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3. Outcome of Patients With Cardiogenic Shock and Previous Right Ventricular Impairment Represented by Decreased Tricuspid Annular Plane Systolic Excursion and Tricuspid Annular Plane Systolic Excursion to Pulmonary Artery Systolic Pressure Ratio

Author

Rusnak, Jonas, Schupp, Tobias, Weidner, Kathrin, Ruka, Marinela, Egner-Walter, Sascha, Forner, Jan, Bertsch, Thomas, Kittel, Maximilian, Mashayekhi, Kambis, Tajti, Péter, Ayoub, Mohamed, Akin, Ibrahim, and Behnes, Michael

Published
2023
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6. External validation of the PROGRESS-CTO complication risk scores: Individual patient data pooled analysis of 3 registries

Author

Simsek, Bahadir, Tajti, Peter, Carlino, Mauro, Ojeda, Soledad, Pan, Manuel, Rinfret, Stephane, Vemmou, Evangelia, Kostantinis, Spyridon, Nikolakopoulos, Ilias, Karacsonyi, Judit, Dens, Joseph A., Agostoni, Pierfrancesco, Alaswad, Khaldoon, Megaly, Michael, Avran, Alexandre, Choi, James W., Jaffer, Farouc A., Doshi, Darshan, Karmpaliotis, Dimitri, Khatri, Jaikirshan J., Knaapen, Paul, La Manna, Alessio, Spratt, James C., Tanabe, Masaki, Walsh, Simon, Mastrodemos, Olga C., Allana, Salman, Rempakos, Athanasios, Rangan, Bavana V., Goktekin, Omer, Gorgulu, Sevket, Poommipanit, Paul, Kearney, Kathleen E., Lombardi, William L., Grantham, J. Aaron, Mashayekhi, Kambis, Brilakis, Emmanouil S., and Azzalini, Lorenzo

Published
2023
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10. Usefulness of Atherectomy in Chronic Total Occlusion Interventions (from the PROGRESS-CTO Registry)

Author

Xenogiannis, Iosif, Karmpaliotis, Dimitri, Alaswad, Khaldoon, Jaffer, Farouc A., Yeh, Robert W., Patel, Mitul, Mahmud, Ehtisham, Choi, James W., Burke, M. Nicholas, Doing, Anthony H., Dattilo, Phil, Toma, Catalin, Smith, A.J. Conrad, Uretsky, Barry, Krestyaninov, Oleg, Khelimskii, Dmitrii, Holper, Elizabeth, Potluri, Srinivas, Wyman, R. Michael, Kandzari, David E., Garcia, Santiago, Koutouzis, Michalis, Tsiafoutis, Ioannis, Khatri, Jaikirshan J., Jaber, Wissam, Samady, Habib, Jefferson, Brian K., Patel, Taral, Moses, Jeffrey W., Lembo, Nicholas J., Parikh, Manish, Kirtane, Ajay J., Ali, Ziad A., Doshi, Darshan, Tajti, Peter, Rangan, Bavana V., Abdullah, Shuaib, Banerjee, Subhash, and Brilakis, Emmanouil S.

Published
2019
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12. Procedural Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusions Via the Radial Approach: Insights From an International Chronic Total Occlusion Registry

Author

Tajti, Peter, Alaswad, Khaldoon, Karmpaliotis, Dimitri, Jaffer, Farouc A., Yeh, Robert W., Patel, Mitul, Mahmud, Ehtisham, Choi, James W., Burke, M. Nicholas, Doing, Anthony H., Dattilo, Phil, Toma, Catalin, Smith, A.J. Conrad, Uretsky, Barry F., Holper, Elizabeth, Potluri, Srinivasa, Wyman, R. Michael, Kandzari, David E., Garcia, Santiago, Krestyaninov, Oleg, Khelimskii, Dmitrii, Koutouzis, Michalis, Tsiafoutis, Ioannis, Khatri, Jaikirshan J., Jaber, Wissam, Samady, Habib, Jefferson, Brian, Patel, Taral, Abdullah, Shuaib, Moses, Jeffrey W., Lembo, Nicholas J., Parikh, Manish, Kirtane, Ajay J., Ali, Ziad A., Doshi, Darshan, Xenogiannis, Iosif, Stanberry, Larissa I., Rangan, Bavana V., Ungi, Imre, Banerjee, Subhash, and Brilakis, Emmanouil S.

Published
2019
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13. Prevalence and Outcomes of Percutaneous Coronary Interventions for Ostial Chronic Total Occlusions: Insights From a Multicenter Chronic Total Occlusion Registry

Author

Tajti, Peter, Burke, M. Nicholas, Karmpaliotis, Dimitri, Alaswad, Khaldoon, Jaffer, Farouc A., Yeh, Robert W., Patel, Mitul, Mahmud, Ehtisham, Choi, James W., Doing, Anthony H., Datilo, Phil, Toma, Catalin, Smith, A.J. Conrad, Uretsky, Barry, Holper, Elizabeth, Garcia, Santiago, Krestyaninov, Oleg, Khelimskii, Dimitrii, Koutouzis, Michalis, Tsiafoutis, Ioannis, Moses, Jeffrey W., Lembo, Nicholas J., Parikh, Manish, Kirtane, Ajay J., Ali, Ziad A., Doshi, Darshan, Jaber, Wissam, Samady, Habib, Rangan, Bavana V., Xenogiannis, Iosif, Ungi, Imre, Banerjee, Subhash, and Brilakis, Emmanouil S.

Published
2018
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15. In-hospital Outcomes of Attempting More Than One Chronic Total Coronary Occlusion Through Percutaneous Intervention During the Same Procedure

Author

Tajti, Peter, Alaswad, Khaldoon, Karmpaliotis, Dimitri, Jaffer, Farouc A., Yeh, Robert W., Patel, Mitul, Mahmud, Ehtisham, Choi, James W., Burke, M. Nicholas, Doing, Anthony H., Toma, Catalin, Uretsky, Barry, Holper, Elizabeth, Wyman, R. Michael, Kandzari, David E., Garcia, Santiago, Krestyaninov, Oleg, Khelimskii, Dmitrii, Koutouzis, Michalis, Tsiafoutis, Ioannis, Jaber, Wissam, Samady, Habib, Moses, Jeffrey W., Lembo, Nicholas J., Parikh, Manish, Kirtane, Ajay J., Ali, Ziad A., Doshi, Darshan, Xenogiannis, Iosif, Rangan, Bavana V., Ungi, Imre, Banerjee, Subhash, and Brilakis, Emmanouil S.

Published
2018
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16. The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry

Author

Tajti, Peter, Karmpaliotis, Dimitri, Alaswad, Khaldoon, Jaffer, Farouc A., Yeh, Robert W., Patel, Mitul, Mahmud, Ehtisham, Choi, James W., Burke, M. Nicholas, Doing, Anthony H., Dattilo, Phil, Toma, Catalin, Smith, A.J. Conrad, Uretsky, Barry, Holper, Elizabeth, Wyman, R. Michael, Kandzari, David E., Garcia, Santiago, Krestyaninov, Oleg, Khelimskii, Dmitrii, Koutouzis, Michalis, Tsiafoutis, Ioannis, Moses, Jeffrey W., Lembo, Nicholas J., Parikh, Manish, Kirtane, Ajay J., Ali, Ziad A., Doshi, Darshan, Rangan, Bavana V., Ungi, Imre, Banerjee, Subhash, and Brilakis, Emmanouil S.

Published
2018
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18. Randomized Comparison of a CrossBoss First Versus Standard Wire Escalation Strategy for Crossing Coronary Chronic Total Occlusions: The CrossBoss First Trial

Author

Karacsonyi, Judit, Tajti, Peter, Rangan, Bavana V., Halligan, Sean C., Allen, Raymond H., Nicholson, William J., Harvey, James E., Spaedy, Anthony J., Jaffer, Farouc A., Grantham, J. Aaron, Salisbury, Adam, Hart, Anthony J., Safley, David M., Lombardi, William L., Hira, Ravi, Don, Creighton, McCabe, James M., Burke, M. Nicholas, Alaswad, Khaldoon, Koenig, Gerald C., Sanghvi, Kintur A., Ice, Daniel, Kovach, Richard C., Varghese, Vincent, Murad, Bilal, Baran, Kenneth W., Resendes, Erica, Martinez-Parachini, Jose R., Karatasakis, Aris, Danek, Barbara A., Iwnetu, Rahel, Roesle, Michele, Khalili, Houman, Banerjee, Subhash, and Brilakis, Emmanouil S.

Published
2018
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19. Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention

Author

Danek, Barbara Anna, Karatasakis, Aris, Tajti, Peter, Sandoval, Yader, Karmpaliotis, Dimitri, Alaswad, Khaldoon, Jaffer, Farouc, Yeh, Robert W., Kandzari, David E., Lembo, Nicholas J., Patel, Mitul P., Mahmud, Ehtisham, Choi, James W., Doing, Anthony H., Lombardi, William L., Wyman, R. Michael, Toma, Catalin, Garcia, Santiago, Moses, Jeffrey W., Kirtane, Ajay J., Hatem, Raja, Ali, Ziad A., Parikh, Manish, Karacsonyi, Judit, Rangan, Bavana V., Khalili, Houman, Burke, M. Nicholas, Banerjee, Subhash, and Brilakis, Emmanouil S.

Published
2017
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22. External validation of the PROGRESS‐CTO perforation risk score: Individual patient data pooled analysis of three registries.

Author

Simsek, Bahadir, Tajti, Peter, Carlino, Mauro, Ojeda, Soledad, Pan, Manuel, Rinfret, Stephane, Vemmou, Evangelia, Kostantinis, Spyridon, Nikolakopoulos, Ilias, Karacsonyi, Judit, Rempakos, Athanasios, Dens, Joseph A., Agostoni, Pierfrancesco, Alaswad, Khaldoon, Megaly, Michael, Avran, Alexandre, Choi, James W., Jaffer, Farouc A., Doshi, Darshan, and Karmpaliotis, Dimitri

Published
2023
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24. Management of Microcatheter Fracture in Complex Percutaneous Coronary Intervention With Laser Atherectomy.

Author

Tajti, Peter, Ayoub, Mohamed, Loffelhardt, Nicolaus, and Mashayekhi, Kambis

Subjects
*PERCUTANEOUS coronary intervention, *TREATMENT of fractures, *CHRONIC total occlusion, *EXCIMER lasers, *MYOCARDIAL infarction, *ENTRAPMENT neuropathies, *ATHERECTOMY
Abstract

Background/objective: Microcatheters and dedicated guidewires for both chronic total occlusion (CTO) and non-CTO percutaneous coronary intervention (PCI) are increasingly being used to overcome complex coronary anatomy with severe tortuosity and calcification. In extremely resistant lesions, a potential over-rotation and device fatigue may result in entrapment or even fracture causing abrupt vessel closure and hinder successful revascularization.Method/result: We demonstrate two consecutive cases complicated with dislodged microcatheter tip which was rescued uniquely with coronary laser atherectomy. We describe an algorithmic approach for management of microcatheter fracture which are increasingly occur in contemporary practice of complex PCI.Conclusion: In summary, our cases illustrate the feasibility of using coronary excimer laser system to release fractured and entrapped intracoronary MC tips when other conventional percutaneous techniques fail. [ABSTRACT FROM AUTHOR]

Published
2021
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29. Expecting the unexpected: preventing and managing the consequences of coronary perforations.

Author

Tajti, Peter, Xenogiannis, Iosif, Chavez, Ivan, Gössl, Mario, Mooney, Michael, Poulose, Anil, Sorajja, Paul, Traverse, Jay, Wang, Yale, Burke, M. Nicholas, and Brilakis, Emmanouil S.

Subjects
CORONARY disease, PERCUTANEOUS coronary intervention, CORONARY arteries, MEDICAL care, MYOCARDIAL infarction, CORONARY heart disease treatment, MEDICAL equipment, CORONARY artery injuries, HEART injuries, CARDIOVASCULAR system, TREATMENT effectiveness, THERAPEUTICS
Abstract

Introduction: Coronary artery perforations are more likely to occur during percutaneous coronary intervention of complex coronary lesions, such as heavily calcified lesions and chronic total occlusions. Areas covered: Authors provide an update on the management of coronary perforations by performing a critical review of the related, recently published literature. Expert commentary: Meticulous attention to guidewire position and to device selection is critical for minimizing the risk for coronary perforation. If a perforation occurs, following a structured, algorithmic approach can maximize the likelihood of a successful outcome. [ABSTRACT FROM AUTHOR]

Published
2018
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30. Meta-analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling.

Author

Megaly, Michael, Saad, Marwan, Tajti, Peter, Burke, M. Nicholas, Chavez, Ivan, Gössl, Mario, Lips, Daniel, Mooney, Michael, Poulose, Anil, Sorajja, Paul, Traverse, Jay, Wang, Yale, Kohl, Louis P., Bradley, Steven M., and Brilakis, Emmanouil S.

Subjects
PERCUTANEOUS coronary intervention, SYSTEMATIC reviews, META-analysis, SCIENTIFIC observation, REVASCULARIZATION (Surgery), CORONARY heart disease surgery, CARDIOVASCULAR system, CORONARY disease, LEFT heart ventricle, HEART physiology, MEDICAL care, VENTRICULAR remodeling, TREATMENT effectiveness
Abstract

Background: We sought to examine the impact of coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on left ventricular (LV) function.Methods: We performed a systematic review and meta-analysis of studies published between January 1980 and November 2017 on the impact of successful CTO PCI on LV function.Results: A total of 34 observational studies including 2735 patients were included in the meta-analysis. Over a weighted mean follow-up of 7.9 months, successful CTO PCI was associated with an increase in LV ejection fraction by 3.8% (95%CI 3.0-4.7, P < 0.0001, I2  = 45%). In secondary analysis of 15 studies (1248 patients) that defined CTOs as occlusions of at least 3-month duration and reported follow-up of at least 3-months after the procedure, successful CTO PCI was associated with improvement in LV ejection fraction by 4.3% (95%CI [3.1, 5.6], P < 0.0001). In the 10 studies (502 patients) that reported LV end-systolic volume, successful CTO PCI was associated with a decrease in LV end-systolic volume by 4 mL, (95%CI -6.0 to -2.1, P < 0.0001, I2  = 0%). LV end-diastolic volume was reported in 9 studies with 403 patients and did not significantly change after successful CTO PCI (-2.3 mL, 95%CI -5.7 to 1.2 mL, P = 0.19, I2  = 0%).Conclusions: Successful CTO PCI is associated with a statistically significant improvement in LV ejection fraction and decrease in LV end-systolic volume, that may reflect a beneficial effect of CTO recanalization on LV remodeling. The clinical implications of these findings warrant further investigation. [ABSTRACT FROM AUTHOR]

Published
2018
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34. Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion.

Author

Tajti, Peter, Ayoub, Mohamed, Nuehrenberg, Thomas, Ferenc, Miroslaw, Behnes, Michael, Buettner, Heinz Joachim, Neumann, Franz-Josef, Mashayekhi, Kambis, and Hochholzer, Willibald

Subjects
*PERCUTANEOUS coronary intervention, *CORONARY disease, *FLUOROSCOPY, *CHRONIC diseases, *INTRAVASCULAR ultrasonography, *MYOCARDIAL infarction, *CHRONIC total occlusion
Abstract

Background: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy time (FT) on procedural outcomes is poorly studied. Methods and Results: We analyzed the outcomes of 12,538 consecutive elective PCIs. The primary endpoint was procedure failure (PF), the composite of technical failure, and adverse in-hospital events including all-cause death, myocardial infarction, stroke, and target vessel revascularization (MACCE), as well as pericardial tamponade. We stratified the procedures as PCI for chronic total occlusion (CTO, n = 2720) and PCI for non-CTO (n = 9818). Logistic regression demonstrated a significant association between fluoroscopy time and procedural failure with a significant interaction with PCI type (both p < 0.001). The odds ratios (OR) of procedural failure for a 10-min increment in FT were 1.15 (confidence interval (CI) 95% 1.12–1.18, p < 0.001) in non-CTO PCI and 1.05 (CI 95% 1.03–1.06, p < 0.001) in CTO PCI. The optimal cut-point for prediction of PF was 21.1 min in non-CTO PCI (procedural success in 98.4% versus 95.3%, adjusted OR for PF 2.79 (CI 95% 1.93–4.04), p < 0.001) and 41 min in CTO PCI (procedural success in 92.3% versus 83.8%, adjusted OR for PF 2.18 (CI 95% 1.64–2.94), p < 0.001). In CTO PCI, the increase in PF with FT was largely driven by technical failure (adjusted OR 2.25 (CI 95% 1.65–3.10), p < 0.001), whereas in non-CTO PCI, it was driven by major complications (adjusted OR 2.94 (CI 95% 1.93–4.53), p < 0.001). Conclusions: Prolonged FT is strongly associated with procedural failure in both non-CTO and CTO PCI. In CTO PCI, this relation is shifted towards longer FT. The mechanisms of procedural failure differ between CTO and non-CTO PCI. [ABSTRACT FROM AUTHOR]

Published
2021
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37. IMPACT OF DISTAL VESSEL QUALITY ON ACUTE PROCEDURAL OUTCOMES IN CTO PCI: INSIGHT FROM THE PROGRESS CTO REGISTRY.

Author

Tajti, Peter, Karmpaliotis, Dimitrios, Alaswad, Khaldoon, Jaffer, Farouc, Yeh, Robert, Patel, Mitul, Mahmud, Ehtisham, Choi, James, Burke, M. Nicholas, Toma, Catalin, Potluri, Srinivasa, Wyman, R. Michael, Kandzari, David, Garcia, Santiago, Krestyaninov, Oleg, Khelimskii, Dmitrii, Koutouzis, Michalis, Khatri, Jaikirshan, Jaber, Wissam, and Kirtane, Ajay

Subjects
*QUALITY, *INSIGHT, *PROGRESS
Published
2019
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38. PROCEDURAL OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTIONS FOR CHRONIC TOTAL OCCLUSIONS IN PATIENTS WITH LOW LEFT VENTRICULAR EJECTION FRACTION: INSIGHTS FROM THE PROGRESS CTO REGISTRY.

Author

Tajti, Peter, Karmpaliotis, Dimitrios, Alaswad, Khaldoon, Jaffer, Farouc, Yeh, Robert, Patel, Mitul, Mahmud, Ehtisham, Choi, James, Burke, M. Nicholas, Doing, Anthony, Toma, Catalin, Potluri, Srinivasa, Kandzari, David, Garcia, Santiago, Krestyaninov, Oleg, Khelimskii, Dmitrii, Koutouzis, Michalis, Khatri, Jaikirshan, Jaber, Wissam, and Jefferson, Brian

Subjects
*PERCUTANEOUS coronary intervention, *VENTRICULAR ejection fraction
Published
2019
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39. CONTEMPORARY OUTCOMES OF CHRONIC TOTAL OCCLUSION INTERVENTIONS FOR IN-STENT RESTENOSIS OCCLUSIONS: UPDATE FROM AN INTERNATIONAL MULTICENTER REGISTRY.

Author

Tajti, Peter, Karmpaliotis, Dimitrios, Alaswad, Khaldoon, Jaffer, Farouc, Burke, M. Nicholas, Dattilo, Philip, Uretsky, Barry, Holper, Elizabeth, Koutouzis, Michalis, Tsiafoutis, Ioannis, Samady, Habib, Jefferson, Brian, Patel, Taral, Abdullah, Shuaib, Moses, Jeffrey, Lembo, Nicholas, Parikh, Manish, Kirtane, Ajay, Ali, Ziad, and Doshi, Darshan

Subjects
*INTRAVASCULAR ultrasonography, *MYOCARDIAL infarction
Published
2019
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40. In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery: Insights From an International Multicenter Chronic Total Occlusion Registry.

Author

Tajti, Peter, Karmpaliotis, Dimitri, Alaswad, Khaldoon, Jaffer, Farouc A., Yeh, Robert W., Patel, Mitul, Mahmud, Ehtisham, Choi, James W., Burke, M. Nicholas, Doing, Anthony H., Dattilo, Phil, Toma, Catalin, Smith, A. J. Conrad, Uretsky, Barry, Holper, Elizabeth, Potluri, Srinivas, Wyman, R. Michael, Kandzari, David E., Garcia, Santiago, and Krestyaninov, Oleg

Abstract

Supplemental Digital Content is available in the text. Background: We examined the procedural outcomes of chronic total occlusions (CTO) percutaneous coronary interventions in patients with prior coronary artery bypass graft surgery (CABG). Methods and Results: We compared the clinical, angiographic characteristics and outcomes of 3486 CTO interventions performed in patients with (n=1101) and without (n=2317) prior CABG at 21 centers. Prior CABG patients (32% of total cohort) were older (67±9 versus 63±10 years; P <0.001) and had more comorbidities and lower left ventricular ejection fraction (50% [40–58] versus 55% [45–60]; P <0.001). The CTO target vessel in prior CABG patients was the right coronary artery (56%), circumflex (26%), and left anterior descending artery (17%). The mean J-CTO (2.9±1.2 versus 2.2±1.3; P <0.001) and PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; 1.5±1.1 versus 1.2±1.0; P <0.001) score was higher in prior CABG patients. Retrograde (53% versus 30%, P <0.001) and antegrade dissection reentry (35% versus 28%; P <0.001) techniques were used more frequently in prior CABG patients. Prior CABG patients had lower technical (84% versus 89%; P <0.001) and procedural (82% versus 87%, P <0.001) success, but similar incidence of in-hospital major complications (3.1% versus 2.5%; P =0.287). In-hospital mortality (1% versus 0.4%; P =0.016) and coronary perforation (7.1% versus 3.1%; P <0.001) occurred more frequently in prior CABG patients, however, CABG patients had a lower incidence of pericardial tamponade (0.1% versus 1.0%; P =0.002) and pericardiocentesis (0% versus 1.3%; P <0.001). Conclusions: In a large multicenter CTO percutaneous coronary interventions registry, prior CABG patients had lower success rate but similar overall risk for complications, although mortality was higher and the incidence of tamponade was lower. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02061436. [ABSTRACT FROM AUTHOR]

Published
2019
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41. Intravascular Imaging for Chronic Total Occlusion Intervention.

Author

Xenogiannis, Iosif, Tajti, Peter, Karmpaliotis, Dimitri, Garbo, Roberto, Gagnor, Andrea, Burke, M. Nicholas, and Brilakis, Emmanouil S.

Abstract

Purpose of Review: We sought to summarize the current evidence on use of intravascular imaging (with intravascular ultrasound [IVUS] or optical coherence tomography [OCT]) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).Recent Findings: Utilization of intravascular imaging in CTO PCI is increasing over time, both to facilitate CTO crossing and for optimization of the final result. OCT is used less often than IVUS due to its lower depth of penetration and need for contrast injection.Summary: Intravascular imaging has multiple uses in CTO PCI: (a) it can facilitate CTO crossing by resolving proximal cap ambiguity and facilitating and confirming true lumen wire re-entry in case of initial subintimal wire crossing in both the antegrade and retrograde direction (for example by selecting the appropriate balloon size during the reverse controlled antegrade and retrograde tracking (reverse CART) technique; (b) it can be used to optimize the PCI result by ensuring good stent expansion and stent strut apposition, which may in turn result in lower rates of subsequent in-stent restenosis and stent thrombosis; (c) can facilitate evaluation and treatment of complications. [ABSTRACT FROM AUTHOR]

Published
2018
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42. Chronic Total Occlusion Interventions: Update on Current Tips and Tricks.

Author

Tajti, Peter, Xenogiannis, Iosif, Karmpaliotis, Dimitris, Alaswad, Khaldoon, Jaffer, Farouc A., Nicholas Burke, M., Ungi, Imre, and Brilakis, Emmanouil S.

Abstract

Purpose of Review: To summarize novel techniques and developments in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).Recent Findings: Using an algorithmic, step-by-step approach can help overcome several complex CTO lesions subsets, such as proximal cap ambiguity, ostial location, in-stent occlusion, bifurcations, balloon uncrossable and undilatable lesions. Similarly, an algorithmic approach can help prevent and optimally treat CTO PCI-related complication, such as perforation, radiation, and contrast-induced nephropathy.Summary: Continual update and reassessment of each operator’s algorithm for performing CTO PCI can lead to improved outcomes. [ABSTRACT FROM AUTHOR]

Published
2018
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43. Abstract 11214: Application of the Hybrid Approach to Percutaneous Coronary Interventions for Chronic Total Occlusions: Update From the PROGRESS CTO (PROspective Global REgistry for the Study of Chronic Total Occlusion Intervention) International Registry

Author

Tajti, Peter, Karmpaliotis, Dimitri, Alaswad, Khaldoon, Jaffer, Farouc A, Yeh, Robert W, Patel, Mitul, Mahmud, Ehtisham, Choi, James W, Burke, M N, Doing, Anthony H, Dattilo, Philip, Toma, Catalin, Smith, AJ C, Uretsky, Barry, Krestyaninov, Oleg, Khelimskii, Dmitrii, Holper, Elizabeth, Wyman, R M, Kandzari, David E, and Garcia, Santiago

Subjects
*PERCUTANEOUS coronary intervention, *CORONARY artery bypass, *TRANSPLANTATION of organs, tissues, etc., *PERICARDIUM paracentesis, *GLOBAL studies, *SURGICAL emergencies, *HEART failure, *STROKE, *FLUOROSCOPY
Abstract

Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) evolves rapidly over time. The hybrid approach to CTO PCI is a crossing algorithm that emphasizes dual coronary injection, structured review of the angiogram, and change of crossing strategies in case of failure. Methods: We analyzed the contemporary outcomes from the PROGRESS CTO registry by analyzing the clinical, angiographic and procedural characteristics of 3,571 CTO interventions performed in 3,503 patients enrolled between 2012 and 2018 at 21 centers. Results: Mean patient age was 65±10 years and 85% of the patients were men. A high prevalence of diabetes (42%), heart failure (31%), prior coronary artery bypass graft surgery (32%), prior myocardial infarction (47%), and prior PCI (65%) was observed. The most common CTO target vessel was the right coronary artery (56%), left anterior descending artery (24%), and left circumflex artery (19%). Mean J-CTO and PROGRESS-CTO scores were 2.4±1.3 and 1.3±1.0, respectively. The final successful crossing strategy was antegrade wire escalation in 53%, retrograde in 27%, and antegrade dissection re-entry in 20%. The initial crossing strategy was successful in 56%, however using multiple approaches (Figure), the overall technical and procedural success rate was 87% and 85%, respectively. In-hospital major complications were 2.9%, and consisted of death [0.8%], acute myocardial infarction [1.0%], stroke [0.3%], tamponade requiring pericardiocentesis [0.9%], emergency surgery [0.1%] and repeat PCI [0.3%]. Median contrast volume, air kerma radiation dose, procedure and fluoroscopy time were 260 (194-350) ml, 2.8 (1.6-4.7) Gray, 120 (78-184) and 46 (28-76) minutes, respectively. Conclusions: The hybrid approach to CTO PCI is associated with high overall success and acceptable complication rates in diverse patient populations. [ABSTRACT FROM AUTHOR]

Published
2018

44. Abstract 11045: Contemporary Outcomes of the Retrograde Approach to Chronic Total Occlusion Interventions: Insights From the PROGRESS CTO (PROspective Global REgiStry for the Study of Chronic Total Occlusion Intervention) International Registry.

Author

Tajti, Peter, Karmpaliotis, Dimitri, Alaswad, Khaldoon, Jaffer, Farouc A, Yeh, Robert W, Patel, Mitul, Mahmud, Ehtisham, Choi, James W, Burke, M N, Doing, Anthony H, Dattilo, Philip, Toma, Catalin, Smith, AJ C, Uretsky, Barry, Krestyaninov, Oleg, Khelimskii, Dmitrii, Holper, Elizabeth, Wyman, R M, Kandzari, David E, and Garcia, Santiago

Subjects
*INTERNAL thoracic artery, *PERCUTANEOUS coronary intervention, *GLOBAL studies, *CORONARY artery bypass, *PERICARDIUM paracentesis, *TRANSPLANTATION of organs, tissues, etc.
Abstract

Introduction: The retrograde approach is critical for achieving high success rates in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We compared the clinical, angiographic and procedural outcomes of retrograde (n=1,350) vs. antegrade-only CTO PCIs (n=2,221) in a contemporary multicenter CTO registry. Results: The mean age of patients undergoing retrograde PCI was 65±10 years and 86% were men, with high prevalence of prior myocardial infarction (51%), prior PCI (71%), and coronary artery bypass graft surgery (45%). CTO target vessels with the retrograde approach was the right coronary artery (68%), left anterior descending artery (16%), and left circumflex artery (15%). Lesions undergoing retrograde attempt were longer (42±27 mm vs 28±19 mm, p<0.001), and more likely to have proximal cap ambiguity (54% vs 25%), distal cap at bifurcation (47% vs 25%), diseased distal target vessel (46% vs 24%, p<0.001), and interventional collaterals (79% vs 45%, p<0.001), as compared with antegrade-only cases. The mean J-CTO (3±1 vs 2±1 p<0.001) and PROGRESS CTO complication score (4±2 vs 2±2, p<0.001) was higher in retrograde PCIs. The most commonly used collateral channels were septals (61%), epicardials (33%), saphenous venous grafts (13%) and left internal mammary artery grafts (2%). As lesion complexity increased, successful retrograde crossing was more frequently needed (Figure). The overall technical (81% vs 91%, p<0.001) and procedural (77% vs 90%, p<0.001) success rates were lower with retrograde approach, and patients had higher in-hospital major complications rate than antegrade-only PCIs (5.6% vs 1.1%, p<0.001), due to higher in-hospital mortality (1.5% vs. 0.3%, p<0.001), acute myocardial infarction (2.1% vs 0.3%, p<0.001), repeat PCI (0.7% vs 0.1%, p<0.001), and tamponade requiring pericardiocentesis (1.7% vs 0.3%, p<0.01). Conclusions: The retrograde approach to CTO PCI is commonly required among more complex lesions, which likely explains why it is associated with lower procedural success and higher complication rates. [ABSTRACT FROM AUTHOR]

Published
2018

45. TCT-729 Procedural Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusions via the Radial Approach: Insight from an International CTO Registry.

Author

Tajti, Peter, Karmpaliotis, Dimitri, Alaswad, Khaldoon, Jaffer, Farouc Amin, Yeh, Robert, Patel, Mitul, Mahmud, Ehtisham, Choi, James, Burke, M. Nicholas, Doing, Anthony, Dattilo, Philip, Toma, Catalin, Smith, A.J. Conrad, Uretsky, Barry, Krestyaninov, Oleg, Khelimskii, Dmitrii, Holper, Elizabeth, Wyman, R. Michael, Kandzari, David, and Garcia, Santiago

Subjects
*PERCUTANEOUS coronary intervention, *ARTERIAL catheterization, *TRANSPLANTATION of organs, tissues, etc.
Published
2018
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46. TCT-167 In-hospital Outcomes of Using the Hybrid Approach of Percutaneous Coronary Interventions for Chronic Total Occlusions: Update from the PROGRESS-CTO (PROspective Global REgiStry for the Study of Chronic Total Occlusion Intervention) International Registry

Author

Tajti, Peter, Doshi, Darshan, Basir, Mir, Longlade, Julianne, Fox, Margaret, Topacio, Aimee, Mary cadigan, Tamez, Hector, Almasoud, Abdullah, Behnamfar, Omid, Al Khiami, Belal, Rosol, Zach, Barbin, Clay, Bollino, Amanda, Miller, Kristin, Byrd, Jesse, Khelimskii, Dmitrii, McCracken, Julie, Podias, Christina, and Nguyen, Jennifer

Subjects
*PERCUTANEOUS coronary intervention, *SURGICAL emergencies, *TRANSPLANTATION of organs, tissues, etc.
Published
2018
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47. PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH PREVIOUS CORONARY ARTERY BYPASS GRAFT SURGERY: INSIGHTS FROM A MULTICENTER REGISTRY.

Author

Tajti, Peter, Karmpaliotis, Dimitrios I., Alaswad, Khaldoon, Jaffer, Farouc, Yeh, Robert, Patel, Mitul, Mahmud, Ehtisham, Choi, James, Burke, M. Nicholas, Doing, Anthony, Toma, Catalin, Uretsky, Barry, Holper, Elizabeth, Kandzari, David, Lembo, Nicholas, Garcia, Santiago, Krestyaninov, Oleg, Khelimskii, Dmitrii, Koutouzis, Michalis, and Moses, Jeffrey

Published
2018
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48. PERCUTANEOUS CORONARY INTERVENTIONS FOR AORTOOSTIAL CHRONIC TOTAL OCCLUSIONS: INSIGHTS FROM A MULTICENTER REGISTRY.

Author

Tajti, Peter, Karmpaliotis, Dimitrios I., Alaswad, Khaldoon, Jaffer, Farouc, Yeh, Robert, Patel, Mitul, Mahmud, Ehtisham, Choi, James, Burke, M. Nicholas, Doing, Anthony, Toma, Catalin, Uretsky, Barry, Holper, Elizabeth, Kandzari, David, Lembo, Nicholas, Garcia, Santiago, Krestyaninov, Oleg, Khelimskii, Dmitrii, Koutouzis, Michalis, and Moses, Jeffrey

Published
2018
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49. PROCEDURAL OUTCOMES OF MULTIPLE CTO INTERVENTION CARRIED OUT IN THE SAME PROCEDURE: INSIGHT FROM A MULTICENTER CTO REGISTRY.

Author

Tajti, Peter, Karmpaliotis, Dimitrios I., Alaswad, Khaldoon, Jaffer, Farouc, Yeh, Robert, Patel, Mitul, Mahmud, Ehtisham, Choi, James, Burke, M. Nicholas, Doing, Anthony, Toma, Catalin, Uretsky, Barry, Holper, Elizabeth, Kandzari, David, Lembo, Nicholas, Garcia, Santiago, Krestyaninov, Oleg, Khelimskii, Dmitrii, Koutouzis, Michalis, and Moses, Jeffrey

Published
2018
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50. APPLICATION OF THE HYBRID APPROACH FOR PERCUTANEOUS CORONARY INTERVENTIONS FOR CHRONIC TOTAL OCCLUSIONS: UPDATE FROM AN INTERNATIONAL MULTICENTER REGISTRY.

Author

Tajti, Peter, Karmpaliotis, Dimitrios I., Alaswad, Khaldoon, Jaffer, Farouc, Yeh, Robert, Patel, Mitul, Mahmud, Ehtisham, Choi, James, Burke, M. Nicholas, Doing, Anthony, Toma, Catalin, Uretsky, Barry, Holper, Elizabeth, Kandzari, David, Lembo, Nicholas, Garcia, Santiago, Krestyaninov, Oleg, Khelimskii, Dmitrii, Koutouzis, Michalis, and Moses, Jeffrey

Published
2018
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