1) Over 100,000 CABG operations are performed annually in the US, with 10,000 re-do CABG procedures each year. Hundreds of thousands of post-CABG patients have occluded/degenerated grafts causing symptoms that are often under-treated.
2) CTO PCI in post-CABG patients is more technically challenging due to diffuse disease, calcified vessels, distortion of anatomy from vessel tenting, and progression of native vessel disease.
3) Technical success rates for CTO PCI in post-CABG patients have improved in recent years to over 80% due to improved techniques like retrograde recanalization, but it remains a difficult subset of patients with
Safety and efficacy of using a single transradial MAC guiding catheter for coronary angiography and intervention in patients with ST-elevation myocardial infarction (RAPID)
Factors Predicting Neurological Complications Following Percutaneous Coronary Angiography and Interventions in a Large Series of Transfemoral and Transradial Approach.
Safety and efficacy of using a single transradial MAC guiding catheter for coronary angiography and intervention in patients with ST-elevation myocardial infarction (RAPID)
Factors Predicting Neurological Complications Following Percutaneous Coronary Angiography and Interventions in a Large Series of Transfemoral and Transradial Approach.
Debate: Is there a difference between RDR and reverse CART? – NoEuro CTO Club
Debate: Is there a difference between RDR and reverse CART? – No
Dimitri Karmpaliotis, New York, USA
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Which CTO should be treated by PCI or CABG & The specific problems of PCI for...Euro CTO Club
Which CTO should be treated by PCI or CABG & The specific problems of PCI for post CABG patients
Gerald S. Werner, Darmstadt, Germany
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Kambis Masheyekhi: Optimal planning of CTO-PCIEuro CTO Club
14th Experts Live CTO
September 2nd - 3rd, 2022 - Mainz, Germany
AGIK Parallel Session - Session 1:
The 101 of the global consensus approaches
Optimal planning of CTO-PCI
Kambis Masheyekhi, Lahr, Germany
Room:
West Foyer - Friday 10:10
Chairmen:
Thomas Schmitz, Essen, Germany;
Heinz Joachim Büttner, Bad Krozingen, Germany
15th Experts Live CTO - Carlo Di Mario: ConclusionsEuro CTO Club
PLENARY SESSION
Wrap up of live cases, awards to the winners of the best abstracts and case competitions and take home messages
Auditorium Zubin Mehta - Saturday 16:00 - 17:00
Speakers:
Daniela Benedetto (Rome),
Francesco Burzotta (Rome),
Carlo Di Mario (Florence),
Roberto Garbo (Turin),
Rocco Stio (Rome)
Challengers:
Stelios Pyxaras (Furth - D),
Sudhir Rathore (London - UK)
Discussants:
Shunsuke Matsuno (Tokyo - J),
Alexander Nap (Amsterdam - NL),
Masahisa Yamane (Tokyo - J)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Francesco Burzotta: Wrap up Gemelli CasesEuro CTO Club
PLENARY SESSION
Wrap up of live cases, awards to the winners of the best abstracts and case competitions and take home messages
Auditorium Zubin Mehta - Saturday 16:00 - 17:00
Speakers:
Daniela Benedetto (Rome),
Francesco Burzotta (Rome),
Carlo Di Mario (Florence),
Roberto Garbo (Turin),
Rocco Stio (Rome)
Challengers:
Stelios Pyxaras (Furth - D),
Sudhir Rathore (London - UK)
Discussants:
Shunsuke Matsuno (Tokyo - J),
Alexander Nap (Amsterdam - NL),
Masahisa Yamane (Tokyo - J)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Jonathan Hill: Role of mechanica support in CTO recanalizationEuro CTO Club
10:42
Role of mechanica support in CTO recanalization
Jonathan Hill (London - UK)
___________________________________________
PARALLEL SESSION
Challenges And Opportunities In Cto Recanalization
Auditorium Zubin Mehta - Saturday 10:00 - 11:10
Chairperson:
Jonathan Hill (London - UK)
Discussants:
Lesnek Bryniarski (Krakow - PL),
Ugo Fabrizio (Vercelli),
Paul Knaapen (Amsterdam - NL),
Eugenio La Scala (Ollioiouls - F)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Gregor Leibundgut: Role of DEB in CTO-PCIEuro CTO Club
10:35 Role of DEB in CTO-PCI
Gregor Leibundgut (Basel - CH)
___________________________________________
PARALLEL SESSION
Challenges And Opportunities In Cto Recanalization
Auditorium Zubin Mehta - Saturday 10:00 - 11:10
Chairperson:
Jonathan Hill (London - UK)
Discussants:
Lesnek Bryniarski (Krakow - PL),
Ugo Fabrizio (Vercelli),
Paul Knaapen (Amsterdam - NL),
Eugenio La Scala (Ollioiouls - F)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...Euro CTO Club
AUDITORIUM ZUBIN MEHTA
08/09/2023 04:30 - 05:20
PLENARY SESSION - INTERVENTIONAL CTO & CHIP RESEARCH Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...Euro CTO Club
16:53
CTO PCI Outcome associated with poor quality of the distal target vessel
Emmanouil Brilakis (Minneapolis - USA)
_____________________________________________
PARALLEL SESSION
Interventional CTO & Chip Research
Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Auditorium Zubin Mehta - Friday 16:30 - 17:16
Chairpersons:
Davide Capodanno (Catania),
Carlo Di Mario (Florence),
Giuseppe Tarantini (Padua)
Panelist:
Roberto Diletti (Rotterdam - NL),
Giovanni Esposito (Naples),
Paul Knaapen (Amsterdam - NL),
Maksymilian Opolski (Warsaw - PL)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...Euro CTO Club
16:33
EuroCTO Consensus on Guide Catheter Extensions JACC Cardiovasc Interventions
Mario Iannaccone (Turin)
_____________________________________________
PARALLEL SESSION
Interventional CTO & Chip Research
Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Auditorium Zubin Mehta - Friday 16:30 - 17:16
Chairpersons:
Davide Capodanno (Catania),
Carlo Di Mario (Florence),
Giuseppe Tarantini (Padua)
Panelist:
Roberto Diletti (Rotterdam - NL),
Giovanni Esposito (Naples),
Paul Knaapen (Amsterdam - NL),
Maksymilian Opolski (Warsaw - PL)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Dimitri Karmpaliotis - CTO PCI in Post-CABG Patients
1. CTO PCI in Post-CABG Patients
Dimitri Karmpaliotis, MD, PhD, FACC
Assistant Professor of Medicine
Columbia University Medical Center
Director of CTO, Complex and High Risk Angioplasty
CIVT/NYPH
Email: dk2787@columbia.edu
EURO CTO
Krakow, Poland, September 30-Oct 1, 2016
2. Disclosures
• As a faculty member for this program,
I disclose the following relationships
with industry:
• Speakers Bureau for Abbott Vascular,
MDT vascular, ASAHI Intel and Boston
Scientific
3. CTO PCI in post CABG Patients
• Despite declining rates of overall re-vascularization in
the U.S, more than 100,00 CABG operations are
performed every year
• 10,000 re-do CABG/year
• Hundreds of thousands of patients with
occluded/degenerated grafts and symptoms/ischemia
are under-treated
• CTO PCI is more technically challenging in post-
CABG patients
• Diffuse disease/Calcified vessels
• Progression of native vessel disease
• Distortion of anatomy due to vessel “tenting”
4. CABG
n=266
Not Bypassed
n=81
ITT, Per Lesion
Bypassed
n=173
CABG
n=254
12 were not treated with CABG
Overall 68.1 % of TO were
successfully bypassed
49.6% overall complete
revascularization in CTO subset
SYNTAX CTO Subset Procedural
Characteristics: Per Lesion Analysis
Serruys P, CRT 2009 [modified]; courtesy Prof Serruys and the SYNTAX investigators
• 26.2% patients with CTO
• CTO accounted for 266
lesions (7.4%)
Reason not bypassed:
Not intended to treat (n=12)
Diseased (n=11)
Inadequate conduit (n=2)
Too small (n=19)
Unable to find (n=1)
Other (n=36)
5. New CTOs After CABG Surgery
338 patients with 1 yr angio in Radial Artery Patency Study (RAPS)
Pereg et al, JACC CV Intv 2014
169 pts (43.6%)
had at least 1 new
native CTO
CTOs were almost
5X more likely to
occur in vessel with
pre CABG visual
stenosis >90% and
bypassed by SVG
or radial graft
6. Drug-Eluting vs. Bare-Metal Stents in
Saphenous Vein Graft (SVG) Lesions
Conclusion: In high-risk SVG lesions, DES cut TLR rates almost in half,
leading to an overall decrease in late outcomes.
ISAR-CABG: Randomized, superiority trial in 610 pts.
Mehilli J, et al. Lancet.
2011. Epub ahead of print.
DES reduced angiographic restenosis at 7 months (15% vs. 29%; P < 0.0001).
7. Author Year
N (CTO
lesions)
Prior
CABG Diabetes Retrograde
Technical
Success
Major
complicati
ons Death
Tampon
ade
Fluoroscopy
time
(minutes)
Contrast use,
(ml)
Rathore 2009 904 12.6 40.0 17 87.5 1.9 0.6 0.6 NR NR
Morino 2010 528 9.6 43.3 26 86.6 NR 0.4 0.4 45
(1-301)*
293
(53-1,097)*
Galassi 2011 1983 14.6 28.8 14 82.9 1.8 0.3 0.5 42.3±47.4 313 ±184
U.S
Registry*
2013 1361 37.0 40.0 34
85.5
1.8
0.22 0.6 42±29 294 ±158
* Median (range)
Summary of Large Contemporary Registry Publications of
Percutaneous Coronary Interventions of Chronic Total Occlusions
* Tesfaldet, Karmpaliotis, Brilakis, Lembo,
Lombardi, Kandzari. Am J Cardiol 2013
8. Author Year n
Prior
CABG
(%)
Septal
collaterals
used (%)
Reverse
CART
(%)
Technical
Success
(%)
Major
complications
(%)
Fluoroscopy
time, min
Contrast
use, mL
Sianos 2008 175 10.9 79.4 NR 83.4 4.6 59 ± 29 421 ± 167
Rathore 2009 157 17.8 67.5 NR 84.7 4.5 NR NR
Kimura 2009 224 17.6 79 14 92.4 1.8 73 ± 42 457 ± 199
Tsuchikane 2010 93 10.8 82.8 60.9 98.9 0 60 ± 26 256 ± 169
Morino 2010 136 9.6 63.9 NR 79.2 NR* NR* NR*
Karmpaliotis* 2012 462 50.0 71 41 81.4 2.6
61 ± 40 345 ± 177
Karmpaliotis, Tesfaldet, Brilakkis, Lembo, Lombardi, Kandzari:
JACC Cardiovasc Interv. 2012 Dec;5(12):1273-9.
Retrograde Coronary Chronic Total Occlusion Revascularization:
Procedural and In-Hospital Procedural Outcomes from a Multicenter
Registry in the United States
9. Study
Retrograde PCI,
n (%)
Primary
Retrograde, %*
Previous Failed
CTO PCI in
Retrograde
Group, %
Overall
Technical
Success in
Retrograde
Group, %†
MACE in
Retrograde
Group, %†
Kimura et al22 224 100 65 92 1.8
Galassi et al23 234 (12) 76 U 65 3.0
Karmpaliotis et
al12
462 (34) 46 18 81 2.6
Yamane et al24 378 (25) 75 32 84 0.5
Tsuchikane et
al25
801 (27) 67 29 85 1.6
Galassi et al7 1582 (16) 76 43 75 0.8
Karmpaliotis, et
al
539 (41) 46 21 85 4.3
Circ Cardiovasc Interv. 2016;9:
10. Author Year
N
(CTO
lesions)
Prior
CABG,
(%)
Prior
CABG in
successful
PCI group
(%)
Prior
CABG in
unsuccessf
ul PCI
group (%)
Overall,
retrograde
(%)
Overall,
technical
Success
(%)
Overall,
major
comp-
lications
(%)
Overall,
fluoroscopy
time, min
Overall, contrast
use,
ml
Olivari 2003 376 5.0 4.5 6.9 NR 77.2 5.1 NR NR
Rathore 2009 904 12.6 11.9 17.7 17 87.5 1.9 NR NR
Morino 2010 528 9.6 NR NR 26 86.6 NR 45 (1-301)* 293 (53-1,097)‡
Mehran 2011 1791 15.9 13.6 20.9 NR 68.0 NR NR 448±229
Galassi 2011 1983 14.6 NR NR 14 82.9 1.8 42.3±47.4 313 ±184
Jones 2012 836 10.2 16.5 7.4 NR 69.6 2.3 NR NR
U.S
Registry*
2012 1363 37.0 35.0 50.8 34
85.5
1.8
42±29 294 ±158
Summary of Large Contemporary CTO PCI Registry Publications that
Reported Outcomes for the Subgroup of Patients with Prior CABG
* Tesfaldet, Karmpaliotis, Brilakis, Lembo,
Lombardi, Kandzari. Am J Cardiol 2013
11. 87.2
93.7
78.1
90.0
70
80
90
100
2006-2011 2012-2013
%
No prior CABG
Prior CABG
Pre “Hybrid” era
Michael, Karmpaliotis, Brilakis, Lombardi,
Kandzari et al. Heart 2013;99:1515-8
Δ=9.1%
P<0.001
Christopoulos, Menon, Karmpaliotis, Alaswad, Lombardi,
Grantham, Brilakis et al, AJC 2014;113-1990-4
CTO PCI: success and prior CABG
N= 1,363
3 US sites
Prior CABG: 37%
Complications: 1.5% vs. 2.1%
Retrograde: 27.1% vs. 46.7%
Δ=3.7%
P=0.092
“Hybrid” era
N= 630
6 US sites
Prior CABG: 37%
Complications: 2.5% vs. 0.8%
Retrograde: 34% vs. 39%
12. N= 21 - 4 US centers/14% OF RETROGRADE CASES)
The most common re-entry technique was rCART.
Technical success: 86%
Procedural success: 81%
Retrograde failure due to inability to wire the SVG or collaterals
Major complications: 2 patients (periprocedural MI, tamponade resulting in death)
Nguyen-Trong PKJ, Alaswad K, Karmpaliotis D, Lombardi W, Grantham J, Lembo N, Kandzari D, Karatasakis
A, Rangan B, Ayers CR, Thompson C, Banerjee S, Brilakis ES. J Invasive Cardiol. 2016 Jun;28:218-24
Native CTO PCI through retrograde SVG
PROspective Global REgiStry for the Study of CTO interventions
44. CTO PCI in post CABG Patients:
Conclusions
• Despite declining rates of overall re-vascularization in
the U.S, more than 100,00 CABG operations are
performed every year
• 10,000 re-do CABG/year
• Hundreds of thousands of patients with
occluded/degenerated grafts and symptoms/ischemia
are under-treated
• Re-Do CABG especially with patent LIMA is ill advised
• Great opportunity exists to benefit public health by
expanding CTO revascularization