrast Media adverse effects, Coronary Occlusion diagnostic imaging, Humans, Injections, Intralesional, Microinjections, Percutaneous Coronary Intervention adverse effects, Predictive Value of Tests, Risk Factors, Treatment Outcome, Contrast Media administration & dosage, Coronary Angiography adverse effects, Coronary Occlusion therapy, Percutaneous Coronary Intervention methods, Radiography, Interventional adverse effects
- Abstract
The intraplaque injection of contrast media in the recanalization of coronary chronic total occlusions (CTO) has witnessed a dynamic journey since its initial formulation. Contrast-guided subintimal tracking and re-entry (STAR) was the first contrast modulation technique for CTO percutaneous coronary intervention (PCI). With this technique, a forceful injection of a large volume of contrast (3-4 mL) was performed in order to achieve hydraulic recanalization of the vessel. This approach was associated with extensive vessel injury and unpredictable true lumen re-entry, which were in turn linked to high rates of restenosis on follow-up. In the subsequent iteration, called the "microchannel technique", a smaller amount of contrast media (1 mL) was gently injected inside the plaque to modify its compliance by softening and recruiting loose tissue, which facilitated subsequent true-to-true lumen crossing with a polymer-jacketed wire along paths of least resistance. The microchannel technique has later evolved into what is currently known as the "Carlino technique", where a minimal volume of contrast media (<0.5 mL) is gently injected inside the occlusion, with the goal of modifying plaque compliance to facilitate guidewire and microcatheter advancement through a fibrocalcific plaque. The Carlino technique is now widely utilized to allow negotiation of difficult-to-cross occlusions, particularly by the "hybrid operators", with high success rates and low incidence of complications. The purpose of this article is to provide a historical perspective on the use of contrast modulation in CTO PCI, its pathophysiological basis, as well as technical recommendations on how and when to perform these maneuvers., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2019
- Full Text
- View/download PDF
35. Microcatheter knuckle technique: A novel technique for negotiating the subintimal space during chronic total occlusion recanalization.
- Author
-
Carlino M, Demir OM, Colombo A, and Azzalini L
- Subjects
- Aged, Cardiac Catheterization adverse effects, Cardiac Catheterization instrumentation, Cardiac Catheters, Chronic Disease, Coronary Occlusion diagnostic imaging, Equipment Design, Humans, Male, Middle Aged, Miniaturization, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention instrumentation, Time Factors, Treatment Outcome, Cardiac Catheterization methods, Coronary Occlusion therapy, Percutaneous Coronary Intervention methods
- Abstract
Objectives: To establish if novel microcatheter knuckle technique (MKT) is feasible and efficacious in negotiating the subintimal space in difficult lesions during chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Background: CTOs remain one of the most challenging lesion subsets in PCI. Guidewire manipulation and advancement of equipment within the subintimal space is sometimes challenging and aggressive manipulation in the subintimal space is feared, because of concern of vessel disruption and perforation. Here we introduce the MKT, for negotiating the subintimal space during challenging CTO PCI., Methods: MKT is performed by creating a wire knuckle with polymer-jacketed guidewire and positioned in the subintimal space. Subsequently, a tapered-tip, kink-resistant microcatheter is advanced towards the knuckled tip of guidewire and the guidewire is simultaneously withdrawn; creating a knuckle-shaped microcatheter tip. The MKT was considered in CTO PCIs that involved subintimal techniques where resistance to guidewire knuckle advancement was encountered. Procedures were performed between March 2013 and June 2017 at our institution., Results: During the study period, a total of 440 CTO PCIs were performed, from which seven were treated with MKT. MKT was successful in six patients and technical success was achieved in all seven patients. The MKT was successfully performed with both the antegrade and retrograde approach., Conclusion: We present a novel technique for negotiating the subintimal space in CTO PCI for cases where significant resistance is experienced restricting guidewire or material advancement in antegrade or retrograde dissection. The MKT appears to be efficacious complementing the CTO operator's armamentarium., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
36. First report of the use of long-tapered sirolimus-eluting coronary stent for the treatment of chronic total occlusions with the hybrid algorithm.
- Author
-
Zivelonghi C, van Kuijk JP, Nijenhuis V, Poletti E, Suttorp MJ, van der Heyden JAS, Eefting FD, Rensing BJ, Ten Berg JM, Azzalini L, van den Brink FS, Ribichini F, Colombo A, Henriques JPS, and Agostoni P
- Subjects
- Aged, Cardiovascular Agents adverse effects, Chronic Disease, Coronary Occlusion diagnostic imaging, Coronary Occlusion physiopathology, Female, Humans, Male, Middle Aged, Prosthesis Design, Retrospective Studies, Sirolimus adverse effects, Time Factors, Treatment Outcome, Vascular Patency, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary instrumentation, Cardiovascular Agents administration & dosage, Coronary Occlusion therapy, Drug-Eluting Stents, Sirolimus administration & dosage
- Abstract
Background: Coronary chronic total occlusions (CTO) usually coexist with diffusely diseased coronary segments proximal and/or distal to the CTO segment. During percutaneous treatment of CTO, multiple overlapping stents are often needed to treat these long lesions., Objectives: Aim of this study is to report the first use of long, tapered coronary sirolimus-eluting stents (SES) in this setting., Methods and Results: This is a retrospective analysis of 100 consecutive patients undergoing CTO recanalization following the hybrid algorithm. Procedural success rate was 89% (11 failures). Among the successful cases, "conventional" drug-eluting stents(DES) were used in 40(44.9%) patients, while in 49(55%) patients long-tapered SES were attempted with a success rate of 98% (1 cross-over to regular stents). Total stent length in the long-tapered DES group was higher compared to the "conventional" stenting group (76 ± 28 mm vs 46 ± 22 mm, P < .001), with a similar total number of stent (1.6 ± 0.8 vs 1.9 ± 0.8). At quantitative coronary analysis, proximal and distal segment involvement was more extended in patients undergoing long-tapered stenting, with longer overall lesion length. No differences in periprocedural complications and clinical outcomes at a mean follow-up of 303 ± 179 days were observed., Conclusions: The use of long tapered coronary DES is technically feasible and safe for the percutaneous treatment of CTOs, especially for patients presenting with long lesions., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
37. Definite stent thrombosis after drug-eluting stent implantation in coronary bifurcation lesions: A meta-analysis of 3,107 patients from 14 randomized trials.
- Author
-
Zhou Y, Chen S, Huang L, Hildick-Smith D, Ferenc M, Jabbour RJ, Azzalini L, Colombo A, Chieffo A, and Zhao X
- Subjects
- Aged, Coronary Artery Disease diagnostic imaging, Coronary Thrombosis diagnostic imaging, Female, Humans, Male, Middle Aged, Randomized Controlled Trials as Topic, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Coronary Artery Disease therapy, Coronary Thrombosis etiology, Drug-Eluting Stents, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention instrumentation
- Abstract
Background: Bifurcation percutaneous coronary intervention (PCI) is a challenging procedure, but there are currently inadequate data about definite stent thrombosis (ST) rates of single-stent versus double-stent strategies (SS and DS, respectively)., Methods and Results: Randomized clinical trials (RCTs) comparing SS and DS strategies were searched through PubMed, Embase, and the Cochrane Central Register of Controlled Trials. Fourteen RCTs involving 3,107 patients were analyzed. Owing to the high crossover rate (16.49%), both intention-to-treat (ITT) and as-treated (AT) analyses were performed. In the ITT population, there was a significantly lower rate of early definite ST in the SS group (0.26%; DS group 1.14%; P = 0.021). Similarly, in the AT population, there was a significantly lower rate of early definite ST in the SS group (0.23%, DS group 1.07%; P = 0.042). True bifurcation subgroup analysis also showed a significantly lower early definite ST in the SS group (OR = 0.36, 95% CI = 0.15-0.86, P = 0.042) in the ITT population. There was no significant difference of overall, acute, subacute, and late definite ST between the 2 groups., Conclusions: Early definite ST is reduced when a SS strategy is used in bifurcation lesions., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
38. Subadventitial stenting around occluded stents: A bailout technique to recanalize in-stent chronic total occlusions.
- Author
-
Azzalini L, Karatasakis A, Spratt JC, Tajti P, Riley RF, Ybarra LF, Schumacher SP, Benincasa S, Bellini B, Candilio L, Mitomo S, Henriksen P, Hidalgo F, Timmers L, Kraaijeveld AO, Agostoni P, Roy J, Ramsay DR, Weaver JC, Knaapen P, Nap A, Starcevic B, Ojeda S, Pan M, Alaswad K, Lombardi WL, Carlino M, Brilakis ES, Colombo A, Rinfret S, and Mashayekhi K
- Subjects
- Aged, Australia, Canada, Chronic Disease, Computed Tomography Angiography, Coronary Angiography methods, Coronary Occlusion diagnostic imaging, Coronary Occlusion etiology, Coronary Occlusion mortality, Coronary Restenosis diagnostic imaging, Coronary Restenosis etiology, Coronary Restenosis mortality, Europe, Female, Humans, Male, Middle Aged, Multidetector Computed Tomography, Prosthesis Design, Registries, Retreatment, Retrospective Studies, Time Factors, Tomography, Optical Coherence, Treatment Outcome, Ultrasonography, Interventional, United States, Vascular Patency, Coronary Occlusion therapy, Coronary Restenosis therapy, Drug-Eluting Stents, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention instrumentation, Percutaneous Coronary Intervention methods, Percutaneous Coronary Intervention mortality
- Abstract
Objectives: To evaluate the outcomes of subadventitial stenting (SS) around occluded stents for recanalizing in-stent chronic total occlusions (IS-CTOs)., Background: There is little evidence on the outcomes of SS for IS-CTO., Methods: We examined the outcomes of SS for IS-CTO PCI at 14 centers between July 2011 and June 2017, and compared them to historical controls recanalized using within-stent stenting (WSS). Target-vessel failure (TVF) on follow-up was the endpoint of this study, and was defined as a composite of cardiac death, target-vessel myocardial infarction, and target-vessel revascularization., Results: During study period, 422 IS-CTO PCIs were performed, of which 32 (7.6%) were recanalized with SS, usually when conventional approaches failed. The most frequent CTO vessel was the right coronary artery (72%). Mean J-CTO score was 3.1 ± 0.9. SS was antegrade in 53%, and retrograde in 47%. Part of the occluded stent was crushed in 37%, while the whole stent was crushed in 63%. Intravascular imaging was used in 59%. One patient (3.1%) suffered tamponade. Angiographic follow-up was performed in 10/32 patients: stents were patent in six cases, one had mild neointimal hyperplasia, and three had severe restenosis at the SS site. Clinical follow-up was available for 29/32 patients for a mean of 388 ± 303 days. The 24-month incidence of TVF was 13.8%, which was similar to historical controls treated with WSS (19.5%, P = 0.49)., Conclusions: SS is rarely performed, usually as last resort, to recanalize complex IS-CTOs. It is associated with favorable acute and mid-term outcomes, but given the small sample size of our study additional research is warranted., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
39. Antegrade fenestration and re-entry: A new controlled subintimal technique for chronic total occlusion recanalization.
- Author
-
Carlino M, Azzalini L, Mitomo S, and Colombo A
- Subjects
- Aged, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary instrumentation, Cardiac Catheters, Chronic Disease, Coronary Angiography, Coronary Occlusion diagnostic imaging, Coronary Occlusion physiopathology, Equipment Design, Female, Humans, Male, Middle Aged, Time Factors, Treatment Outcome, Ultrasonography, Interventional, Vascular Patency, Angioplasty, Balloon, Coronary methods, Coronary Occlusion therapy
- Abstract
Objectives: To describe and evaluate the efficacy of a novel antegrade dissection/re-entry (ADR) technique, called antegrade fenestration and re-entry (AFR), for chronic total occlusions (CTO) percutaneous coronary intervention (PCI)., Background: The widespread adoption of ADR is limited by several technical, logistic, and financial factors. Therefore, novel ADR techniques are needed., Methods: AFR consists in creating multiple fenestrations of the dissection flap separating the false and true lumen. This is achieved by advancing a balloon (sized 1:1 with the artery diameter) onto the antegrade wire into the subintimal space, and inflating it at the level of the distal cap. A soft polymer-jacketed guidewire is then advanced across the fenestrations created by balloon inflation from the subintimal space into the true lumen. Following its theoretical formulation, patients undergoing ADR-based CTO recanalization at our institution were considered for AFR treatment., Results: Between November 2015 and October 2017, 279 CTO PCIs were performed. Of those, ADR was utilized in 33 (12%) cases, of whom AFR was used in 6 (18%). In all but one cases, AFR was performed after failed true-to-true lumen crossing, while in the remainder it was utilized after extensive subintimal space disruption following alternative ADR techniques. AFR was successful in all six cases and no complications were observed., Conclusions: We have developed a novel ADR technique which aims at complementing the CTO operator's armamentarium. AFR does not preclude alternative bailout techniques, and is inexpensive and easy to perform. A dedicated study should confirm our findings in a large cohort., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
40. A comparison of the fully repositionable and retrievable Boston Lotus and direct flow medical valves for the treatment of severe aortic stenosis: A single center experience.
- Author
-
Giannini F, Latib A, Montorfano M, Ruparelia N, Romano V, Longoni M, Ferri L, Jabbour R, Mangieri A, Regazzoli D, Ancona M, Buzzatti N, Azzalini L, Tanaka A, Agricola E, Chieffo A, Alfieri O, and Colombo A
- Subjects
- Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Echocardiography, Female, Hemodynamics, Humans, Italy, Male, Postoperative Complications etiology, Postoperative Complications therapy, Prosthesis Design, Recovery of Function, Retrospective Studies, Severity of Illness Index, Time Factors, Transcatheter Aortic Valve Replacement adverse effects, Treatment Outcome, Aortic Valve surgery, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement instrumentation
- Abstract
Background: Second generation transcatheter aortic valve implantation (TAVI) devices have been designed to reduce the rate of paravalvular leak (PVL) and other complications. An important technological advancement has been the ability to fully reposition devices to facilitate optimal implantation depth and position to reduce the likelihood of PVL., Objectives: To compare procedural and 30-day outcomes according to the Valve Academic Research Consortium (VARC)-2 criteria following TAVI with the fully repositionable and retrievable Lotus and DFM devices., Methods and Results: 175 patients with severe aortic stenosis underwent transfemoral TAVI with the Lotus (n = 60) and DFM (n = 115) valve. Baseline clinical characteristics did not differ between the two groups. All devices were successfully implanted, with one case of valve embolization in the Lotus group. Device success (95 vs. 98.2%, P = 0.89), VARC-defined combined safety (90 vs. 93%, P = 0.48), and clinical efficacy (86.7 vs. 90.4%, P = 0.65) rates at 30-days were similar between Lotus and DFM groups. There was no severe PVL; one patient in both Lotus and DFM group developed moderate PVL after the procedure. The Lotus valve was associated with a higher rate of new pacemaker implantation (37.3 vs. 11.2%, P < 0.001) and a lower mean aortic gradient (9.4 ± 5 vs. 12.3 ± 5, P < 0.001) at 30-days as compared with the DFM valve., Conclusions: In this single-center, retrospective analysis, both Lotus and DFM devices demonstrated excellent device success, safety and efficacy at 30-day follow-up. The DFM valve was associated with minimally higher transvalvular gradients but lower new pacemaker implantation rates when compared to the Lotus valve., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
41. Subadventitial techniques for chronic total occlusion percutaneous coronary intervention: The concept of "vessel architecture".
- Author
-
Azzalini L, Carlino M, Brilakis ES, Vo M, Rinfret S, Uretsky BF, Karmpaliotis D, and Colombo A
- Subjects
- Adventitia diagnostic imaging, Chronic Disease, Coronary Angiography, Coronary Occlusion diagnostic imaging, Coronary Vessels diagnostic imaging, Humans, Percutaneous Coronary Intervention adverse effects, Postoperative Complications prevention & control, Risk Factors, Treatment Outcome, Adventitia surgery, Coronary Occlusion surgery, Coronary Vessels surgery, Percutaneous Coronary Intervention methods
- Abstract
Despite improvements in guidewire technologies, the traditional antegrade wire escalation approach to chronic total occlusion (CTO) recanalization is successful in only 60-80% of selected cases. In particular, long, calcified, and tortuous occlusions are less successfully approached with a true-to-true lumen approach. Frequently, the guidewire tracks into the subadventitial space, with no guarantee of distal re-entry into the true lumen. The ability to manage the subadventitial space has been a key step in the tremendous improvement in success rates of contemporary CTO percutaneous coronary intervention (PCI), whether operating antegradely or retrogradely. A modern approach to CTO PCI involves understanding the concept of "vessel architecture," which is based on the distinction between coronary structures (occlusive plaque, comprising the disrupted intima and media, and the outer adventitia) and extravascular space. The vessel architecture represents a safe work environment for guidewire and device manipulation. This review provides an anatomy-based description of the concept of vessel architecture, along with a historical perspective of subadventitial techniques for CTO PCI, and outcome data of CTO PCI utilizing the subadventitial space. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
42. Intracoronary snaring of the retrograde guidewire: How to overcome extreme takeoff angles in chronic total occlusion percutaneous coronary intervention.
- Author
-
Azzalini L, Candilio L, Carlino M, and Colombo A
- Subjects
- Aged, Angioplasty, Balloon, Coronary instrumentation, Cardiac Catheterization instrumentation, Cardiac Catheters, Chronic Disease, Coronary Angiography, Coronary Occlusion diagnostic imaging, Coronary Occlusion physiopathology, Coronary Vessels diagnostic imaging, Coronary Vessels physiopathology, Drug-Eluting Stents, Humans, Male, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Cardiac Catheterization methods, Coronary Occlusion surgery, Coronary Vessels surgery
- Abstract
Extreme angulation of coronary artery takeoff represents a challenge for wiring and device advancement in percutaneous coronary intervention (PCI). This anatomic feature is particularly adverse in cases of chronic total occlusion (CTO) of the ostial-proximal segment of the target vessel. In this setting, the retrograde approach can help getting access to the occlusion. However, difficulties might arise at the critical step of wire externalization, due to the need to overcome the extreme ostial angle. Here, we describe a case of successful CTO PCI of the proximal circumflex artery, which presented an extreme angle at its takeoff. Due to inability to perform antegrade wiring of the occlusion, the retrograde approach was undertaken via epicardial collaterals from the right coronary artery. Since conventional attempts at re-entering the antegrade guiding catheter failed due to the aforementioned extreme angle, the retrograde wire was snared in the mid left anterior descending artery, and externalization was performed. This case demonstrates the usefulness of coronary snares in the CTO operator's toolkit and shows how such devices can be used to safely and successfully complete challenging retrograde procedures., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
43. Rotational atherectomy in the subadventitial space to allow safe and successful chronic total occlusion recanalization: Pushing the limit further.
- Author
-
Capretti G, Carlino M, Colombo A, and Azzalini L
- Subjects
- Chronic Disease, Coronary Angiography, Coronary Occlusion diagnostic imaging, Coronary Occlusion physiopathology, Drug-Eluting Stents, Humans, Male, Middle Aged, Treatment Outcome, Angioplasty, Balloon, Coronary instrumentation, Atherectomy, Coronary methods, Coronary Occlusion surgery
- Abstract
Dissection and re-entry (DR) techniques have played a key role in the increase of success rates of chronic total occlusion (CTO) recanalization. DR usually allows wiring complex occlusions, even in case of important calcification. In extreme cases, such as in balloon failure-to-cross, rotational atherectomy (RA) might be decisive. However, according to experts' recommendations, RA should not be performed in dissection planes because of the high risk of perforation and further extending the dissection, so that its use after DR might be limited. Here, we describe a case of successful right coronary artery CTO recanalization in which, after failure of several antegrade and retrograde techniques, RA was safely performed antegradely in the subadventitial space, thus eventually enabling reverse controlled antegrade and retrograde subintimal tracking (CART). Although the feasibility of RA in CTO percutaneous coronary intervention had already been suggested, this case reports on the novel use of RA to allow further manipulation of the subadventitial space (reverse CART) prior to successful recanalization. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
44. Long-term outcomes of rotational atherectomy for the percutaneous treatment of chronic total occlusions.
- Author
-
Azzalini L, Dautov R, Ojeda S, Serra A, Benincasa S, Bellini B, Giannini F, Chavarría J, Gheorghe LL, Pan M, Carlino M, Colombo A, and Rinfret S
- Subjects
- Aged, Chronic Disease, Coronary Angiography, Coronary Occlusion diagnosis, Female, Follow-Up Studies, Humans, Incidence, Italy epidemiology, Male, Middle Aged, Postoperative Complications epidemiology, Prevalence, Retrospective Studies, Time Factors, Treatment Outcome, Atherectomy, Coronary methods, Coronary Occlusion surgery, Percutaneous Coronary Intervention methods, Registries
- Abstract
Objectives: To study the long-term outcomes of rotational atherectomy (RA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Background: There is little evidence on the incidence, procedural results and long-term outcomes of RA for CTO PCI., Methods: This registry included data from consecutive patients undergoing CTO PCI at four specialized centers. Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and ischemia-driven target-vessel revascularization) on follow-up were the primary endpoint., Results: A total of 1003 patients were included. Of these, 35 (3.5%) required RA. As compared with Conventional PCI, RA patients were older (68.9 ± 9.5 vs. 64.6 ± 10.7 years, P = 0.02), had higher prevalence of diabetes (58% vs. 37%, P = 0.01) and of a J-CTO score ≥2 (80% vs. 58%, P = 0.009), driven by severe calcification. Antegrade wire escalation was used more frequently in RA (74% vs. 53%, P = 0.08). RA was performed for balloon failure-to-cross in 51% and failure-to-expand in 49%. One burr was utilized in 86%. The 1.25-mm burr was the largest burr used in 43%. Slow flow/no-reflow was observed in 17%. No other serious RA-related complications were observed. Procedural success was 77% vs. 89% (P = 0.04) in RA vs. Conventional PCI. After a mean follow-up of 658 ± 412 days, MACE rates were similar between groups (15% vs. 13%, P = 0.70)., Conclusions: The use of RA in CTO PCI was safe, despite a worse patient risk profile and higher procedural complexity, as compared with conventional techniques. Although procedural success was lower in the RA group, there were no differences in long-term clinical outcomes between groups. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2017
- Full Text
- View/download PDF
45. Ipsilateral vs. contralateral vs. no collateral (antegrade only) chronic total occlusion percutaneous coronary interventions: What is the right choice for your practice?
- Author
-
Azzalini L and Brilakis ES
- Subjects
- Angioplasty, Balloon, Coronary, Collateral Circulation, Coronary Angiography, Coronary Circulation, Humans, Treatment Outcome, Coronary Occlusion, Percutaneous Coronary Intervention
- Published
- 2017
- Full Text
- View/download PDF
46. The wise radialist's guide to optimal transfemoral access: Selection, performance, and troubleshooting.
- Author
-
Azzalini L and Jolicœur EM
- Subjects
- Coronary Angiography, Femoral Artery, Humans, Treatment Outcome, Percutaneous Coronary Intervention, Radial Artery
- Abstract
Transradial access (TRA) has reduced vascular access-site complication (VASC) and bleeding rates in patients undergoing coronary angiography and intervention. A "radial-first" approach should be adopted and indications of TRA extended in order to maximize its beneficial effect. However, in certain clinical scenarios, transfemoral access (TFA) is a preferable or a mandatory route to successfully perform the procedure. Since the widespread adoption of TRA, a paradoxical increase in VASC rates has been observed in patients undergoing TFA, which might be attributed to a combination of increased risk profile of both the procedures and the patients, and a loss of skills in securing TFA by those who are now default radial operators. In the present article we provide recommendations on how to optimize patient selection for TRA and TFA, how to manage access site crossover, and how to perform state-of-the-art femoral artery puncture. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2017
- Full Text
- View/download PDF
47. A novel maneuver to facilitate retrograde wire externalization during retrograde chronic total occlusion percutaneous coronary intervention.
- Author
-
Carlino M, Azzalini L, and Colombo A
- Subjects
- Aged, Aged, 80 and over, Chronic Disease, Coronary Angiography, Coronary Occlusion diagnostic imaging, Equipment Design, Female, Humans, Male, Middle Aged, Percutaneous Coronary Intervention adverse effects, Time Factors, Treatment Outcome, Cardiac Catheters, Coronary Occlusion therapy, Percutaneous Coronary Intervention instrumentation, Percutaneous Coronary Intervention methods
- Abstract
Background: Although the retrograde approach has improved the success rate and procedural efficiency of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), it can still be challenging and time-consuming. We introduce a novel technique that aims to facilitate the critical step of retrograde wire externalization during reverse controlled antegrade and retrograde tracking and dissection (CART), which we named DRAFT (Deflate, Retract and Advance into the Fenestration Technique)., Materials and Methods: DRAFT is performed by simultaneous retraction of the deflating antegrade balloon (after inflation in the subintimal space) and advancement of the retrograde looped wire in the same plane through the transient fenestrations created by reverse CART, in order to cross through the fenestrated dissection flap before its collapse. The retrograde wire is then quickly and easily advanced into the antegrade guiding catheter., Results: DRAFT was used in 11 patients (8 with right coronary artery and 3 with left anterior descending artery CTOs). Several different guidewires were used, since this technique does not need any specific wire to be performed. DRAFT was successful in all cases, after at most five attempts. CTO PCI was then completed as per standard retrograde practice. No complications occurred., Conclusions: DRAFT is a versatile approach that allows easy and quick re-entry of the retrograde wire into the true lumen during reverse CART. It can be performed with a variety of guidewires and is feasible both in the left and right coronary arteries. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2017
- Full Text
- View/download PDF
48. Efficacy of a balloon-expandable vascular access system in transfemoral TAVI patients.
- Author
-
Millán X, Azzalini L, Khan R, Cournoyer D, Dorval JF, Ibrahim R, Bonan R, and Asgar AW
- Subjects
- Aged, Aged, 80 and over, Angioplasty, Balloon adverse effects, Catheterization, Peripheral adverse effects, Catheterization, Peripheral methods, Equipment Design, Feasibility Studies, Female, Heart Valve Diseases complications, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases physiopathology, Hemorrhage etiology, Humans, Male, Peripheral Arterial Disease complications, Peripheral Arterial Disease diagnostic imaging, Peripheral Arterial Disease physiopathology, Punctures, Quebec, Retrospective Studies, Risk Factors, Treatment Outcome, Vascular System Injuries etiology, Angioplasty, Balloon instrumentation, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Cardiac Catheterization adverse effects, Cardiac Catheterization methods, Catheterization, Peripheral instrumentation, Femoral Artery diagnostic imaging, Femoral Artery injuries, Femoral Artery physiopathology, Heart Valve Diseases therapy, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods, Peripheral Arterial Disease therapy, Vascular Access Devices
- Abstract
Background: Vascular complications (VC) are a serious and frequent complication of transfemoral transcatheter aortic valve implantation (TAVI) and result in increased morbidity and mortality. It has been suggested that newly developed vascular sheaths may increase the ability to perform transfemoral TAVI in patients with normal and access-limiting peripheral artery disease (PAD) and reduce vascular complications., Aims: We sought to assess the safety and efficacy of the 19 French (F) SoloPath balloon-expandable transfemoral vascular access system in patients who underwent transfemoral TAVI at our center between 2011 and 2014., Methods and Results: Single-center retrospective study of 90 patients who underwent transfemoral TAVI with the use of the SoloPath sheath. Patients were categorized into two groups according to a sheath to femoral artery ratio (SFAR) of less than or equal to 1.05, or greater than 1.05. Overall, the incidence of major bleeding complications was low, 4.4%. No significant differences were found in technical or procedural success rates (100% in both groups and 100% vs. 91.3; P = 0.09; respectively), total vascular complications (20.8 vs. 21.7; P = 0.92) or total bleeding complications (20.8 vs. 30.4; P = 0.36 between those with SFAR greater or less than 1.05., Conclusions: The use of the SoloPath balloon-expandable sheath is feasible and safe even in patients with SFAR > 1.05, showing no increased vascular or bleeding complications compared to patients with larger vascular access. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2016
- Full Text
- View/download PDF
49. Impact of left ventricular function on clinical outcomes of functional mitral regurgitation patients undergoing transcatheter mitral valve repair.
- Author
-
Azzalini L, Millán X, Khan R, Couture P, Ducharme A, Basmadjian A, Bonan R, and Asgar AW
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Mitral Valve diagnostic imaging, Mitral Valve Insufficiency complications, Mitral Valve Insufficiency mortality, Mitral Valve Insufficiency physiopathology, Recovery of Function, Retrospective Studies, Risk Factors, Severity of Illness Index, Stroke Volume, Time Factors, Treatment Outcome, Ventricular Dysfunction, Left complications, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left mortality, Cardiac Catheterization adverse effects, Cardiac Catheterization instrumentation, Cardiac Catheterization mortality, Mitral Valve physiopathology, Mitral Valve Insufficiency therapy, Ventricular Dysfunction, Left physiopathology, Ventricular Function, Left
- Abstract
Objectives: To evaluate the impact of baseline left ventricular (LV) function on the clinical outcomes of patients with functional mitral regurgitation (FMR) treated with MitraClip., Background: It is unknown whether patients with significant FMR and severe LV dysfunction benefit from MitraClip., Methods: A cohort of 77 patients with significant FMR undergoing MitraClip procedure between December 2010 and January 2015 was categorized by baseline LV ejection fraction (LVEF) into tertiles: LVEF <27% (n = 27), LVEF 27-37% (n = 25), and LVEF >37% (n = 25). We sought to evaluate the impact of LVEF on all-cause mortality at follow-up., Results: There were no significant differences in baseline comorbidities, medical treatment and MR severity among tertiles of LVEF. Overall procedural success was 94%, with no differences among groups (LVEF <27%: 89%; LVEF 27-37%: 100%; LVEF >37%: 92%; P = 0.25). Median follow-up was 372 days (interquartile range: 128-627 days). MR severity improved in all three groups, as compared to baseline. There were no differences in the prevalence of MR ≤2+ on follow-up (P = 0.40). Mortality was highest in patients with LVEF <27% (41%), as compared with LVEF 27-37% (16%) and LVEF >37% (4%), P = 0.004. Patient who died had a lower baseline LVEF compared to those who survived (24.8 ± 7.7% versus 35.5 ± 13.7%, P < 0.001). An LVEF <27% was an independent predictor of mortality after adjusting for procedural success: hazard ratio 3.4 (95% CI: 1.1 to 10.0; P = 0.030)., Conclusions: MitraClip is effective in FMR patients regardless of the severity of LV dysfunction. However, low baseline LVEF is associated with increased mortality, despite procedural success. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2016
- Full Text
- View/download PDF
50. Prognostic impact of the residual SYNTAX score on in-hospital outcomes in patients undergoing primary percutaneous coronary intervention.
- Author
-
Khan R, Al-Hawwas M, Hatem R, Azzalini L, Fortier A, Joliecoeur EM, Tanguay JF, Lavoie-L'Allier P, and Ly HQ
- Subjects
- Aged, Coronary Angiography, Female, Follow-Up Studies, Hospital Mortality trends, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Quebec epidemiology, ST Elevation Myocardial Infarction diagnosis, Time Factors, Percutaneous Coronary Intervention methods, Postoperative Complications epidemiology, ST Elevation Myocardial Infarction surgery
- Abstract
Objectives: This study sought to assess the impact of residual coronary artery disease (CAD), using the residual SYNTAX score (rSS), on in-hospital outcomes after primary percutaneous intervention (PPCI). The study also aimed to determine independent predictors for high rSS. Residual CAD has been associated with worsened prognosis in patients undergoing PCI for non-ST acute coronary syndromes. The rSS is a systematic angiographic score that measures the extent and complexity of residual CAD after PCI., Materials and Methods: Data from 243 consecutive patients undergoing PPCI for ST-elevation myocardial infarction (STEMI) were analyzed. The rSS was derived from post-PPCI angiography. Patients were dichotomized into low (<8) and high rSS (≥8) groups and outcomes were compared between groups. The primary outcome of net adverse cardiovascular events (NACE) consisted of a composite of in-hospital death, congestive heart failure (CHF), recurrent MI and bleeding., Results: The mean rSS was 4.7 (±7.2). A high rSS was associated with the primary outcome (P < 0.0001), in-hospital death (P = 0.0026), periprocedural death (P < 0.0001), CHF (P < 0.0004) and acute kidney injury (P < 0.0019). A high rSS was also an independent predictor of the primary outcome with an OR of 3.82. Independent predictors of a high rSS included a history of diabetes (OR 2.8), previous MI (OR 5.75), 2-vessel disease (VD) (OR 15.48, vs. 1-VD) and 3-VD (OR 57.06, vs. 1-VD)., Conclusions: Residual CAD, as assessed by the rSS, confers a worsened prognosis in patients undergoing PPCI. Diabetes, previous MI and multi-vessel disease were independent predictors of a high rSS. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2016
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.