Search

Your search keyword '"Basem Elbarouni"' showing total 88 results
Start Over Author "Basem Elbarouni"
88 results on '"Basem Elbarouni"'

1. Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation: Findings From the CONNECT AF+PCI Study

Author

Felipe H. Valle, MD, PhD, Shaun G. Goodman, MD, MSc, Mary Tan, MSc, Andrew Ha, MD, Samer Mansour, MD, Robert C. Welsh, MD, Andrew T. Yan, MD, Kevin R. Bainey, MD, MSc, Stephane Rinfret, MD, Brian J. Potter, MDCM SM, Razi Khan, MD, Gerald Simkus, MD, Madhu K. Natarajan, MD, J.D. Schwalm, MD, Benoit Daneault, MD, Mark J. Eisenberg, MD, MPH, Joseph Abunassar, MD, Bryan Har, MD, MPH, Jean Gregoire, MD, Jean-Francois Tanguay, MD, Christopher B. Overgaard, MD, Jean-Pierre Dery, MD, Robert De Larochelliere, MD, Jean-Michel Paradis, MD, Mina Madan, MD, MHS, Basem Elbarouni, MBBCh, Derek Y.F. So, MD, Ata-Ur-Rehman Quraishi, MBBS, and Akshay Bagai, MD, MHS

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), selecting an antithrombotic regimen requires balancing risks of ischemic cardiac events, stroke, and bleeding. Methods: We studied 467 patients with AF undergoing PCI in the time period from December 2015 to July 2018 identified via a chart audit by 47 Canadian cardiologists in the CONNECT AF+PCI (the Coordinated National Network to Engage Interventional Cardiologists in the Antithrombotic Treatment of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) study, to determine patterns of initial antithrombotic therapy selection. Results: The median (25th, 75th percentile) CHADS2 score was 2 (1, 3), and PCI was performed in the setting of acute coronary syndrome in 62.1%. Triple antithrombotic therapy (TAT) was the initial treatment in 62.7%, dual-pathway therapy in 25.7%, and dual antiplatelet therapy in 11.6%, with a temporal increase in use of dual-pathway therapy during the course of the study; median intended TAT duration was 1 (1, 3) month. Compared with patients selected for TAT, patients selected for dual-pathway therapy were less likely to have prior myocardial infarction (35.8% vs 25.8%, P = 0.045) and prior PCI (33.8% vs 23.3%, P = 0.03), and they received shorter total length of stents (38 [23, 56] vs 30 [20, 46] mm, P = 0.03). Patients selected for dual-pathway therapy had a higher prevalence of prior stroke/transient ischemic attack (13.0% vs 23.3%, P = 0.01). There was no difference in prevalence of anemia (21.5% vs 25.8%, P = 0.30). Use of dual-pathway therapy was similar among patients with acute coronary syndrome and those with stable disease (24.1% vs 28.2%, P = 0.32). Conclusions: Approximately one-quarter of AF patients undergoing PCI are treated with dual-pathway therapy in Canadian practice, with its use increasing during the studied period. Patients selected for dual-pathway therapy have less-complex coronary disease history and intervention. Résumé: Introduction: Les patients atteints de fibrillation auriculaire (FA) qui subissent une intervention coronarienne percutanée (ICP) et choisissent un schéma posologique antithrombotique ont besoin de peser les risques d’événements cardiaques d’origine ischémique, d’accidents vasculaires cérébraux et d’hémorragies. Méthodes: Les 467 patients atteints de FA ayant subi une ICP de décembre 2015 à juillet 2018 qui ont fait l’objet de notre étude ont été trouvés lors de la vérification des dossiers par 47 cardiologues canadiens de l’étude CONNECT AF+PCI (Coordinated National Network to Engage Interventional Cardiologists in the Antithrombotic Treatment of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) pour déterminer les schémas de sélection du traitement antithrombotique initial. Résultats: Le score CHADS2 médian (25e, 75e percentile) était de 2 (1, 3), et l’ICP avait été réalisée dans le cadre du syndrome coronarien aigu chez 62,1 % des patients. La trithérapie antithrombotique (TTA) était le traitement initial chez 62,7 % des patients, la bithérapie, chez 25,7 % des patients, et la bithérapie antiplaquettaire, chez 11,6 % des patients, mais il y avait une augmentation temporelle dans l’utilisation de la bithérapie durant l’étude; la durée médiane prévue de la TTA était de 1 (1, 3) mois. Comparativement aux patients sélectionnés pour la TTA, les patients sélectionnés pour la bithérapie étaient moins susceptibles d’avoir eu un infarctus du myocarde précédent (35,8 % vs 25,8 %, P = 0,045) et une ICP précédente (33,8 % vs 23,3 %, P = 0,03), et recevaient des endoprothèses de longueur totale plus courte (38 [23, 56] vs 30 [20, 46] mm, P = 0,03). Les patients sélectionnés pour la bithérapie montraient une prévalence plus élevée d’accidents vasculaires cérébraux/accidents ischémiques transitoires (13,0 % vs 23,3 %, P = 0,01). Il n’existait aucune différence dans la prévalence de l’anémie (21,5 % vs 25,8 %, P = 0,30). L’utilisation de la bithérapie était similaire chez les patients atteints d’un syndrome coronarien aigu et chez les patients dont la maladie était stable (24,1 % vs 28,2 %, P = 0,32). Conclusions: Dans la pratique canadienne, environ le quart des patients atteints de FA qui subissent une ICP sont traités par bithérapie, mais durant la période étudiée, son utilisation avait augmenté. Les patients sélectionnés pour la bithérapie ont des antécédents et des interventions liées aux maladies coronariennes moins complexes.

Published
2021
Full Text
View/download PDF

3. Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention

Author

Judit Karacsonyi, Spyridon Kostantinis, Bahadir Simsek, Athanasios Rempakos, Salman S. Allana, Khaldoon Alaswad, Oleg Krestyaninov, Jaikirshan Khatri, Paul Poommipanit, Farouc A. Jaffer, James Choi, Mitul Patel, Sevket Gorgulu, Michalis Koutouzis, Ioannis Tsiafoutis, Abdul M. Sheikh, Ahmed ElGuindy, Basem Elbarouni, Taral Patel, Brian Jefferson, Jason R. Wollmuth, Robert Yeh, Dimitrios Karmpaliotis, Ajay J. Kirtane, Margaret B. McEntegart, Amirali Masoumi, Rhian Davies, Bavana V. Rangan, Olga C. Mastrodemos, Darshan Doshi, Yader Sandoval, Mir B. Basir, Michael S. Megaly, Imre Ungi, Nidal Abi Rafeh, Omer Goktekin, and Emmanouil S. Brilakis

Subjects
percutaneous coronary intervention, chronic total occlusion, balloon uncrossable, Medicine
Abstract

Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions.

Published
2023
Full Text
View/download PDF

4. Management of Acute Coronary Syndromes Beyond the First Year: A Canadian Clinical Practice Survey

Author

Khai-Tuan A. Bui, Alexis Matteau, MD, SM, Basem Elbarouni, MD, Kevin R. Bainey, MD, Christopher B. Fordyce, MD, Akshay Bagai, MD, Barry Rose, MD, Sohrab Lutchmedial, MD, Benjamin Leis, MD, Andrea Lavoie, MD, Jafna Cox, MD, Samer Mansour, MD, and Brian J. Potter, MDCM, SM

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: Antithrombotic management following acute coronary syndromes (ACSs) has evolved significantly. However, given lingering uncertainty as to when an ACS may be considered stable, there is the possibility of practice divergence beyond the first year. Methods: An online adaptive survey describing patients with varying cardiac and extracardiac ischemic risk was developed in order to asses self-reported physician practice intentions pertaining to the antithrombotic management of ACS patients who lack a formal indication for therapeutic anticoagulation. Provincial “champions” (Prince Edward Island not represented) were identified to ensure dissemination of the survey within their jurisdictions via 3 coordinated e-mailings; the survey was made available in French and English from November 2018 through January 2019. Results: A total of 135 practitioners responded to the survey (response rate 15%). Surveys were fully completed in all cases. Nearly all respondents (97%) were cardiologists; 76% worked at an academic center, and 54% had been in practice ≥ 10 years. Most respondents (81%-90%, depending on the scenario) preferred ticagrelor-based dual antiplatelet therapy as the initial ACS treatment. However, beyond 12 months, management decisions differed significantly according to the balance of cardiac and extracardiac risk. Conclusions: This study provides a first look at how the introduction of rivaroxaban 2.5 mg might be integrated into the clinical management of ACS patients beyond the first year in Canada. Whether to pursue dual antiplatelet therapy or transition early to low-dose rivaroxaban plus acetylsalicylic acid will likely be driven by patient clinical characteristics and perceived cardiac vs extra-cardiac ischemic risk. Résumé: Contexte: La prise en charge antithrombotique des patients ayant subi un syndrome coronarien aigu (SCA) a sensiblement évolué au fil du temps. Toutefois, compte tenu de l’incertitude qui persiste quant aux critères définissant un SCA stable, il est possible que les pratiques divergent après la première année. Méthodologie: Nous avons mis au point un questionnaire adaptatif en ligne décrivant les cas de patients présentant divers degrés de risque d’ischémie cardiaque ou extracardiaque, afin d’évaluer les objectifs autodéclarés des médecins quant à la prise en charge antithrombotique des patients ayant subi un SCA chez qui une anticoagulothérapie n’est pas formellement indiquée. Des « champions » provinciaux (l’Île-du-Prince-Édouard n’étant pas représentée) ont été désignés pour assurer la diffusion du questionnaire dans leur province respective en trois envois par courriel coordonnés; le questionnaire était offert en français et en anglais, et l’enquête s’est déroulée de novembre 2018 à janvier 2019. Résultats: Au total, 135 praticiens ont répondu au sondage (taux de réponse : 15 %). Tous les participants ont répondu à toutes les questions. Presque tous les participants (97 %) étaient cardiologues; 76 % des participants travaillaient dans un centre universitaire, et 54 % exerçaient depuis 10 ans ou plus. La plupart des participants (de 81 à 90 %, selon le scénario) préféraient une bithérapie antiplaquettaire à base de ticagrélor comme premier traitement après un SCA. Toutefois, les décisions quant au traitement au-delà des 12 premiers mois suivant le SCA variaient considérablement selon le risque cardiaque et extracardiaque résiduel évalué. Conclusions: L’étude constitue une première évaluation de la façon dont le rivaroxaban à 2,5 mg pourrait être intégré à la stratégie canadienne de prise en charge des patients au-delà de la première année suivant le SCA. Le choix de poursuivre la bithérapie antiplaquettaire ou de faire promptement la transition vers un traitement associant rivaroxaban à faible dose et acide acétylsalicylique dépendra vraisemblablement des caractéristiques cliniques du patient et du risque d’ischémie cardiaque et extracardiaque perçu.

Published
2020
Full Text
View/download PDF

6. When rotational atherectomy is not enough

Author

Negar Atefi, Basem Elbarouni, Amir Ravandi, and David W. Allen

Subjects
Cardiovascular disorders, Medicine, Medicine (General), R5-920
Abstract

Abstract Extreme coronary calcification may require rotational atherectomy to create a navigable intravascular lumen followed by intravascular lithotripsy to fracture areas of deep calcification to allow for successful percutaneous coronary intervention.

Published
2021
Full Text
View/download PDF

7. Cardiovascular Medication Use and Long‐Term Outcomes of First Nations and Non–First Nations Patients Following Diagnostic Angiography: A Retrospective Cohort Study

Author

Lindsey Dahl, Annette Schultz, Elizabeth McGibbon, Jarvis Brownlie, Catherine Cook, Basem Elbarouni, Alan Katz, Thang Nguyen, Jo Ann Sawatzky, Moneca Sinclaire, Karen Throndson, Heather J. Prior, and Randy Fransoo

Subjects
angiography, disparities, medication adherence, outcomes research, population studies, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background In Canada, First Nations (FN) people are at greater risk of mortality than the general population following index angiography. This disparity has not been investigated while considering guideline‐recommended cardiovascular medication use. Methods and Results Retrospective analysis of administrative health data investigated patterns of medication dispensation during the first year after index angiography among patients in Manitoba, Canada. Medication possession ratios (MPRs) reflecting the percentage of days in which medications were supplied were calculated separately for β‐blockers, angiotensin‐converting enzyme inhibitors, statins, and antiplatelets (clopidogrel). Patients were assigned to 1 of 4 categories: (1) not dispensed (0% MPR), (2) low (1–39% MPR), (3) intermediate (40–79% MPR), (4) high (≥80% MPR). Cox regression models that adjusted for MPR categories were used to explore the association between FN patients and both 5‐year all‐cause mortality and cardiovascular mortality. FN patients were less likely to have an intermediate MPR (odds ratio: 0.75; 95% CI, 0.57–0.99) or a high MPR (odds ratio: 0.64; 95% CI, 0.50–0.81) for statin medications than non‐FN patients. FN patients also had higher adjusted risks of all‐cause and cardiovascular mortality than non‐FN patients (hazard ratio, all‐cause: 1.54 [95% CI, 1.25–1.89]; cardiovascular: 1.62 [95% CI, 1.16–2.25]). Conclusions FN status was independently associated with intermediate and high MPRs for statins during the first year following index angiography among patients with known ischemic heart disease. Differences in MPR categories did not explain the disparity in all‐cause and cardiovascular mortality between the 2 populations. Reduction of cardiovascular disparities may be best addressed using primary prevention strategies that include decolonizing policies and practices.

Published
2019
Full Text
View/download PDF

8. GuideLiner Balloon Assisted Tracking (GBAT): A New Addition to the Interventional Toolbox

Author

Basem Elbarouni, Motaz Moussa, Malek Kass, Olga Toleva, Minh Vo, and Amir Ravandi

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

The use of guide extension catheters, such as GuideLiner, allows for increased guide support and facilitates device delivery in tortuous vessels. In cases which the GuideLiner catheter cannot be advanced even with balloon anchoring technique, we inflate a noncompliant balloon protruding from the GuideLiner catheter at nominal pressure and both the GuideLiner and the balloon are advanced over the coronary guidewire through the tortuous segments. This technique can be applied to 5.5 Fr., 6 Fr., and 7 Fr. GuideLiner catheters. This technique is termed GuideLiner Balloon Assisted Tracking (GBAT).

Published
2016
Full Text
View/download PDF

9. Educational Experience of Interventional Cardiology Fellows in the United States and Canada

Author

Bahadir Simsek, Spyridon Kostantinis, Judit Karacsonyi, Abdul Hakeem, Abhiram Prasad, Anand Prasad, Anna E. Bortnick, Basem Elbarouni, Hani Jneid, J. Dawn Abbott, Lorenzo Azzalini, Louis P. Kohl, Mario Gössl, Rajan A.G. Patel, Salman Allana, Tamim M. Nazif, Usman Baber, Olga C. Mastrodemos, Tarek Chami, Madeline Mahowald, Athanasios Rempakos, Bavana V. Rangan, Yader Sandoval, and Emmanouil S. Brilakis

Subjects
Cardiology and Cardiovascular Medicine
Published
2023

11. Predicting Periprocedural Complications in Chronic Total Occlusion Percutaneous Coronary Intervention

Author

Bahadir Simsek, Spyridon Kostantinis, Judit Karacsonyi, Khaldoon Alaswad, Oleg Krestyaninov, Dmitrii Khelimskii, Rhian Davies, Jeremy Rier, Omer Goktekin, Sevket Gorgulu, Ahmed ElGuindy, Raj H. Chandwaney, Mitul Patel, Nidal Abi Rafeh, Dimitrios Karmpaliotis, Amirali Masoumi, Jaikirshan J. Khatri, Farouc A. Jaffer, Darshan Doshi, Paul B. Poommipanit, Bavana V. Rangan, Yader Sandoval, James W. Choi, Basem Elbarouni, William Nicholson, Wissam A. Jaber, Stephane Rinfret, Michael Koutouzis, Ioannis Tsiafoutis, Robert W. Yeh, M. Nicholas Burke, Salman Allana, Olga C. Mastrodemos, and Emmanouil S. Brilakis

Subjects
Cardiology and Cardiovascular Medicine
Published
2022

13. Antithrombotic therapies in Canadian atrial fibrillation patients with concomitant coronary artery disease: Insights from the CONNECT AF + PCI-II program

Author

James K. Chow, Akshay Bagai, Mary K. Tan, Bryan J. Har, Amelia M.C. Yip, Mario Paniagua, Basem Elbarouni, Kevin R. Bainey, Jean-Michel Paradis, Robert Maranda, Warren J. Cantor, Mark J. Eisenberg, Jean-Pierre Dery, Mina Madan, Tomas Cieza, Alexis Matteau, Sherryn Roth, Shahar Lavi, Anthony Glanz, Dongsheng Gao, Ravi Tahiliani, Robert C. Welsh, Hahn Hoe Kim, Simon D. Robinson, Benoit Daneault, Aun-Yeong Chong, Michel R. Le May, Vineeta Ahooja, Jean C. Gregoire, Pierre-Louis Nadeau, Zachary Laksman, Brett Heilbron, Derek Yung, Kunal Minhas, Ronald Bourgeois, Christopher B. Overgaard, Hamid Bonakdar, Giridhar Logsetty, Andrea J. Lavoie, Robert De LaRochelliere, Samer Mansour, Caroline Spindler, Andrew T. Yan, and Shaun G. Goodman

Subjects
Cardiology and Cardiovascular Medicine
Published
2023

14. Single vs. multiple operators for chronic total occlusion percutaneous coronary interventions: From the PROGRESS‐CTO Registry

Author

Judit Karacsonyi, Khaldoon Alaswad, Oleg Krestyaninov, Dimitri Karmpaliotis, Ajay Kirtane, Ziad Ali, Margaret McEntegart, Amirali Masoumi, Paul Poomipanit, Farouc A. Jaffer, Jaikirshan Khatri, James Choi, Mitul Patel, Michalis Koutouzis, Ioannis Tsiafoutis, Sevket Gorgulu, Abdul M. Sheikh, Basem Elbarouni, Wissam Jaber, Ahmed ElGuindy, Robert Yeh, Spyridon Kostantinis, Bahadir Simsek, Bavana Rangan, Olga C. Mastrodemos, Evangelia Vemmou, Ilias Nikolakopoulos, Imre Ungi, Nidal A. Rafeh, Omer Goktekin, M. Nicholas Burke, Emmanouil S. Brilakis, Yader Sandoval, and Tıp Fakültesi

Subjects
Percutaneous Coronary Intervention, Operator, Radiology, Nuclear Medicine and imaging, Chronic Total Occlusion, General Medicine, 03.02. Klinikai orvostan, Cardiology and Cardiovascular Medicine, Clinical Outcomes
Abstract

Background: There is limited data on the impact of a second attending operator on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) outcomes. Methods: We analyzed the association between multiple operators (MOs) (>1 attending operator) and procedural outcomes of 9296 CTO PCIs performed between 2012 and 2021 at 37 centers. Results: CTO PCI was performed by a single operator (SO) in 85% of the cases and by MOs in 15%. Mean patient age was 64.4 ± 10 years and 81% were men. SO cases were more complex with higher Japan-CTO (2.38 ± 1.29 vs. 2.28 ± 1.20, p = 0.005) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention scores (1.13 ± 1.01 vs. 0.97 ± 0.93, p < 0.001) compared with MO cases. Procedural time (131 [87, 181] vs. 112 [72, 167] min, p < 0.001), fluoroscopy time (49 [31, 76] vs. 42 [25, 68] min, p < 0.001), air kerma radiation dose (2.32 vs. 2.10, p < 0.001), and contrast volume (230 vs. 210, p < 0.001) were higher in MO cases. Cases performed by MOs and SO had similar technical (86% vs. 86%, p = 0.9) and procedural success rates (84% vs. 85%, p = 0.7), as well as major adverse complication event rates (MACE 2.17% vs. 2.42%, p = 0.6). On multivariable analyses, MOs were not associated with higher technical success or lower MACE rates. Conclusion: In a contemporary, multicenter registry, 15% of CTO PCI cases were performed by multiple operators. Despite being more complex, SO cases had lower procedural and fluoroscopy times, and similar technical and procedural success and risk of complications compared with MO cases.

Published
2023

15. Impact of proximal cap ambiguity on the procedural techniques and outcomes of chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS‐CTO Registry

Author

Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, Athanasios Rempakos, Khaldoon Alaswad, Michael Megaly, Oleg Krestyaninov, Dmitrii Khelimskii, Dimitrios Karmpaliotis, Farouc A. Jaffer, Jaikirshan J. Khatri, Paul Poommipanit, Mitul P. Patel, Ehtisham Mahmud, Michael Koutouzis, Ioannis Tsiafoutis, Sevket Gorgulu, Basem Elbarouni, William Nicholson, Wissam Jaber, Stephane Rinfret, Nidal Abi Rafeh, Omer Goktekin, Ahmed M. ElGuindy, Salman S. Allana, Bavana V. Rangan, Yader Sandoval, M. Nicholas Burke, Emmanouil S. Brilakis, and Tıp Fakültesi

Subjects
Percutaneous Coronary Intervention, Radiology, Nuclear Medicine and imaging, General Medicine, Chronic Total Occlusion, Proximal Cap Ambiguity, Cardiology and Cardiovascular Medicine
Abstract

Background: Proximal cap ambiguity is a key parameter in the global chronic total occlusion (CTO) percutaneous coronary intervention (PCI) crossing algorithm. Methods: We examined the baseline characteristics and procedural outcomes of 9718 CTO PCIs performed in 9498 patients at 41 US and non-US centers between 2012 and 2022. Results: Proximal cap ambiguity was present in 35% of CTO lesions. Patients whose lesions had proximal cap ambiguity were more likely to have had prior coronary artery bypass graft surgery (37% vs. 24%; p < 0.001). Lesions with proximal cap ambiguity were more complex with higher J-CTO score (3.1 ± 1.0 vs. 2.0 ± 1.2; p < 0.001) and lower technical (79% vs. 90%; p < 0.001) and procedural (77% vs. 89%; p < 0.001) success rates compared with nonambiguous CTO lesions. The incidence of major adverse cardiovascular events (MACE) was higher in cases with proximal cap ambiguity (2.5% vs. 1.7%; p < 0.001). The retrograde approach was more commonly used among cases with ambiguous proximal cap (50% vs. 21%; p < 0.001) and was more likely to be the final successful crossing strategy (29% vs. 13%; p < 0.001). The antegrade dissection and re-entry (ADR) "move-the-cap" techniques were also more common among cases with proximal cap ambiguity. Conclusions: Proximal cap ambiguity in CTO lesions is associated with higher utilization of the retrograde approach and ADR, lower technical and procedural success rates, and higher incidence of in-hospital MACE.

Published
2023

16. List of contributors

Author

Nidal Abi Rafeh, Pierfrancesco Agostoni, Sukru Akyuz, Khaldoon Alaswad, Ziad A. Ali, Salman S. Allana, Chadi Alraies, Mario Araya, Alexandre Avran, Lorenzo Azzalini, Avtandil Babunashvili, Subhash Banerjee, Sripal Bangalore, Baktash Bayani, Michael Behnes, Ravinay Bhindi, Nicolas Boudou, Nenad Ž. Božinović, Leszek Bryniarski, Alexander Bufe, Christopher E. Buller, M. Nicholas Burke, Pedro Pinto Cardoso, Mauro Carlino, Joao L. Cavalcante, Tarek Chami, Raj H. Chandwaney, Konstantinos Charitakis, Victor Y. Cheng, James W. Choi, Evald Høj Christiansen, Yashasvi Chugh, Antonio Colombo, Claudia Cosgrove, Kevin Croce, Ramesh Daggubati, Félix Damas de los Santos, Rustem Dautov, Rhian E. Davies, Tony de Martini, Ali E. Denktas, Joseph Dens, Carlo di Mario, Roberto Diletti, Zisis Dimitriadis, Darshan Doshi, Parag Doshi, Kefei Dou, Mohaned Egred, Basem Elbarouni, Ahmed M. ElGuindy, Amr Elhadidy, Stephen Ellis, Javier Escaned, Panayotis Fasseas, Farshad Forouzandeh, Sergey Furkalo, Andrea Gagnor, Alfredo R. Galassi, Robert Gallino, Roberto Garbo, Santiago Garcia, Gabriele Gasparini, Junbo Ge, Lei Ge, Pravin Kumar Goel, Omer Goktekin, Nieves Gonzalo, Sevket Gorgulu, Luca Grancini, J. Aaron Grantham, Raviteja Guddeti, Elias V. Haddad, Allison B. Hall, Jack J. Hall, Sean Halligan, Franklin Leonardo Hanna Quesada, Colm Hanratty, Stefan Harb, Scott A. Harding, Raja Hatem, David Hildick-Smith, Jonathan M. Hill, Taishi Hirai, Mario Iannaccone, Wissam Jaber, Farouc A. Jaffer, Yangsoo Jang, Brian K. Jefferson, Allen Jeremias, Risto Jussila, Nikolaos Kakouros, Artis Kalnins, Sanjog Kalra, Arun Kalyanasundaram, David E. Kandzari, Hsien-Li Kao, Judit Karacsonyi, Dimitri Karmpaliotis, Hussien Heshmat Kassem, Kathleen Kearney, Jimmy Kerrigan, Jaikirshan Khatri, Dmitrii Khelimskii, Ajay J. Kirtane, Paul Knaapen, Spyridon Kostantinis, Michalis Koutouzis, Mihajlo Kovacic, Oleg Krestyaninov, A.V. Ganesh Kumar, Prathap Kumar N., Katherine J. Kunkel, Pablo Manuel Lamelas, Seung-Whan Lee, Thierry Lefevre, Gregor Leibundgut, Nicholas J. Lembo, Martin Leon, John R. Lesser, Raymond Leung, Soo-Teik Lim, Sidney Tsz Ho Lo, William Lombardi, Michael Luna, Ehtisham Mahmud, Madeline K. Mahowald, Anbukarasi Maran, Konstantinos Marmagkiolis, Evandro Martins Filho, Kambis Mashayekhi, Margaret B. McEntegart, Michael Megaly, Perwaiz Meraj, Lampros Michalis, Anastasios N. Milkas, Owen Mogabgab, Jeffrey Moses, Muhammad Munawar, Bilal Murad, Alexander Nap, Andres Navarro, William J. Nicholson, Anja Øksnes, Göran Olivecrona, Mohamed A. Omer, Jacopo Andrea Oreglia, Lucio Padilla, Mitul P. Patel, Rajan A.G. Patel, Taral Patel, Ashish Pershad, Duane Pinto, Paul Poommipanit, Marin Postu, Srini Potluri, Stylianos Pyxaras, Alexandre Schaan de Quadros, Michael Ragosta, Sunil V. Rao, Vithala Surya Prakasa Rao, Sudhir Rathore, Joerg Reifart, Athanasios Rempakos, Jeremy Rier, Robert Riley, Stéphane Rinfret, Juan J. Russo, Meruzhan Saghatelyan, Gurpreet S. Sandhu, Yader Sandoval, Ricardo Santiago, James Sapontis, Alpesh Shah, Evan Shlofmitz, Kendrick A. Shunk, George Sianos, Bahadir Simsek, Elliot J. Smith, Anthony Spaedy, James Spratt, Julian W. Strange, Bradley Strauss, Péter Tajti, Hector Tamez, Khalid O. Tammam, Craig A. Thompson, Aurel Toma, Catalin Toma, Ioannis Tsiafoutis, Etsuo Tsuchikane, Imre Ungi, Barry F. Uretsky, Georgios J. Vlachojannis, Minh Nhat Vo, Hoang Vu Vu, Simon Walsh, Daniel Weilenmann, Gerald Werner, Jarosław Wójcik, Jason Wollmuth, Eugene B. Wu, R. Michael Wyman, Iosif Xenogiannis, Bo Xu, Masahisa Yamane, Luiz F. Ybarra, and Robert W. Yeh

Published
2023

17. Collagenase to facilitate guidewire crossing in chronic total occlusion PCI—The Total Occlusion Study in Coronary Arteries-5 (TOSCA-5) trial

Author

John J. Graham, Akshay Bagai, Harindra Wijeysundera, Giora Weisz, Stéphane Rinfret, Alexander Dick, Sanjit S. Jolly, Erick Schaempert, Samer Mansour, Vladimir Dzavik, Jose P. S. Henriques, Basem Elbarouni, Minh N. Vo, Patrick Teefy, David Goodhart, G. B. John Mancini, Bradley H. Strauss, Christopher E. Buller, Cardiology, and ACS - Atherosclerosis & ischemic syndromes

Subjects
interventional devices/innovation, CTO-percutaneous coronary intervention, General Medicine, Coronary Angiography, Coronary Vessels, CTO, Percutaneous Coronary Intervention, Treatment Outcome, Coronary Occlusion, Chronic Disease, Humans, Radiology, Nuclear Medicine and imaging, Collagenases, Cardiology and Cardiovascular Medicine, coronary artery disease
Abstract

Background: Chronic total occlusions (CTO) are common and are associated with lower percutaneous coronary intervention (PCI) success rates, often due to failure of antegrade guidewire crossing. Local, intralesional delivery of collagenase (MZ-004) may facilitate guidewire crossing in CTO. Aims: To evaluate the effect of MZ-004 in facilitating antegrade wire crossing in CTO angioplasty. Methods: A total of 76 patients undergoing CTO PCI were enrolled at 13 international sites: 38 in the randomized training stage (collagenase [MZ-004] 900 or 1200 μg) and 38 in the placebo-controlled stage (MZ-004 900 or 1200 μg or placebo). Patients received the MZ-004 or identical volume saline (placebo group) in a double-blind design, injected via microcatheter directly into the proximal cap of the CTO. The following day patients underwent CTO PCI using antegrade wire techniques only. Results: Patients were generally similar except for a trend for higher Japanese chronic total occlusion (J-CTO) score in the MZ-004 group (MZ-004 J-CTO score 1.9 vs. 1.4, p = 0.07). There was a numerical increase in the rates of guidewire crossing in the MZ-004 groups compared to placebo (74% vs. 63%, p = 0.52). Guidewire crossing with a soft-tip guidewire (≤1.5 g tip load) was significantly higher in the MZ-004 groups (0% in placebo, 17% in 900 μg, and 29% in 1200 μg MZ-004 group, p = 0.03). Rates of the major adverse cardiovascular event were similar between groups. Conclusion: Local delivery of MZ-004 into coronary CTOs appears safe and may facilitate CTO crossing, particularly with softer tipped guidewires. These data support the development of a pivotal trial to further evaluate this agent.

Published
2022

18. Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation: Findings From the CONNECT AF+PCI Study

Author

Shaun G. Goodman, Gerald Simkus, Mark J. Eisenberg, Mina Madan, Akshay Bagai, Jean-François Tanguay, Samer Mansour, Felipe H. Valle, Andrew T. Yan, Benoit Daneault, Jean Grégoire, Derek So, Christopher B. Overgaard, Jean-Michel Paradis, Stéphane Rinfret, Kevin R. Bainey, Jean-Pierre Déry, Mary Tan, B. Har, Razi Khan, Basem Elbarouni, Robert C. Welsh, Ata-Ur-Rehman Quraishi, J. Schwalm, Robert De Larochellière, Madhu K. Natarajan, Andrew C.T. Ha, Brian J. Potter, and Joseph Abunassar

Subjects
Acute coronary syndrome, medicine.medical_specialty, Anemia, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Atrial fibrillation, medicine.disease, Regimen, RC666-701, Internal medicine, Conventional PCI, Antithrombotic, medicine, Cardiology, Diseases of the circulatory (Cardiovascular) system, Original Article, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Stroke
Abstract

Background: In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), selecting an antithrombotic regimen requires balancing risks of ischemic cardiac events, stroke, and bleeding. Methods: We studied 467 patients with AF undergoing PCI in the time period from December 2015 to July 2018 identified via a chart audit by 47 Canadian cardiologists in the CONNECT AF+PCI (the Coordinated National Network to Engage Interventional Cardiologists in the Antithrombotic Treatment of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) study, to determine patterns of initial antithrombotic therapy selection. Results: The median (25th, 75th percentile) CHADS2 score was 2 (1, 3), and PCI was performed in the setting of acute coronary syndrome in 62.1%. Triple antithrombotic therapy (TAT) was the initial treatment in 62.7%, dual-pathway therapy in 25.7%, and dual antiplatelet therapy in 11.6%, with a temporal increase in use of dual-pathway therapy during the course of the study; median intended TAT duration was 1 (1, 3) month. Compared with patients selected for TAT, patients selected for dual-pathway therapy were less likely to have prior myocardial infarction (35.8% vs 25.8%, P = 0.045) and prior PCI (33.8% vs 23.3%, P = 0.03), and they received shorter total length of stents (38 [23, 56] vs 30 [20, 46] mm, P = 0.03). Patients selected for dual-pathway therapy had a higher prevalence of prior stroke/transient ischemic attack (13.0% vs 23.3%, P = 0.01). There was no difference in prevalence of anemia (21.5% vs 25.8%, P = 0.30). Use of dual-pathway therapy was similar among patients with acute coronary syndrome and those with stable disease (24.1% vs 28.2%, P = 0.32). Conclusions: Approximately one-quarter of AF patients undergoing PCI are treated with dual-pathway therapy in Canadian practice, with its use increasing during the studied period. Patients selected for dual-pathway therapy have less-complex coronary disease history and intervention. Résumé: Introduction: Les patients atteints de fibrillation auriculaire (FA) qui subissent une intervention coronarienne percutanée (ICP) et choisissent un schéma posologique antithrombotique ont besoin de peser les risques d’événements cardiaques d’origine ischémique, d’accidents vasculaires cérébraux et d’hémorragies. Méthodes: Les 467 patients atteints de FA ayant subi une ICP de décembre 2015 à juillet 2018 qui ont fait l’objet de notre étude ont été trouvés lors de la vérification des dossiers par 47 cardiologues canadiens de l’étude CONNECT AF+PCI (Coordinated National Network to Engage Interventional Cardiologists in the Antithrombotic Treatment of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) pour déterminer les schémas de sélection du traitement antithrombotique initial. Résultats: Le score CHADS2 médian (25e, 75e percentile) était de 2 (1, 3), et l’ICP avait été réalisée dans le cadre du syndrome coronarien aigu chez 62,1 % des patients. La trithérapie antithrombotique (TTA) était le traitement initial chez 62,7 % des patients, la bithérapie, chez 25,7 % des patients, et la bithérapie antiplaquettaire, chez 11,6 % des patients, mais il y avait une augmentation temporelle dans l’utilisation de la bithérapie durant l’étude; la durée médiane prévue de la TTA était de 1 (1, 3) mois. Comparativement aux patients sélectionnés pour la TTA, les patients sélectionnés pour la bithérapie étaient moins susceptibles d’avoir eu un infarctus du myocarde précédent (35,8 % vs 25,8 %, P = 0,045) et une ICP précédente (33,8 % vs 23,3 %, P = 0,03), et recevaient des endoprothèses de longueur totale plus courte (38 [23, 56] vs 30 [20, 46] mm, P = 0,03). Les patients sélectionnés pour la bithérapie montraient une prévalence plus élevée d’accidents vasculaires cérébraux/accidents ischémiques transitoires (13,0 % vs 23,3 %, P = 0,01). Il n’existait aucune différence dans la prévalence de l’anémie (21,5 % vs 25,8 %, P = 0,30). L’utilisation de la bithérapie était similaire chez les patients atteints d’un syndrome coronarien aigu et chez les patients dont la maladie était stable (24,1 % vs 28,2 %, P = 0,32). Conclusions: Dans la pratique canadienne, environ le quart des patients atteints de FA qui subissent une ICP sont traités par bithérapie, mais durant la période étudiée, son utilisation avait augmenté. Les patients sélectionnés pour la bithérapie ont des antécédents et des interventions liées aux maladies coronariennes moins complexes.

Published
2021

19. Impacto de la adherencia a un algoritmo híbrido para la selección de la estrategia inicial de cruce en la intervención coronaria percutánea de oclusiones crónicas

Author

Habib Samady, Mohamed Omer, Michael Megaly, Oleg Krestyaninov, Taral Patel, Assaad Maalouf, Dmitrii Khelimskii, Ehtisham Mahmud, Robert W. Yeh, M. Nicholas Burke, Nidal Abi Rafeh, Shuaib M Abdullah, Hector Tamez, Jaikirshan Khatri, Subhash Banerjee, Bavana V. Rangan, Ioannis Tsiafoutis, Mitul Patel, Raj H. Chandwaney, Brian K. Jefferson, Michael P. Love, Dimitri Karmpaliotis, Emmanouil S. Brilakis, Evangelia Vemmou, Catalin Toma, Phil Dattilo, Alpesh Shah, Anthony Doing, Abou Jaoudeh Fadi, James W. Choi, Michalis Koutouzis, Farouc A. Jaffer, Abdul M. Sheikh, Santiago Garcia, Basem Elbarouni, Ilias Nikolakopoulos, Khaldoon Alaswad, Iosif Xenogiannis, Wissam Jaber, and Barry F. Uretsky

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Retrograde approach, Medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Resumen Introduccion y objetivos El algoritmo hibrido se diseno para ayudar en la seleccion de las estrategias de cruce inicial y siguientes en la intervencion coronaria percutanea (ICP) para la oclusion cronica total (OTC); sin embargo, el exito de la estrategia de inicio seleccionada se ha estudiado poco hasta ahora. Metodos Se estudio el impacto de la adherencia a la recomendacion del algoritmo hibrido para la seleccion de la tecnica de cruce inicial en 4.178 ICP de OTC en un registro multicentrico de gran tamano. Resultados La estrategia de cruce inicial coincidio con la recomendacion del algoritmo hibrido en 1.833 casos (44%). Los pacientes en el grupo concordante tuvieron una edad similar, pero un indice J-OTC menor (2,0 ± 1,4 frente a 2,8 ± 1,1; p Conclusiones La adherencia al algoritmo hibrido para la seleccion de la estrategia inicial de cruce se asocio con mayor exito de la ICP para la OTC y similar tasa de eventos cardiovasculares hospitalarios graves.

Published
2021

20. Saphenous Vein Graft Occlusion Following Native Vessel Chronic Total Occlusion Percutaneous Coronary Intervention

Author

Spyridon, Kostantinis, Bahadir, Simsek, Judit, Karacsonyi, Khaldoon, Alaswad, Michael, Megaly, Farouc A, Jaffer, Jaikirshan J, Khatri, Paul, Poommipanit, Rhian E, Davies, Stephane, Rinfret, Basem, Elbarouni, Luiz F, Ybarra, Abdul M, Sheikh, Catalin, Toma, Raj, Chandwaney, Nidal, Abi Rafeh, Omer, Goktekin, Ahmed M, El Guindy, Salman, Allana, Olga C, Mastrodemos, Bavana V, Rangan, Yader, Sandoval, M Nicholas, Burke, and Emmanouil S, Brilakis

Abstract

Whether saphenous vein grafts (SVGs) should be occluded after successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of the corresponding native vessel remains controversial.We analyzed the clinical and angiographic characteristics and procedural outcomes of 51 patients who underwent SVG occlusion following successful CTO-PCI of the corresponding native vessel between 2015 and 2022 at 14 centers.Mean patient age was 71 ± 8 years and 80% were men. The most common CTO target vessel was the right coronary artery (41%), followed by the left circumflex (37%). Retrograde crossing through the SVG was the successful crossing strategy in 40 cases (78%). SVG occlusion was achieved with coils (1.9 ± 1.0) in 35 of 51 patients (69%) and vascular plugs in the other 16 cases (31%). All procedures were technically successful and the SVG was occluded completely (TIMI 0 flow) in 38 of the cases (75%), with the remaining cases having TIMI 1 flow. Follow-up was available for 37 patients (73%); during a mean follow-up of 312 days from CTO-PCI, the incidence of target-lesion failure due to restenosis was 5.4% (n = 2) with no other major events reported.Following native vessel CTO-PCI, SVG occlusion is often performed and is associated with favorable mid-term outcomes.

Published
2022

21. Rotational Atherectomy in the Management of Ruptured and Entrapped Coronary Angioplasty Balloon

Author

Basem Elbarouni, Karthik Balasubramaniam, Malek Kass, Amir Ravandi, and Kunal Minhas

Subjects
Atherectomy, Coronary, medicine.medical_specialty, Percutaneous, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Stent, General Medicine, Coronary Angiography, Revascularization, Balloon, Surgery, Atherectomy, Percutaneous Coronary Intervention, Treatment Outcome, Right coronary artery, medicine.artery, Coronary vessel, medicine, Humans, Stents, Angioplasty, Balloon, Coronary, Cardiology and Cardiovascular Medicine, business
Abstract

Retention and entrapment of angioplasty device fragments is a rare consequence of percutaneous coronary intervention (PCI). Due to advances in retrieval devices and introduction of new interventional techniques the need for emergency surgery has reduced significantly. There might also be clinical scenarios were remnants of retained fragments might have to be left within the coronary vessel and this might be the most appropriate option. Here we report a case of a ruptured non-compliant angioplasty balloon that was entrapped in the right coronary artery and retained in situ after multiple failed attempts at percutaneous retrieval. Medical therapy failed and hence rotation atherectomy had to be performed followed by stent implantation, there by jailing the retained fragments underneath the stent struts. To our knowledge this is the first description of rotational atherectomy of an entrapped balloon to allow for percutaneous revascularization .

Published
2021

23. B-12 | Approaches to and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention of the Left Anterior Descending Artery: Insights from the PROGRESS-CTO Registry

Author

Spyridon Kostantinis, Athanasios Rempakos, Bahadir Simsek, Judit Karacsonyi, Salman S. Allana, Khaldoon Alaswad, Mir B. Basir, Oleg Krestyaninov, Dmitrii Khelimskii, Şevket Görgülü, Rhian E. Davies, Farouc A. Jaffer, Jaikirshan Khatri, Paul Poommipanit, James W. Choi, Wissam A. Jaber, Stéphane Rinfret, William J. Nicholson, Brian Jefferson, Taral N. Patel, Karim Al-Azizi, Srini Potluri, Basem Elbarouni, Nazif Aygul, Bulent Behlul Altunkeser, Ahmed Elguindy, Nidal Abi Rafeh, Ömer Göktekin, Olga Mastrodemos, Bavana V. Rangan, Yader B. Sandoval, M. Nicholas Burke, and Emmanouil S. Brilakis

Published
2023

24. E-35 | Educational Experience of Interventional Cardiology Fellows in the United States and Canada

Author

Bahadir Simsek, Spyridon Kostantinis, Judit Karacsonyi, Abdul Hakeem, Abhiram Prasad, Anand Prasad, Anna Bortnick, Basem Elbarouni, Hani Jneid, J. Dawn Abbott, Lorenzo Azzalini, Louis P. Kohl, Mario Goessl, Rajan A. Patel, Salman S. Allana, Tamim M. Nazif, Usman Baber, Olga C. Mastrodemos, Tarek Chami, Madeline Mahowald, Athanasios Rempakos, Bavana V. Rangan, Yader B. Sandoval, and Emmanouil S. Brilakis

Published
2023

25. CONTEMPORARY OUTCOMES OF CHRONIC TOTAL OCCLUSION INTERVENTIONS: UPDATE FROM THE PROGRESS-CTO (PROSPECTIVE GLOBAL REGISTRY FOR THE STUDY OF CHRONIC TOTAL OCCLUSION INTERVENTION) INTERNATIONAL REGISTRY

Author

Salman S. Allana, Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, Khaldoon Alaswad, Athanasios Rempakos, Dmitrii Khelimskii, Dimitrios I. Karmpaliotis, Farouc A. Jaffer, Jaikirshan J. Khatri, Paul Poommipanit, James W. Choi, Mitul P. Patel, Michail Koutouzis, Ehtisham Mahmud, Basem Elbarouni, Wissam A. Jaber, Stéphane Rinfret, Srinivasa P. Potluri, William J. Nicholson, Brian K. Jefferson, Sevket Gorgulu, Raj H. Chandwaney, Bavana V. Rangan, and Emmanouil S. Brilakis

Subjects
Cardiology and Cardiovascular Medicine
Published
2023

26. IMPACT OF QUALITY OF DISTAL TARGET VESSEL ON THE OUTCOMES OF CHRONIC TOTAL OCCLUSION INTERVENTION: INSIGHTS FROM THE PROGRESS-CTO REGISTRY

Author

Salman S. Allana, Spyridon Kostantinis, Judit Karacsonyi, Bahadir Simsek, Paul Poommipanit, Jaikirshan J. Khatri, James W. Choi, Khaldoon Alaswad, Stéphane Rinfret, Wissam A. Jaber, William J. Nicholson, Oleg Krestianinov, Dmitrii Khelimskii, Dimitrios I. Karmpaliotis, Farouc A. Jaffer, Mitul P. Patel, Ehtisham Mahmud, Michail Koutouzis, Basem Elbarouni, Yader Sandoval, Ufuk Yildirim, Barry F. Uretsky, Korhan Soylu, Bavana V. Rangan, and Emmanouil S. Brilakis

Subjects
Cardiology and Cardiovascular Medicine
Published
2023

27. EQUIPMENT UTILIZATION IN CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTIONS: INSIGHTS FROM THE PROGRESS-CTO REGISTRY

Author

Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, Khaldoon Alaswad, Farouc A. Jaffer, Jaikirshan J. Khatri, Paul Poommipanit, Rhian E. Davies, Stéphane Rinfret, Wissam A. Jaber, James W. Choi, Mitul P. Patel, Brian K. Jefferson, Jimmy L. Kerrigan, Basem Elbarouni, Nidal Abi Rafeh, Omer Goktekin, Ahmed Mohamed ElGuindy, Salman S. Allana, Olga Mastrodemos, Athanasios Rempakos, Bavana V. Rangan, Yader Sandoval, M Nicholas Burke, and Emmanouil S. Brilakis

Subjects
Cardiology and Cardiovascular Medicine
Published
2023

28. TCT-109 Use of Subintimal Tracking and Reentry Technique in Chronic Total Occlusion Percutaneous Coronary Intervention

Author

Judit Karacsonyi, Spyridon Kostantinis, Bahadir Simsek, Khaldoon Alaswad, Dimitri Karmpaliotis, Ajay Kirtane, Margaret McEntegart, Farouc Jaffer, James Choi, Paul Poommipanit, Michalis Koutouzis, Ioannis Tsiafoutis, Jaikirshan Khatri, David Kandzari, Raj Chandwaney, Basem Elbarouni, Sevket Gorgulu, Ahmed ElGuindy, Nidal Abi-Rafeh, Omer Goktekin, Imre Ungi, Bavana Rangan, Olga Mastrodemos, Yader Sandoval, Salman Allana, M. Nicholas Burke, and Emmanouil Brilakis

Subjects
Cardiology and Cardiovascular Medicine
Published
2022

29. TCT-117 Impact of Proximal Cap Ambiguity on the Outcomes of Chronic Total Occlusion Intervention: Insights From the PROGRESS-CTO Registry

Author

Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, Khaldoon Alaswad, Michael Megaly, Oleg Krestyaninov, Dmitrii Khelimskii, Farouc Jaffer, Jaikirshan Khatri, Paul Poommipanit, Mitul Patel, Ehtisham Mahmud, Michail Koutouzis, Ioannis Tsiafoutis, Sevket Gorgulu, Basem Elbarouni, William Nicholson, Wissam Jaber, Stephane Rinfret, Omer Goktekin, Ahmed ElGuindy, Yader Sandoval, M. Nicholas Burke, Salman Allana, Bavana Rangan, and Emmanouil Brilakis

Subjects
Cardiology and Cardiovascular Medicine
Published
2022

30. 2022 CCS/CAIC Guidelines for Training and Retraining in Adult Interventional Cardiology

Author

Kevin R. Bainey, Alexandra Bastiany, Eric Cohen, Janine Eckstein, Basem Elbarouni, Michelle M. Graham, Bakhtiar Kidwai, null Andrea Lavoie, Shuangbo Liu, Samer Mansour, Alexis Matteau, Blair O’Neill, Janarthanan Sathananthan, Mathew Sibbald, Robert C. Welsh, and Mina Madan

Subjects
Adult, Cardiology, Humans, Cardiology and Cardiovascular Medicine, Societies, Medical
Published
2022

31. Use of the Limited Antegrade Subintimal Tracking Technique in Chronic Total Occlusion Percutaneous Coronary Intervention

Author

Judit Karacsonyi, Spyridon Kostantinis, Bahadir Simsek, Khaldoon Alaswad, Dimitri Karmpaliotis, Ajay Kirtane, Farouc Jaffer, James W. Choi, Michalis Koutouzis, Ioannis Tsiafoutis, David E. Kandzari, Paul Poommipanit, Jaikirshan J. Khatri, Basem Elbarouni, Sevket Gorgulu, Ahmed ElGuindy, Nidal Abi Rafeh, Omer Goktekin, Imre Ungi, Bavana V. Rangan, Yader Sandoval, Salman Allana, M. Nicholas Burke, Emmanouil S. Brilakis, and Tıp Fakültesi

Subjects
Male, Chronic Total Occlusion, Middle Aged, Percutaneous Coronary Intervention, Treatment Outcome, Coronary Occlusion, Humans, Female, Prospective Studies, Registries, 03.02. Klinikai orvostan, Cardiology and Cardiovascular Medicine, Limited Antegrade Subintimal Tracking, Aged
Abstract

BACKGROUND There are limited data on the limited antegrade subintimal tracking (LAST) technique for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).OBJECTIVES The aim of this study was to analyze the frequency of use and outcomes of the LAST technique for CTO PCI.METHODS We analyzed 2,177 CTO PCIs performed using antegrade dissection and re-entry (ADR) in the PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) registry between 2012 and January 2022 at 39 centers. ADR was attempted in 1,465 cases (67.3%).RESULTS Among antegrade re-entry cases, LAST was used in 163 (11.1%) (primary LAST in 127 [8.7%] and secondary LAST [LAST after other ADR approaches failed] in 36 [2.5%]), the Stingray system (Boston Scientific) in 980 (66.9%), subintimal tracking and re-entry in 387 (26.4%), and contrast-guided subintimal tracking and re-entry in 29 (2.0%). The mean patient age was 65.2 similar to 10 years, and 85.8% were men. There was no significant difference in technical (71.8% vs 77.8%; P 1/4 0.080) and procedural (69.9% vs 75.3%; P 1/4 0.127) success and major cardiac adverse events (1.84% vs 3.53%; P 1/4 0.254) between LAST and non-LAST cases. However, on multivariable analysis, the use of LAST was associated with lower procedural success (OR: 0.61; 95% CI: 0.41-0.91). Primary LAST was associated with higher technical (76.4% vs 55.6%; P 1/4 0.014) and procedural (75.6% vs 50.0%; P 1/4 0.003) success and similar major adverse cardiac event (1.57% vs 2.78%; P 1/4 0.636) rates compared with secondary LAST.CONCLUSIONS LAST was used in 11.1% of antegrade re-entry CTO PCI cases and was associated with lower procedural success on multivariable analysis, suggesting a limited role of LAST in contemporary CTO PCI. (J Am Coll Cardiol Intv 2022;15:2284-2293) (c) 2022 by the American College of Cardiology Foundation.

Published
2022

32. Abstract 11342: Contemporary in-hospital Outcomes of Chronic Total Occlusion Interventions: Update from the Progress-cto (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) International Registry

Author

Spyridon Kostantinis, Khaldoon Alaswad, Dimitrios Karmpaliotis, Oleg Krestyaninov, Dmitrii Khelimskii, James Choi, Farouc A Jaffer, Paul Poommipanit, Judit Karacsonyi, Evangelia Vemmou, Ilias Nikolakopoulos, Sevket Gorgulu, Michael Koutouzis, Ioannis Tsiafoutis, Robert Riley, Basem Elbarouni, Wissam Jaber, Habib Samady, Khalid Tammam, Ahmed M Elguindy, OMER GOKTEKIN, Nidal Abi-Rafeh, Bavana V Rangan, M Nicholas Burke, and Emmanouil S Brilakis

Subjects
Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract

Introduction: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is an evolving field. Methods: We examined the clinical and angiographic characteristics and procedural outcomes of 8,666 CTO PCIs performed at 36 centers between 2012 and 2021. Results: Mean age was 64±10 years and 82% of the patients were men. The prevalence of prior PCI (62%) and diabetes mellitus (43%) was high. Median ejection fraction was 54% (42%, 60%). Radial access was used in 50%. The most common target vessel was the right coronary artery (52%), followed by the left anterior descending artery (26%). The target CTOs were highly complex with mean J-CTO score of 2.4 ±1.3 and PROGRESS score of (1.3 ±1). Technical and procedural success rates were high (86% and 85% respectively) with a relatively low percentage of in-hospital major adverse cardiac events (Figure 1). The final successful crossing strategy was antegrade wire escalation in 62%, retrograde in 22%, and antegrade dissection re-entry in 16%. Median contrast volume, air kerma radiation dose and procedure time were 220 (155, 300) ml, 2.2 (1.2, 3.8) Gray and 116 (75, 172) minutes, respectively. Conclusions: High success and acceptable complication rates can currently be achieved in CTO PCI among high-volume, experienced centers.

Published
2021

33. Drill and blast: acute stent regret treated with roto-tripsy

Author

Basem Elbarouni, Scott Donald, and Michael P Love

Subjects
medicine.medical_specialty, Drill, business.industry, medicine.medical_treatment, Stent, Regret, General Medicine, Coronary Vessels, Surgery, Calcification, Physiologic, Percutaneous Coronary Intervention, Lithotripsy, Medicine, Humans, ST Elevation Myocardial Infarction, Cardiology and Cardiovascular Medicine, business
Published
2021

34. Distal Radial Access in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry

Author

Ilias, Nikolakopoulos, Taral, Patel, Brian K, Jefferson, Abdul M, Sheikh, Wissam, Jaber, Habib, Samady, Jaikirshan J, Khatri, Robert W, Yeh, Hector, Tamez, Michalis, Koutouzis, Ioannis, Tsiafoutis, Farouc A, Jaffer, Anthony H, Doing, Phil, Dattilo, Barry F, Uretsky, Catalin, Toma, Basem, Elbarouni, Khaldoon, Alaswad, James W, Choi, Nicholas J, Lembo, Manish, Parikh, Ajay J, Kirtane, Ziad A, Ali, Mohamed, Omer, Evangelia, Vemmou, Iosif, Xenogiannis, Judit, Karacsonyi, Bavana V, Rangan, Shuaib, Abdullah, Subhash, Banerjee, Santiago, Garcia, M Nicholas, Burke, Emmanouil S, Brilakis, and Dimitri, Karmpaliotis

Subjects
Percutaneous Coronary Intervention, Treatment Outcome, Coronary Occlusion, Risk Factors, Humans, Registries
Abstract

The outcomes of distal radial access (dRA) in chronic total occlusion percutaneous coronary intervention (CTO-PCI) have received limited study.We compared the clinical, angiographic, and procedural characteristics of 120 CTO-PCIs performed via dRA access with 2625 CTO-PCIs performed via proximal radial access (pRA) in a large, multicenter registry.The dRA group had lower mean PROGRESS-CTO score than the pRA group (1.0 ± 1 vs 1.2 ± 1, respectively; P=.05), while J-CTO score (2.4 ± 1.2 vs 2.3 ± 1.3; P=.43) and PROGRESS-CTO Complications score (2.8 ± 1.8 vs 2.6 ± 1.9; P=.16) were similar in the dRA vs pRA groups, respectively. Technical success was similar in the 2 groups (90% dRA vs 86% pRA; P=.14). Concomitant use of femoral access did not alter procedural success. The incidence of major periprocedural adverse cardiac events was similar in the 2 groups (0.8% dRA vs 2.4% pRA; P=.26), whereas the incidence of tamponade requiring pericardiocentesis was lower with dRA (0% dRA vs 4.69% pRA; P.001), as was air kerma radiation dose (median, 1.7 Gy; interquartile range [IQR], 0.97-2.63 Gy in the dRA group vs median, 2.27 Gy; IQR, 1.2-3.9 Gy in the pRA group; P.001).Use of dRA in CTO-PCI is associated with similar procedural success and risk of complications as compared with pRA.

Published
2021

35. TCT-112 Predicting In-Hospital Acute Myocardial Infarction in Chronic Total Occlusion Percutaneous Coronary Intervention: The PROGRESS-CTO Acute Myocardial Infarction Score

Author

Bahadir Simsek, Spyridon Kostantinis, Judit Karacsonyi, Khaldoon Alaswad, Oleg Krestyaninov, Dmitrii Khelimskii, Rhian Davies, Jeremy Rier, Omer Goktekin, Sevket Gorgulu, Ahmed ElGuindy, Raj Chandwaney, Mitul Patel, Dimitri Karmpaliotis, Jaikirshan Khatri, Farouc Jaffer, Paul Poommipanit, Bavana Rangan, Yader Sandoval, Basem Elbarouni, William Nicholson, Stephane Rinfret, Michail Koutouzis, Ioannis Tsiafoutis, Robert Yeh, M. Nicholas Burke, Salman Allana, Olga Mastrodemos, and Emmanouil Brilakis

Subjects
Cardiology and Cardiovascular Medicine
Published
2022

36. TCT-171 Predicting the Risk of Perforation Requiring Pericardiocentesis in Chronic Total Occlusion Percutaneous Coronary Intervention: The PROGRESS-CTO Pericardiocentesis Score

Author

Bahadir Simsek, Spyridon Kostantinis, Judit Karacsonyi, Khaldoon Alaswad, Oleg Krestyaninov, Dmitrii Khelimskii, Rhian Davies, Jeremy Rier, Omer Goktekin, Sevket Gorgulu, Ahmed ElGuindy, Raj Chandwaney, Mitul Patel, Dimitri Karmpaliotis, Jaikirshan Khatri, Farouc Jaffer, Paul Poommipanit, Bavana Rangan, Yader Sandoval, Basem Elbarouni, William Nicholson, Stephane Rinfret, Michail Koutouzis, Ioannis Tsiafoutis, Robert Yeh, M. Nicholas Burke, Salman Allana, Olga Mastrodemos, and Emmanouil Brilakis

Subjects
Cardiology and Cardiovascular Medicine
Published
2022

37. TCT-128 Saphenous Vein Graft Occlusion Following Native Vessel Chronic Total Occlusion Percutaneous Coronary Intervention

Author

Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, Khaldoon Alaswad, Michael Megaly, Farouc Jaffer, Jaikirshan Khatri, Paul Poommipanit, Rhian Davies, Stephane Rinfret, Basem Elbarouni, Luiz Ybarra, Abdul Sheikh, Catalin Toma, Raj Chandwaney, Omer Goktekin, Ahmed ElGuindy, Olga Mastrodemos, Bavana Rangan, M. Nicholas Burke, and Emmanouil Brilakis

Subjects
Cardiology and Cardiovascular Medicine
Published
2022

38. TCT-113 Predicting the Risk of In-Hospital Major Adverse Cardiovascular Events in Chronic Total Occlusion Percutaneous Coronary Intervention: The PROGRESS-CTO MACE Score

Author

Bahadir Simsek, Spyridon Kostantinis, Judit Karacsonyi, Khaldoon Alaswad, Oleg Krestyaninov, Dmitrii Khelimskii, Rhian Davies, Jeremy Rier, Omer Goktekin, Sevket Gorgulu, Ahmed ElGuindy, Raj Chandwaney, Mitul Patel, Dimitri Karmpaliotis, Jaikirshan Khatri, Farouc Jaffer, Paul Poommipanit, Bavana Rangan, Yader Sandoval, Basem Elbarouni, William Nicholson, Stephane Rinfret, Michail Koutouzis, Ioannis Tsiafoutis, Robert Yeh, M. Nicholas Burke, Salman Allana, and Emmanouil Brilakis

Subjects
Cardiology and Cardiovascular Medicine
Published
2022

39. TCT-110 Use of Atherectomy in Chronic Total Occlusion Percutaneous Coronary Intervention

Author

Judit Karacsonyi, Bahadir Simsek, Spyridon Kostantinis, Khaldoon Alaswad, Oleg Krestyaninov, Dimitri Karmpaliotis, Ajay Kirtane, Margaret McEntegart, Jaikirshan Khatri, Paul Poommipanit, Farouc Jaffer, James Choi, Ehtisham Mahmud, Mitul Patel, Michalis Koutouzis, Ioannis Tsiafoutis, Basem Elbarouni, Wissam Jaber, Stephane Rinfret, Brian Jefferson, Taral Patel, Sevket Gorgulu, Ahmed ElGuindy, Nidal Abi-Rafeh, Omer Goktekin, Imre Ungi, Bavana Rangan, Olga Mastrodemos, Yader Sandoval, Salman Allana, M. Nicholas Burke, and Emmanouil Brilakis

Subjects
Cardiology and Cardiovascular Medicine
Published
2022

40. TCT-319 Use of Limited Antegrade Subintimal Tracking Technique in Chronic Total Occlusion Percutaneous Coronary Intervention

Author

Ioannis Tsiafoutis, Judit Karacsonyi, Farouc A. Jaffer, Robert Riley, Omer Goktekin, Imre Ungi, Vennela Avula, Bahadir Simsek, Dimitri Karmpaliotis, Alessandra Gutierrez, Spyridon Kostantinis, Ahmed ElGuindy, Basem Elbarouni, Paul Poommipanit, Sevket Gorgulu, Nidal Abi-Rafeh, David E. Kandzari, Khaldoon Alaswad, James W. Choi, Emmanouil S. Brilakis, and Jaikirshan Khatri

Subjects
medicine.medical_specialty, business.industry, Internal medicine, medicine.medical_treatment, medicine, Cardiology, Percutaneous coronary intervention, Cardiology and Cardiovascular Medicine, business, Total occlusion
Published
2021

41. ANTITHROMBOTIC THERAPIES IN CANADIAN ATRIAL FIBRILLATION PATIENTS WITH CONCOMITANT CORONARY ARTERY DISEASE: INSIGHTS FROM THE CONNECT AF+PCI-I AND -II PROGRAMS

Author

Akshay Bagai, Derek So, R. Khan, Jason G. Andrade, R Maranda, A Hameed, P Nadeau, S. Lavi, M. Le May, V Ahooja, Kevin R. Bainey, M Paniagua, H. Kim, Andrew T. Yan, Benoit Daneault, A Lam, B. Har, A Glanz, D Gao, Mark J. Eisenberg, A Yip, Aun-Yeong Chong, Jean Grégoire, Jean-Michel Paradis, C. Spindler, Zachary Laksman, Tomas Cieza, Jean-Pierre Déry, P Malek-Marzban, Basem Elbarouni, W.J. Cantor, J. Schwalm, Brett Heilbron, Alexis Matteau, R Tahiliani, Robert C. Welsh, H Bonakdar, Mary Tan, S Roth, M Doucet, D Yung, Mina Madan, S.G. Goodman, L Noronha, and Simon D. Robinson

Subjects
Acute coronary syndrome, Rivaroxaban, medicine.medical_specialty, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Canadian Cardiovascular Society, medicine.disease, Dabigatran, Coronary artery disease, Internal medicine, Conventional PCI, Antithrombotic, Cardiology, Medicine, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

BACKGROUND The Coordinated National Network to Engage Cardiologists in the antithrombotic Treatment of patients with Atrial Fibrillation undergoing Percutaneous Coronary Intervention (CONNECT AF+PCI-I) program provided a snapshot (Nov 2015-Jul 2018) of the antithrombotic management of 467 non-valvular atrial fibrillation (NVAF) patients undergoing PCI in Canada (Bagai et al Can J Cardiol 2018;34:S16). Since then, further randomized clinical trials have supported updated Canadian Cardiovascular Society (CCS) AF and Antiplatelet guideline recommendations for antithrombotic strategies for NVAF and coronary artery disease (CAD) patients undergoing PCI and/or medical management. Thus, an updated quality enhancement assessment in Canadian practice (CONNECT AF+PCI-II) was undertaken. METHODS AND RESULTS By retrospective chart audit (Aug 2018-Dec 2020), 68 cardiologists from 8 provinces identified 626 patients with NVAF. 37% had stable CAD, 56% had an acute coronary syndrome (ACS) and PCI, and 7% had an ACS and were medically managed. Median age was 76 (25th,75th percentiles 69, 83; 87% ≥65 years); 29% female; 38% diabetes; median CHADS2 score 2 (1, 3); median CHA2DS2-VASc score 4 (3, 5); median HAS-BLED score 3 (2, 3). 73% were receiving oral anticoagulation (OAC) before the index ACS/PCI (apixaban 31%, rivaroxaban 24%, dabigatran 6%, edoxaban 2%, warfarin 10%). Initial antithrombotic therapy after the index ACS/PCI was: 53% triple therapy (OAC+dual antiplatelet therapy [DAPT=ASA+P2Y12 receptor inhibitor], 31% OAC+P2Y12 inhibitor, 9% DAPT, 4% OAC+ASA, 2% OAC alone, and CONCLUSION While triple therapy remains the most common initial antithrombotic strategy used in AF patients undergoing PCI and/or admitted with ACS in Canada, treatment duration has shortened over time. Further, more patients are receiving CCS guideline-recommended OAC+ P2Y12 receptor inhibitor post-PCI compared to previously, and OAC monotherapy 1 year post-ACS/PCI.

Published
2021

42. E-12 | Intravascular Imaging Use in Percutaneous Coronary Interventions Chronic Total Occlusions

Author

Judit Karacsonyi, Spyridon Kostantinis, Bahadir Simsek, Mir B. Basir, Michael S. Megaly, Oleg Krestyaninov, Dmitrii Khelimskii, Jaikirshan Khatri, Paul Poomipanit, Farouc A. Jaffer, Mitul P. Patel, Dimitrios Karmpaliotis, Ajay J. Kirtane, Ziad A. Ali, Margaret McEntegart, Amirali Masoumi, Şevket Görgülü, Michail Koutouzis, Ioannis Tsiafoutis, Abdul M. Sheikh, Basem Elbarouni, Wissam A. Jaber, Taral Patel, Brian Jefferson, Rhian E. Davies, James W. Choi, Ahmed Elguindy, Jason R. Wollmuth, Robert W. Yeh, Bavana V. Rangan, Olga C. Mastrodemos, Darshan Doshi, Yader B. Sandoval, Imre Ungi, Nidal Abi Rafeh, Ömer Göktekin, Emmanouil S. Brilakis, and Khaldoon Alaswad

Published
2022

43. E-13 | Percutaneous Coronary Interventions of Balloon Uncrossable Chronic Total Occlusions

Author

Judit Karacsonyi, Khaldoon Alaswad, Oleg Krestyaninov, Dmitrii Khelimskii, Jaikirshan Khatri, Paul Poomipanit, Farouc A. Jaffer, James W. Choi, Mitul P. Patel, Şevket Görgülü, Michail Koutouzis, Ioannis Tsiafoutis, Abdul M. Sheikh, Ahmed Elguindy, Basem Elbarouni, Taral Patel, Brian Jefferson, Jason R. Wollmuth, Robert W. Yeh, Dimitrios Karmpaliotis, Ajay J. Kirtane, Ziad A. Ali, Margaret McEntegart, Amirali Masoumi, Rhian E. Davies, Spyridon Kostantinis, Bahadir Simsek, Bavana V. Rangan, Olga C. Mastrodemos, Darshan Doshi, Yader B. Sandoval, Mir B. Basir, Michael S. Megaly, Imre Ungi, Nidal Abi Rafeh, Ömer Göktekin, and Emmanouil S. Brilakis

Published
2022

44. LB-4 | Contemporary In-Hospital Outcomes and Temporal Trends of Chronic Total Occlusion Percutaneous Coronary Interventions: Insights from the PROGRESS-CTO International Registry

Author

Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, Khaldoon Alaswad, Oleg Krestyaninov, Dmitrii Khelimskii, Dimitrios Karmpaliotis, Farouc A. Jaffer, Jaikirshan Khatri, Paul Poommipanit, James W. Choi, Wissam A. Jaber, Stéphane Rinfret, William J. Nicholson, Mitul P. Patel, Ehtisham Mahmud, Philip Dattilo, Şevket Görgülü, Michail Koutouzis, Ioannis Tsiafoutis, Basem Elbarouni, Abdul M. Sheikh, Barry F. Uretsky, Ahmed Elguindy, Brian Jefferson, Taral Patel, Jason R. Wollmuth, Robert F. Riley, Stewart M. Benton, Rhian E. Davies, Raj H. Chandwaney, Catalin Toma, Robert W. Yeh, Daniel Schimmel, Nidal Abi Rafeh, Ömer Göktekin, Jimmy Lee Kerrigan, M. Nicholas Burke, Olga C. Mastrodemos, Bavana V. Rangan, and Emmanouil S. Brilakis

Published
2022

45. E-17 | Contemporary In-Hospital Outcomes of Chronic Total Occlusion Interventions: Update from the PROGRESS-CTO (PROspective Global REgiStry for the Study of Chronic Total Occlusion Intervention) International Registry

Author

Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, Khaldoon Alaswad, Mir B. Basir, Michael S. Megaly, Oleg Krestyaninov, Dmitrii Khelimskii, Dimitrios Karmpaliotis, Farouc A. Jaffer, Jaikirshan Khatri, Paul Poommipanit, Mitul P. Patel, Ehtisham Mahmud, Michail Koutouzis, Ioannis Tsiafoutis, James W. Choi, Philip Dattilo, Şevket Görgülü, Basem Elbarouni, William J. Nicholson, Wissam A. Jaber, Stéphane Rinfret, Nidal Abi Rafeh, Ömer Göktekin, Ahmed Elguindy, Olga C. Mastrodemos, Bavana V. Rangan, and Emmanouil S. Brilakis

Published
2022

46. E-11 | Single vs. Multiple Operators for Chronic Total Occlusion Percutaneous Coronary Interventions

Author

Judit Karacsonyi, Khaldoon Alaswad, Oleg Krestyaninov, Dimitrios Karmpaliotis, Ajay J. Kirtane, Ziad A. Ali, Margaret McEntegart, Amirali Masoumi, Paul Poomipanit, Farouc A. Jaffer, Jaikirshan Khatri, James W. Choi, Mitul P. Patel, Michail Koutouzis, Ioannis Tsiafoutis, Şevket Görgülü, Anthony Doing, Abdul M. Sheikh, Basem Elbarouni, Wissam A. Jaber, Ahmed Elguindy, Robert W. Yeh, Spyridon Kostantinis, Bahadir Simsek, Bavana V. Rangan, Olga C. Mastrodemos, Evangelia Vemmou, Ilias Nikolakopoulos, Imre Ungi, Khalid Omar Tammam, Nidal Abi Rafeh, Ömer Göktekin, Emmanouil S. Brilakis, and Yader B. Sandoval

Published
2022

47. Global Chronic Total Occlusion Crossing Algorithm

Author

Kambis Mashayekhi, Ashish Pershad, Alexandre Avran, Nidal Abi Rafeh, Jaikirshan Khatri, R. Leung, Lei Ge, Michael Behnes, Wissam Jaber, William Lombardi, Alexandre Schaan de Quadros, Hung M. Ngo, Göran K. Olivecrona, William J. Nicholson, Colm G. Hanratty, Kevin Croce, José P.S. Henriques, Roberto Garbo, Franklin Hanna Quesada, Anthony Spaedy, Nenad Z. Bozinovic, Gregg W. Stone, Gerald S. Werner, James C. Spratt, Ravinay Bhindi, Angela Hoye, Minh Vo, Tony De Martini, Javier Escaned, Jennifer A. Tremmel, Arun Kalyanasundaram, Khaldoon Alaswad, Jason R Wollmuth, Christopher E. Buller, Anbukarasi Maran, Ji Yan Chen, Avtandil M. Babunashvili, Qi Zhang, Vu Hoang Vu, Raja Hatem, Emmanouil S. Brilakis, Baktash Bayani, Vithala Surya Prakasa Rao, Farouc A. Jaffer, Andrea Gagnor, Achim Buttner, Yu Li, Khalid Tammam, Félix Damas de los Santos, Basem Elbarouni, Aurel Toma, Jie Qian, David Hildick-Smith, Paul Knaapen, Sergey Furkalo, Nicolaus Reifart, Marouane Boukhris, Omer Goktekin, Alexander Bufe, Joseph Dens, Eugene B. Wu, Artis Kalnins, Mohaned Egred, Carlo Di Mario, Margaret McEntegart, Seung-Whan Lee, Risto Jussila, Oleg Krestyaninov, Scott A. Harding, Mauro Carlino, Dimitri Karmpaliotis, Muhammad Munawar, Bo Xu, Alfredo R. Galassi, David E. Kandzari, Jarosław Wójcik, Yue Li, Imre Ungi, M. Nicholas Burke, Yangsoo Jang, Thierry Lefèvre, Luiz F. Ybarra, Robert F. Riley, Julian Strange, Mario Araya, Lucio Padilla, Hsien-Li Kao, Stéphane Rinfret, Craig Thompson, Simon J Walsh, Pravin K. Goel, Sidney Lo, Allison B. Hall, Robert W. Yeh, Andres Navarro, Marin Postu, Gabriele Gasparini, Ran Kornowski, Masahisa Yamane, A. V.Ganesh Kumar, Anja Øksnes, Hussien Heshmat Kassem, Stefan Harb, Soo Teik Lim, Kefei Dou, Nieves Gonzalo, George Sianos, Truls Råmunddal, Lorenzo Azzalini, Pablo Lamelas, Mitul Patel, Nicolas Boudou, Antonio Colombo, Evald Hoej Christiansen, Jeffrey W. Moses, Luca Grancini, Jonathan Hill, Ahmed ElGuindy, Etsuo Tsuchikane, Elliot J. Smith, Ricardo Santiago Trinidad, Leszek Bryniarski, Pedro Cardoso, Meruzhan Saghatelyan, Junbo Ge, and Repositório da Universidade de Lisboa

Subjects
medicine.diagnostic_test, Algoritmos, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Global, State of the art review, Collateral circulation, Total occlusion, Catheter, Chronic total occlusion, Coronary Occlusion, Intravascular ultrasound, Occlusion, Angiography, Treatment algorithm, Medicine, Oclusão Coronária, Cardiology and Cardiovascular Medicine, business, Algorithm, Algorithms
Abstract

© 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC By-NC-ND License (http://creativecommons.org/licenses/by-nc-nd/4), The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.

Published
2021

48. List of contributors

Author

J. Dawn Abbott, Nidal Abi Rafeh, Mazen Abu Fadel, Pierfrancesco Agostoni, Sukru Akyuz, Khaldoon Alaswad, Dimitrios Alexopoulos, Dominick J. Angiolillo, Herbert D. Aronow, Alexandre Avran, Lorenzo Azzalini, Avtandil M. Babunashvili, Jayant Bagai, Subhash Banerjee, Kenneth Baran, Mir Babar Basir, Nicolas Boudou, Konstantinos Dean Boudoulas, Christos V. Bourantas, Nenad Ž. Božinović, Leszek Bryniarski, Alexander Bufe, M. Nicholas Burke, Heinz Joachim Büttner, Pedro Pinto Cardoso, Mauro Carlino, Jeff Chambers, Konstantinos Charitakis, Yiannis S. Chatzizisis, Ivan J. Chavez, James W. Choi, Evald Høj Christiansen, Mauricio G. Cohen, Francesco Costa, Felix Damas de los Santos, Rustem Dautov, Tony De Martini, Ali E. Denktas, Joseph Dens, Zisis Dimitriadis, Anthony Doing, Mohaned Egred, Basem Elbarouni, Ahmed M. El Guindy, Abdallah El Sabbagh, Panayotis Fasseas, Dmitriy N. Feldman, Sergey Furkalo, Andrea Gagnor, Alfredo R. Galassi, Roberto Garbo, Santiago Garcia, Gabriele L. Gasparini, Anthony H. Gershlick, Mario Goessl, Luca Grancini, Abdul Hakeem, Allison B. Hall, Stefan Harb, Raja Hatem, Jose P.S. Henriques, Yangsoo Jang, Risto Jussila, Artis Kalnins, Arun Kalyanasundaram, Paul Hsien-Li Kao, Judit Karacsonyi, Lampros Karagounis, Antonios Karanasos, Dimitri Karmpaliotis, Houman Khalili, Jaikirshan J. Khatri, Dmitrii Khelimskii, Byeong-Keuk Kim, Louis P. Kohl, Daniel M. Kolansky, Michalis Koutouzis, Oleg Krestyaninov, Faisal Latif, Seung-Whan Lee, Thierry Lefevre, Nicholas J. Lembo, Ehtisham Mahmud, Konstantinos Marmagkiolis, Kambis Mashayekhi, Kreton Mavromatis, Michael Megaly, Owen Mogabgab, Michael R. Mooney, Jeffrey W. Moses, Bilal Murad, Alexander Nap, William Nicholson, Dimitrios N. Nikas, Ilias Nikolakopoulos, Goran Olivecrona, Mohamed A. Omer, Jacopo Andrea Oreglia, Lucio Padilla, Ioannis Paizis, Carmelo Panetta, Mitul Patel, Ashish Pershad, Marin Postu, Srini Potluri, Anil Poulose, Stylianos Pyxaras, Sunil V. Rao, Sudhir Rathore, Amir Ravandi, Nicolaus Reifart, Robert F. Riley, Stephane Rinfret, Gurpreet S. Sandhu, Yader Sandoval, Elias Sanidas, Ricardo Santiago Trinidad, Jeffrey M. Schussler, Arnold Seto, Alok Sharma, Arslan Shaukat, Mehdi H. Shishehbor, Evan Shlofmitz, Richard Shlofmitz, Paul Sorajja, Anthony Spaedy, Peter Tajti, Jacqueline E. Tamis-Holland, Aurel Toma, Konstantinos Toutouzas, Jay H. Traverse, Huu Tam Truong, Sotiris Tsalamandris, Ioannis Tsiafoutis, Imre Ungi, Emmanouil Vavouranakis, Evangelia Vemmou, Minh N. Vo, Vassilis Voudris, Yale Wang, Jarosław Wójcik, Jason Wollmuth, Eugene B. Wu, Iosif Xenogiannis, Masahisa Yamane, and Luiz Fernando Ybarra

Published
2021

49. Abstract 16435: Contemporary In-Hospital Outcomes of Chronic Total Occlusion Interventions: Update From the PROGRESS-CTO (prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Multicenter International Registry

Author

Dimitrios Karmpaliotis, Robert W. Yeh, Ehtisham Mahmud, Hector Tamez, Jaikirshan Khatri, Manish Parikh, Abdul Sheikh, Catalin Toma, Barry F. Uretsky, Subhash Banerjee, Evangelia Vemmou, Basem Elbarouni, Ziad A. Ali, Bilal Malik, Philip Dattilo, Khaldoon Alaswad, James W. Choi, Alpesh Shah, Farouc A. Jaffer, Michalis Koutouzis, Brian K. Jefferson, Anthony Doing, Wissam Jaber, Nicholas Lembo, Srinivasa Potluri, Michael P Love, Emmanouil S. Brilakis, Ajay J. Kirtane, Iosif Xenogiannis, Habib Samady, David E. Kandzari, Bavana V. Rangan, Oleg Krestyaninov, Imre Ungi, R. Michael Wyman, Jeffrey W. Moses, Ilias Nikolakopoulos, Mitul P Patel, Santiago Garcia, Ioannis Tsiafoutis, Judit Karacsonyi, and Taral Patel

Subjects
medicine.medical_specialty, Interventional cardiology, business.industry, medicine.medical_treatment, Psychological intervention, Percutaneous coronary intervention, medicine.disease, Total occlusion, Coronary artery disease, Physiology (medical), Intervention (counseling), Occlusion, Emergency medicine, Conventional PCI, Medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Introduction: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been advancing due to improvement of equipment, operator experience, and techniques. Methods: We examined contemporary outcomes of CTO PCI by analyzing the clinical, angiographic, and procedural characteristics of 7,031 CTO interventions performed in 6,984 patients at 35 participating centers between 2012 and 2020. Results: Mean age was 64.5 ± 10 years and 82% of the patients were men. The patients had high prevalence of comorbidities, such as diabetes (42%), prior coronary artery bypass graft surgery (29%), prior myocardial infarction (45%), and prior heart failure (29%). The most common CTO target vessel was the right coronary artery (53%), followed by the left anterior descending artery (26%), and left circumflex artery (20%). The mean J-CTO and PROGRESS scores were 2.41 ± 1.28 and 1.09 ± 1.01, respectively. The overall technical and procedural success rates were 85.9% and 83.8% and the rate of in-hospital major cardiac adverse events (MACE) was 2.06%. Technical success and procedural success rates were lower for higher values of J-CTO and PROGRESS scores, and MACE rate was higher ( Figure 1 ). The final successful crossing strategy was antegrade wire escalation in 53.7%, retrograde in 19.9%, and antegrade dissection reentry in 14.6%. The overall median air kerma radiation dose, contrast volume, procedure and fluoroscopy time were 2.30 (1.30, 3.90) Gray, 225 (160, 305) ml, 115 (75, 170) and 43 (26, 70) minutes, respectively. Conclusions: Using a combination of crossing strategies, high success and acceptable complication rates can be achieved in CTO PCI among various centers and patient populations.

Published
2020

50. Differences in coronary artery disease complexity and associations with mortality and hospital admissions among First Nations and non-First Nations patients undergoing angiography: a comparative retrospective matched cohort study

Author

Karen Throndson, Basem Elbarouni, Elizabeth McGibbon, Moneca Sinclaire, Randy Fransoo, Jo-Ann V. Sawatzky, Catherine Cook, Heather J. Prior, Lindsey Dahl, Jarvis Brownlie, Thang Nguyen, Alan Katz, and Annette S.H. Schultz

Subjects
Adult, Male, medicine.medical_specialty, Population, Myocardial Infarction, Coronary Artery Disease, Coronary Angiography, Coronary artery disease, Risk Factors, Internal medicine, Cause of Death, medicine, Humans, Myocardial infarction, Healthcare Disparities, Mortality, education, Indigenous Peoples, Aged, Proportional Hazards Models, Retrospective Studies, Heart Failure, education.field_of_study, medicine.diagnostic_test, business.industry, Research, Hazard ratio, Manitoba, General Medicine, Middle Aged, medicine.disease, Health equity, Confidence interval, Hospitalization, Angiography, Cohort, Female, business
Abstract

Background First Nations people are more likely than the general population to experience long-term adverse health outcomes after coronary angiography. Our aim was to quantify the extent of coronary artery disease among First Nations and non-First Nations patients undergoing angiography to investigate differences in coronary artery disease and related health disparities. Methods We conducted a retrospective matched cohort study to compare health outcomes of First Nations and non-First Nations adult patients (> 18 yr) who underwent index angiography between Apr. 1, 2008, and Mar. 31, 2012, in Manitoba, Canada. The SYNTAX Score was used to measure and compare severity of coronary artery disease between groups. Primary outcomes of all-cause and cardiovascular mortality were compared between groups using Cox proportional hazard models adjusted by SYNTAX Score results and weighted by the inverse probability of being First Nations. Secondary outcomes included all-cause and cardiovascular-related hospital admissions. Results The cohort consisted of 277 matched pairs of First Nations and non-First Nations patients undergoing angiography; the average age of patients was 56.0 (standard deviation 11.7) years. The median SYNTAX Score results and patient distributions across categories in the matched paired cohort groups were not significantly different. Although proportionally First Nations patients showed worse health outcomes, mortality risks were similar in the weighted sample, even after controlling for revascularization and SYNTAX Score results. Secondary outcomes showed that adjusted risks for hospital admission for acute myocardial infarction (adjusted hazard ratio [HR] 3.03, 95% confidence interval [CI] 1.40-6.55) and for congestive heart failure (adjusted HR 3.84, 95% CI 1.37-10.78) were significantly higher among First Nations patients in the weighted sample. Interpretation The extent of coronary artery disease among matched cohort groups of First Nations and non-First Nations patients appears similar, and controlling for baseline sociodemographic characteristics, coronary artery disease risk factors and SYNTAX Score results explained higher mortality risk and most hospital admissions among First Nations patients. Although there is a need to decrease risk factors for coronary artery disease among First Nations populations, addressing individuals' behaviour without considering root causes underlying risk factors for coronary artery disease will fail to decrease health outcome disparities among First Nations patients undergoing angiography.

Published
2020

Catalog

Books, media, physical & digital resources
See catalog results