Published data on CTO complications
Nikolaos Konstantinidis, Thessaloniki, Greece
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
This document discusses tips and tricks for successful transradial primary PCI. It begins with an introduction and disclosure from the author. It then reviews several studies that found high rates of success (90-100%) and normalization of coronary blood flow with transradial PCI for AMI. No major vascular complications occurred in these studies. Additional studies showed similar success rates and procedural times for transradial PCI compared to transfemoral, with lower rates of major vascular complications. Bleeding complications were associated with increased mortality. The experience of over 880 AMIs at one center using a transradial approach found no major vascular complications. While transradial PCI can present challenges in complex cases, it allows intervention even if thrombolysis was used
The document discusses several studies on vascular complications in overweight patients undergoing percutaneous coronary interventions (PCI) and coronary angiography. The TROP study analyzed outcomes in 346 overweight patients undergoing PCI or angiography. It found the radial approach reduced complications compared to femoral. Other studies also found lower risks with radial access, especially in obese patients. Overall, obesity is a risk factor for cardiovascular disease and complications, and the radial approach may help reduce risks in overweight and obese patients undergoing coronary procedures.
Rotational atherectomy can be performed via the radial or femoral artery approaches with similar success rates. A study compared outcomes of 67 patients who underwent rotational atherectomy via the femoral approach to 52 patients who underwent it via the radial approach and found no significant differences in procedural characteristics, success rates, or in-hospital complications between the two groups except that pacing wires were inserted less often in the radial group. Overall, rotational atherectomy performed via the radial approach was found to be a feasible alternative to the femoral approach.
This document discusses anticoagulation options for percutaneous coronary intervention (PCI). It summarizes trials comparing unfractionated heparin (UFH) to bivalirudin. The HEAT-PPCI trial found UFH was better than bivalirudin for reducing major adverse cardiac events, with equivalent rates of major bleeding. A meta-analysis of 16 trials found UFH reduced MACE compared to bivalirudin, with equivalent major bleeding when provisional glycoprotein IIb/IIIa inhibitors were used symmetrically. The document concludes that UFH at doses of 50-70 units/kg is the preferred anticoagulant for PCI based on superior efficacy and equivalent safety compared to b
Carlo Di Mario - Recent Publications & Research in CTO: 2015-16Euro CTO Club
This document summarizes recent publications and research on chronic total occlusions (CTOs) from 2015-2016. It finds that the number of published manuscripts on CTOs has significantly increased in recent years. Several studies examined outcomes of patients undergoing percutaneous coronary intervention (PCI) on CTOs versus medical therapy or bypass surgery, finding lower mortality and adverse event rates with PCI. Other publications identified predictors of successful CTO recanalization and evaluated new techniques and scoring systems. Additional research investigated the physiological and anatomical changes in CTO arteries pre- and post-PCI using imaging modalities like intravascular ultrasound (IVUS) and computed tomography angiography (CTA).
What is the place of CT coronary angiography in ED chest pain?kellyam18
CT coronary angiography is a relatively new modality for identifying coronary artery disease. What is its place in ED chest pain assessment. See the evidence -and the evidence gaps- and judge for yourself where it might fit!
This document discusses tips and tricks for successful transradial primary PCI. It begins with an introduction and disclosure from the author. It then reviews several studies that found high rates of success (90-100%) and normalization of coronary blood flow with transradial PCI for AMI. No major vascular complications occurred in these studies. Additional studies showed similar success rates and procedural times for transradial PCI compared to transfemoral, with lower rates of major vascular complications. Bleeding complications were associated with increased mortality. The experience of over 880 AMIs at one center using a transradial approach found no major vascular complications. While transradial PCI can present challenges in complex cases, it allows intervention even if thrombolysis was used
The document discusses several studies on vascular complications in overweight patients undergoing percutaneous coronary interventions (PCI) and coronary angiography. The TROP study analyzed outcomes in 346 overweight patients undergoing PCI or angiography. It found the radial approach reduced complications compared to femoral. Other studies also found lower risks with radial access, especially in obese patients. Overall, obesity is a risk factor for cardiovascular disease and complications, and the radial approach may help reduce risks in overweight and obese patients undergoing coronary procedures.
Rotational atherectomy can be performed via the radial or femoral artery approaches with similar success rates. A study compared outcomes of 67 patients who underwent rotational atherectomy via the femoral approach to 52 patients who underwent it via the radial approach and found no significant differences in procedural characteristics, success rates, or in-hospital complications between the two groups except that pacing wires were inserted less often in the radial group. Overall, rotational atherectomy performed via the radial approach was found to be a feasible alternative to the femoral approach.
This document discusses anticoagulation options for percutaneous coronary intervention (PCI). It summarizes trials comparing unfractionated heparin (UFH) to bivalirudin. The HEAT-PPCI trial found UFH was better than bivalirudin for reducing major adverse cardiac events, with equivalent rates of major bleeding. A meta-analysis of 16 trials found UFH reduced MACE compared to bivalirudin, with equivalent major bleeding when provisional glycoprotein IIb/IIIa inhibitors were used symmetrically. The document concludes that UFH at doses of 50-70 units/kg is the preferred anticoagulant for PCI based on superior efficacy and equivalent safety compared to b
Carlo Di Mario - Recent Publications & Research in CTO: 2015-16Euro CTO Club
This document summarizes recent publications and research on chronic total occlusions (CTOs) from 2015-2016. It finds that the number of published manuscripts on CTOs has significantly increased in recent years. Several studies examined outcomes of patients undergoing percutaneous coronary intervention (PCI) on CTOs versus medical therapy or bypass surgery, finding lower mortality and adverse event rates with PCI. Other publications identified predictors of successful CTO recanalization and evaluated new techniques and scoring systems. Additional research investigated the physiological and anatomical changes in CTO arteries pre- and post-PCI using imaging modalities like intravascular ultrasound (IVUS) and computed tomography angiography (CTA).
What is the place of CT coronary angiography in ED chest pain?kellyam18
CT coronary angiography is a relatively new modality for identifying coronary artery disease. What is its place in ED chest pain assessment. See the evidence -and the evidence gaps- and judge for yourself where it might fit!
Cardiogenic shock is a leading cause of death in AMI patients, with mortality rates between 30-60%. While radial access has been shown to reduce bleeding complications, patients presenting with cardiogenic shock are often treated via transfemoral access. Recent studies have demonstrated that radial access PCI is feasible in cardiogenic shock patients, with one study showing a reduction in in-hospital mortality for radial versus transfemoral access. However, experienced radial centers only use the radial approach in around 50% of cardiogenic shock cases, indicating radial access is still underutilized despite potential benefits in this high-risk group.
This document summarizes the results of the SAFE-PCI for Women Trial, which compared radial versus femoral approaches for percutaneous coronary intervention (PCI) in women. The trial was terminated early due to lower than expected rates of bleeding and vascular complications. In both the total randomized cohort and PCI cohort, radial access was associated with significantly lower rates of bleeding/vascular complications and procedural failure compared to femoral access. Secondary endpoints showed no significant differences in outcomes between approaches. The results suggest an initial strategy of radial access is reasonable for PCI in women.
Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
This document summarizes the results of several clinical trials evaluating renal denervation for the treatment of hypertension. The SYMPLICITY HTN-3 trial, the largest study to date, found no significant difference in blood pressure reduction between the renal denervation and sham procedure groups. Subgroup analyses found some predictors of greater blood pressure response, such as use of alpha-1 blockers or baseline blood pressure over 180 mmHg. Overall, the data from clinical trials on renal denervation is mixed, with early studies showing promising results but larger trials like SYMPLICITY HTN-3 finding no clear benefit over sham procedures.
This document summarizes several studies on the risk of acute kidney injury following percutaneous coronary intervention (PCI) via the radial versus femoral artery access site. Registry data from British Columbia and a large US study found that femoral access was associated with significantly higher odds of adverse kidney outcomes after adjusting for risk factors. A single-center study also found higher rates of post-PCI acute kidney injury with femoral compared to radial access after propensity matching. While patient characteristics and contrast load are major risk factors for procedure-associated acute kidney injury, available data suggests radial access may have renoprotective effects compared to the femoral approach.
This document discusses the use of transradial access for primary PCI and in patients with cardiogenic shock. It summarizes data showing that transradial access is associated with lower mortality, MACCE, and bleeding rates compared to transfemoral access in these high-risk settings. However, transradial primary PCI requires an experienced team. The document provides tips for a successful transradial program and overcoming challenges in shock patients, such as using left radial access, ultrasound guidance, and single catheter techniques.
Ultrasound can help with planning and obtaining radial artery access for cardiovascular procedures. Planning ultrasound examines artery size and anatomy to select the optimal access site and sheath size, reducing fluoroscopy time. Ultrasound guided access improves first stick success rates and reduces average access time compared to palpation or blind access techniques. Meta-analyses show ultrasound guidance significantly increases the chance of successful first attempt radial artery access. While radial angiography provides information if access fails, ultrasound is preferable for access planning and guidance due to reduced pain, contrast, and radiation compared to angiography.
This document discusses the use of a slender 6Fr intra-aortic balloon pump (IABP) system compared to the standard 8Fr system. A study of 42 patients undergoing elective percutaneous coronary intervention with prophylactic IABP support found no complications with the 6Fr system, while the 8Fr system had re-bleeding and hematoma in some patients. The 6Fr system also allowed for shorter bed rest time. Trans-brachial insertion of the 6Fr IABP had even shorter bed rest and hospital stay times than transfemoral insertion. However, the 6Fr system has limitations such as a small balloon volume and inability to monitor pressure or use radial approaches.
This document discusses the learning curve for radial angiography and coronary interventions. It summarizes a study that found procedural success rates increase as operators gain more experience, with odds of failure decreasing by 8% for every 10 additional cases and 32% for 50 cases. The document recommends novice operators complete a minimum of 50 radial cases to achieve success rates similar to experienced operators. It also provides tips for the learning phase, such as using technology like hydrophilic sheaths, selecting less complex patients, and performing radial angiography before radial PCI.
This document discusses the use of bivalirudin as an anticoagulant for PCI procedures. It summarizes data from several clinical trials showing that bivalirudin reduces bleeding risks compared to unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor, without increasing ischemic risks. The presentation argues that since bleeding is a common complication of PCI and is associated with worse outcomes, and bivalirudin reduces bleeding while maintaining efficacy, it should be the preferred anticoagulant for PCI procedures for all patients. It acknowledges that while risk models can identify patients at higher risk of bleeding, it is difficult to separate bleeding risk from ischemic risk.
1. Successful PCI of chronic total occlusions (CTO) is associated with improved symptoms, increased exercise capacity, reduced need for CABG, and survival benefit compared to failed CTO PCI based on observational studies.
2. Randomized trials are still needed to provide high-level evidence on the benefits of CTO PCI given limitations of observational data though several large randomized trials are underway.
3. Expert operators can now achieve high success rates of over 90% for CTO PCI with low complication rates even for complex CTOs, using bilateral injections, IVUS, retrograde approaches and specialized guidewires and catheters.
08:25 Di Mario - Recent Pubblications and ResearchEuro CTO Club
- Recent publications on CTOs from 2013-2014 focused on pathology, physiology, epidemiology, outcomes, imaging, technical approaches, and stents.
- Studies showed differences in plaque characteristics between long and short duration CTOs and impact of revascularizing CTOs on donor arteries.
- Registry data from Sweden found a 10.6% prevalence of CTOs and decreasing rates over time.
- Successful CTO PCI was associated with improved survival, less cardiac death, and reduced need for CABG compared to failed procedures.
- Imaging like IVUS and CT angiography improved technical success rates for CTO PCI.
Cardiogenic shock is a leading cause of death in AMI patients, with mortality rates between 30-60%. While radial access has been shown to reduce bleeding complications, patients presenting with cardiogenic shock are often treated via transfemoral access. Recent studies have demonstrated that radial access PCI is feasible in cardiogenic shock patients, with one study showing a reduction in in-hospital mortality for radial versus transfemoral access. However, experienced radial centers only use the radial approach in around 50% of cardiogenic shock cases, indicating radial access is still underutilized despite potential benefits in this high-risk group.
This document summarizes the results of the SAFE-PCI for Women Trial, which compared radial versus femoral approaches for percutaneous coronary intervention (PCI) in women. The trial was terminated early due to lower than expected rates of bleeding and vascular complications. In both the total randomized cohort and PCI cohort, radial access was associated with significantly lower rates of bleeding/vascular complications and procedural failure compared to femoral access. Secondary endpoints showed no significant differences in outcomes between approaches. The results suggest an initial strategy of radial access is reasonable for PCI in women.
Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
This document summarizes the results of several clinical trials evaluating renal denervation for the treatment of hypertension. The SYMPLICITY HTN-3 trial, the largest study to date, found no significant difference in blood pressure reduction between the renal denervation and sham procedure groups. Subgroup analyses found some predictors of greater blood pressure response, such as use of alpha-1 blockers or baseline blood pressure over 180 mmHg. Overall, the data from clinical trials on renal denervation is mixed, with early studies showing promising results but larger trials like SYMPLICITY HTN-3 finding no clear benefit over sham procedures.
This document summarizes several studies on the risk of acute kidney injury following percutaneous coronary intervention (PCI) via the radial versus femoral artery access site. Registry data from British Columbia and a large US study found that femoral access was associated with significantly higher odds of adverse kidney outcomes after adjusting for risk factors. A single-center study also found higher rates of post-PCI acute kidney injury with femoral compared to radial access after propensity matching. While patient characteristics and contrast load are major risk factors for procedure-associated acute kidney injury, available data suggests radial access may have renoprotective effects compared to the femoral approach.
This document discusses the use of transradial access for primary PCI and in patients with cardiogenic shock. It summarizes data showing that transradial access is associated with lower mortality, MACCE, and bleeding rates compared to transfemoral access in these high-risk settings. However, transradial primary PCI requires an experienced team. The document provides tips for a successful transradial program and overcoming challenges in shock patients, such as using left radial access, ultrasound guidance, and single catheter techniques.
Ultrasound can help with planning and obtaining radial artery access for cardiovascular procedures. Planning ultrasound examines artery size and anatomy to select the optimal access site and sheath size, reducing fluoroscopy time. Ultrasound guided access improves first stick success rates and reduces average access time compared to palpation or blind access techniques. Meta-analyses show ultrasound guidance significantly increases the chance of successful first attempt radial artery access. While radial angiography provides information if access fails, ultrasound is preferable for access planning and guidance due to reduced pain, contrast, and radiation compared to angiography.
This document discusses the use of a slender 6Fr intra-aortic balloon pump (IABP) system compared to the standard 8Fr system. A study of 42 patients undergoing elective percutaneous coronary intervention with prophylactic IABP support found no complications with the 6Fr system, while the 8Fr system had re-bleeding and hematoma in some patients. The 6Fr system also allowed for shorter bed rest time. Trans-brachial insertion of the 6Fr IABP had even shorter bed rest and hospital stay times than transfemoral insertion. However, the 6Fr system has limitations such as a small balloon volume and inability to monitor pressure or use radial approaches.
This document discusses the learning curve for radial angiography and coronary interventions. It summarizes a study that found procedural success rates increase as operators gain more experience, with odds of failure decreasing by 8% for every 10 additional cases and 32% for 50 cases. The document recommends novice operators complete a minimum of 50 radial cases to achieve success rates similar to experienced operators. It also provides tips for the learning phase, such as using technology like hydrophilic sheaths, selecting less complex patients, and performing radial angiography before radial PCI.
This document discusses the use of bivalirudin as an anticoagulant for PCI procedures. It summarizes data from several clinical trials showing that bivalirudin reduces bleeding risks compared to unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor, without increasing ischemic risks. The presentation argues that since bleeding is a common complication of PCI and is associated with worse outcomes, and bivalirudin reduces bleeding while maintaining efficacy, it should be the preferred anticoagulant for PCI procedures for all patients. It acknowledges that while risk models can identify patients at higher risk of bleeding, it is difficult to separate bleeding risk from ischemic risk.
1. Successful PCI of chronic total occlusions (CTO) is associated with improved symptoms, increased exercise capacity, reduced need for CABG, and survival benefit compared to failed CTO PCI based on observational studies.
2. Randomized trials are still needed to provide high-level evidence on the benefits of CTO PCI given limitations of observational data though several large randomized trials are underway.
3. Expert operators can now achieve high success rates of over 90% for CTO PCI with low complication rates even for complex CTOs, using bilateral injections, IVUS, retrograde approaches and specialized guidewires and catheters.
08:25 Di Mario - Recent Pubblications and ResearchEuro CTO Club
- Recent publications on CTOs from 2013-2014 focused on pathology, physiology, epidemiology, outcomes, imaging, technical approaches, and stents.
- Studies showed differences in plaque characteristics between long and short duration CTOs and impact of revascularizing CTOs on donor arteries.
- Registry data from Sweden found a 10.6% prevalence of CTOs and decreasing rates over time.
- Successful CTO PCI was associated with improved survival, less cardiac death, and reduced need for CABG compared to failed procedures.
- Imaging like IVUS and CT angiography improved technical success rates for CTO PCI.
The document discusses the background and design of the SYNTAX trial, which compared coronary artery bypass grafting (CABG) to percutaneous coronary intervention (PCI) using drug-eluting stents in patients with complex, multi-vessel coronary artery disease. It found that at 12 months, the primary endpoint of major adverse cardiovascular and cerebrovascular events was significantly lower in the CABG group compared to the PCI group. However, rates of death, myocardial infarction, and stroke were similar between groups. The higher revascularization rate in the PCI group accounted for most of the difference in the primary endpoint. Subset analyses found comparable safety outcomes for CABG and PCI in patients with isolated left main coronary artery disease.
This document summarizes a study from the Department of Cardiology at Tokyo General Hospital investigating the benefits of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the right coronary artery (RCA) based on clinical data from their hospital. The summary is:
1) The study compared outcomes for 14 patients receiving RCA CTO-PCI to 12 patients receiving optimal medical therapy alone over a 2-year follow-up period.
2) There was no significant difference in major adverse cardiac events between the groups, though left ventricular end-diastolic volume was significantly lower in the PCI group.
3) The study suggests RCA CTO-PCI may improve diastolic dysfunction
A 56-year-old male with a history of heart disease presented with ongoing chest pain after an unsuccessful attempt to open a chronic total occlusion of the right coronary artery via percutaneous coronary intervention 6 weeks prior. The patient underwent a second PCI procedure where the CTO was successfully opened using an antegrade approach, resolving his symptoms. At follow-ups 6 months, 12 months and 18 months later, the patient reported continued relief from symptoms and was able to return to exercising and training for triathlons without any chest pain.
CTO PCI today – A summary of recent publicationsEuro CTO Club
CTO PCI today – A summary of recent publications
Carlo Di Mario, London, Great Britain
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
This document summarizes the results of a study analyzing the angiographic and clinical outcomes of patients who underwent successful percutaneous coronary intervention (PCI) to treat a chronic total occlusion (CTO). The study found that the use of everolimus-eluting stents was associated with significantly lower rates of CTO vessel reocclusion compared to first-generation drug-eluting stents. Additionally, the use of the STAR technique for CTO PCI was associated with a very high rate of vessel reocclusion despite initial success. Patients treated with everolimus-eluting stents or conventional antegrade/retrograde approaches had much higher sustained vessel patency linked to improved one-year clinical outcomes.
Saturday 0930 – Werner - Complication Management in PCI for Chronic Total Cor...Euro CTO Club
1) The retrograde approach for chronic total occlusion recanalization leads to increased levels of markers of myocardial injury compared to the antegrade approach, with higher levels seen following septal pathway dilation and epicardial procedures.
2) While periprocedural increases in markers like CK and troponin I are common with retrograde CTO PCI, the clinical significance is unclear as short-term outcomes are generally good.
3) Further study is needed to determine if current definitions of periprocedural myocardial infarction need revising for complex PCI procedures given the sensitivity of current biomarkers.
CTO PCI and length of dual antiplatelet regimenEuro CTO Club
CTO PCI and length of dual antiplatelet regimen
Maciej Lesiak, Poznan, Poland
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Lecture given by Dr Saithna, Orthopedic Surgeon, Overland Park, Kansas on his latest research related to knee and shoulder injuries, including: Anterior cruciate ligament (ACL), ACL repair, ACL reconstruction, ACL rehabilitation, Rotator cuff and Long head of biceps injuries
This document discusses various angiography-based mapping techniques and their role in assessing coronary lesions, including quantitative flow ratio (QFR). It provides information on QFR, including its correlation with fractional flow reserve (FFR), its diagnostic performance compared to FFR, and examples of its use in evaluating lesions alongside computed tomography-derived FFR (FFRCT). It also discusses FFRCT and its diagnostic accuracy compared to QFR and other tests. Finally, it introduces potential applications of FFRCT data like virtual stenting tools.
This document discusses evidence for performing PCI on chronic total occlusions (CTOs). It summarizes several studies that found:
1. Successful CTO-PCI was associated with improved angina symptoms, quality of life, and left ventricular function compared to failed CTO-PCI or medical therapy alone.
2. A study using PET imaging found that successful single-vessel CTO-PCI resulted in increased blood flow and coronary flow reserve in remote myocardium supplied by non-target arteries.
3. Guidelines generally support CTO-PCI for reducing ischemia when performed by experienced operators, though some trials found no benefit of routine CTO-PCI over medical therapy alone on cardiovascular outcomes.
Summary of landmark CTO clinical trials and highlights from registries AhmedElBorae1
This document summarizes information from registries and trials on coronary chronic total occlusions (CTO). It discusses CTO lesion analysis scores, access choices, success rates and complications. It reviews several randomized controlled trials comparing CTO percutaneous coronary intervention (PCI) to medical therapy that had modest sample sizes and open-label designs. It also discusses observational data from large registries on temporal trends in CTO PCI procedures, techniques, success rates and complications. The key takeaway message is that adoption of modern CTO techniques has led to increased success rates with lower complications, and RCTs showed improved quality of life while observational data suggests successful CTO revascularization may improve long-term prognosis.
Intraoperative transesophageal echocardiography (TEE) has been used since the 1980s to improve the efficacy of open heart procedures. Previous studies have shown that TEE provides essential real-time data before, during, and after coronary artery bypass grafting (CABG). TEE allows assessment of cardiac performance, valve function, and great vessel pathology, leading to positive clinical outcomes with low morbidity and mortality. A recent study found that TEE influenced surgical decisions in 7.0% of patients before cardiopulmonary bypass and 2.2% after, and in 12.3% before and 2.2% after for combined CABG and valve procedures. TEE is useful for monitoring left ventric
Neurointerventional Treatment of Acute Stroke in 2015 at Abbott Northwestern ...Allina Health
This document summarizes the neurointerventional treatment of acute stroke using mechanical thrombectomy. It discusses how earlier trials in 2013 that compared IV t-PA to intra-arterial therapy found no difference in outcomes due to outdated technology, inclusion of non-large vessel occlusions, and low recanalization rates. The MR CLEAN trial in 2015 showed improved outcomes with mechanical thrombectomy for large vessel occlusions when using modern stent retrievers in patients treated within 6 hours. Several other 2015 trials also demonstrated the benefits of mechanical thrombectomy. As a result, IV t-PA plus endovascular treatment is now standard of care for acute ischemic stroke due to large vessel occlusions.
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
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Light House Retreats: Plant Medicine Retreat Europe
Published data on CTO complications
1. Nikolaos Konstantinidis MD, MSc, PhD
St Luke’s Hospital of Thessaloniki
AHEPA University Hospital
Thessaloniki, Greece
Published Data on CTO
Complications
Complication Management in
CTOs
September 13th, 2019, Berlin, Germany
2. Potential Conflicts of Interest
I, Nikolaos Konstantinidis MD, MSC, PhD, do not have any potential conflict of
interest to declare
3. Early CTO PCI reports, initial perception
Contemporary series of CTO PCI
Randomized trials of CTO PCI
Revascularization approach and complication rates
Factors associated with CTO PCI complications
Predictive CTO Complication score
Published Data on CTO Complications
4. Procedural Outcomes of Chronic Total Occlusion Percutaneous
Coronary Intervention; A Report From the NCDR (National
Cardiovascular Data Registry)
(22.365 patients with CTO (of 594.510) enrolled between 2009-2013, technical success 59%, in hospital MACE 1.6%)
Brilakis et al, J Am Coll Cardiol Intv 2015;8:245–53
5. In-hospital outcomes of percutaneous coronary intervention in
patients with CTO: insights from the ERCTO registry
(1983 patients enrolled between 2008-2010, procedural success 82.9%, in hospital MACE 1.8%)
Galassi et al, EuroIntervention 2011;7:472-479
6. Patel et al, J Am Coll Cardiol Intv 2013;6:128–36
Angiographic Success and Procedural Complications in Patients
Undergoing Percutaneous Coronary CTO Interventions
A Weighted Meta-Analysis of 18,061 Patients From 65 Studies (published 2000-2011)
Pooled Complication Rates
7. Early CTO PCI reports, initial perception
Contemporary series of CTO PCI
Randomized trials of CTO PCI
Revascularization approach and complication rates
Factors associated with CTO PCI complications
Predictive CTO Complication score
Published Data on CTO Complications
8. Brilakis et al, Circulation. 2019;140:420–433.
Guiding Principles for Chronic Total Occlusion Percutaneous Coronary
Intervention; A Global Expert Consensus Document
9. 5.2
4.7
4.4
4.8
0.7 0.7 0.7
0.5
0.36 0.29
0.07 0.09
0
1
2
3
4
5
6
2008-2009 2010-2011 2012-2013 2014-2015
Complicationrate(%)
Any periprocedural complication MACE In hospital mortality
Any periprocedural complication: p for time 0.793, p for operator <0.001
MACE: p for time 0.034, p for operator 0.003
In hospital mortality: p for time 0.120, p for operator 0.999
Temporal Trends in Chronic Total Occlusion Interventions in Europe
17 626 Procedures From the European Registry of Chronic Total Occlusion
(17626 patients enrolled between 2008-2015, J-CTO score increased from 1.76±1.03 in 2008 to 2.17±0.91 in 2015 –
p<0.001, procedural success 79.7% in 2008 - 89.3% in 2015 - p<0.001, MACE 0.6%)
Konstantinidis et al, on behalf of the EuroCTO Club, Circ Cardiovasc Interv. 2018;11:e006229
10. Comparison of PCI for CTO Outcome According to Operator Experience
from the Japanese Retrograde Summit Registry
(3229 patients enrolled between 2012-2013, procedural success 88.4%, in hospital MACCE 0.53%)
Habara et al, Catheterization and Cardiovascular Interventions 87:1027–1035 (2016)
11. Tajti et al, J Am Coll Cardiol Intv 2018;11:1325–35
The Hybrid Approach to Chronic Total Occlusion Percutaneous
Coronary Intervention Update From the PROGRESS CTO Registry
(3055 patients enrolled between 2012-2017, 87% technical success rate, in-hospital MACE was 3.04% (death, 0.85%;
acute MI, 1.08%; stroke, 0.26%; emergency CABG, 0.16%; urgent repeat PCI, 0.36%; pericardial tamponade, 0.85%)
In-Hospital Major Complications Classified According to Final Successful Crossing Strategy
Use of the retrograde approach was associated with higher overall in-hospital MACE and risk for perforation
12. Tajti et al, J Am Coll Cardiol Intv 2018;11:1325–35
Xenogiannis I, 24 September 2018, San Diego, CA, TCT 2018
The Hybrid Approach to Chronic Total Occlusion Percutaneous
Coronary Intervention Update From the PROGRESS CTO Registry
(3055 patients enrolled between 2012-2017, 87% technical success rate, in-hospital MACE was 3.04% (death, 0.85%;
acute MI, 1.08%; stroke, 0.26%; emergency CABG, 0.16%; urgent repeat PCI, 0.36%; pericardial tamponade, 0.85%)
Most common cause of Death is perforation/tamponade
Mortality 0.8%
13. Perforation type
Danek et al, Am J Cardiol 2017;120:1285–1292
Incidence, Treatment, and Outcomes of Coronary Perforation During
Chronic Total Occlusion Percutaneous Coronary Intervention
(2049 patients enrolled between 2012-2017, 88% technical success rate, in-hospital MACE was 2.64%; Coronary
perforation was 4.1%; Ellis class 1, 2, and 3 perforations were 21%, 26%, and 53%, respectively)
14. Outcomes of Percutaneous Coronary Interventions for Chronic Total
Occlusion Performed by Highly Experienced Japanese Specialists
The First Report From the Japanese CTO-PCI Expert Registry
(2847 patients enrolled between 2014-2015, technical success 89.9%, in hospital MACCE <2%)
Suzuki et al, J Am Coll Cardiol Intv 2017;10:2144–54
15. The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe
The RECHARGE Registry
(1253 patients enrolled between 2014-2015, procedural success 86%, in hospital MACE 2.6%)
Maeremans et al, J Am Coll Cardiol 2016;68:1958–70
16. Hybrid approach improves success of chronic total occlusion
angioplasty; The UK HYBRID CTO Registry
(1156 patients enrolled between 2012-2014, procedural success 90%, 30 day MACE 1.6%)
Wilson et al. Heart 2016;102:1486–1493
Complication rates at 30 days according to final strategy
17. Early Procedural and Health Status Outcomes After Chronic Total
Occlusion Angioplasty A Report From the OPEN-CTO Registry
(1000 patients enrolled between 2014-2015, core-lab adjudicated, J-CTO 2.3± 1.3, technical success 86%, in hospital
MACE 7%)
Sapontis et al, J Am Coll Cardiol Intv 2017;10:1523–34
18. Early CTO PCI reports, initial perception
Contemporary series of CTO PCI
Randomized trials of CTO PCI
Revascularization approach and complication rates
Factors associated with CTO PCI complications
Predictive CTO Complication score
Published Data on CTO Complications
19. A randomized multicentre trial to compare revascularization with
optimal medical therapy for the treatment of CTOs; The EUROCTO Trial
(396 patients enrolled between 2012-2015, J-CTO 1.82±1.07 86.6% success rate, 12 month
follow up)
Werner et al, European Heart Journal (2018) 39, 2484–2493
20. Percutaneous Intervention for Concurrent Chronic Total Occlusions
in Patients With STEMI; The EXPLORE Trial
(304 patients enrolled between 2007-2015, J-CTO 2.0±1.0, 73% success rate, 4 month follow up)
Henriques et al, J Am Coll Cardiol 2016;68:1622–32
21. Mashayekhi et al, J Am Coll Cardiol Intv 2018;11:1982–91
A Randomized Trial to Assess Regional Left Ventricular Function After
Stent Implantation in Chronic Total Occlusion; The REVASC Trial
(205 patients enrolled between 2007-2015, J-CTO 2.0±1.0, 86% success rate (97% after 2nd attempt), 6&12 month follow up)
22. Obedinskiy et al, J Am Coll Cardiol Intv 2018;11;Issue 13:1309–11
The IMPACTOR CTO Trial
(94 patients with CTO RCA enrolled between 2010-2014, 83% success rate, 12 month follow up)
Among patients who underwent CTO PCI attempts, 4 of 47 (8.5%) experienced
periprocedural complications: 2 vascular complications and 2 tamponades.
No death was observed in either group.
In the PCI group, 2 patients underwent target vessel revascularization 5 and 6 months
following the index procedure.
No significant difference was found in MACE-free survival between the PCI and OMT
groups at 12 months (94.9% vs. 100%; p . 0.19).
23. Randomized Trial Evaluating Percutaneous Coronary Intervention for
the treatment of CTO; The DECISION-CTO trial
(834 patients enrolled between 2010-2016, J-CTO 2.2± 1.2, 90.6% success rate, 4-year follow up)
Lee et al, Circulation; 2019 Apr 2;139(14):1674-1683.
24. Early CTO PCI reports, initial perception
Contemporary series of CTO PCI
Randomized trials of CTO PCI
Revascularization approach and complication rates
Factors associated with CTO PCI complications
Predictive CTO Complication score
Published Data on CTO Complications
25. Any periprocedural complication: p <0.001
MACE: p 0.217
Temporal Trends in Chronic Total Occlusion Interventions in Europe
17 626 Procedures From the European Registry of Chronic Total Occlusion
(17626 patients enrolled between 2008-2015, J-CTO score increased from 1.76±1.03 in 2008 to 2.17±0.91 in 2015 –
p<0.001, procedural success 79.7% in 2008 - 89.3% in 2015 - p<0.001, MACE 0.6%)
Konstantinidis et al, on behalf of the EuroCTO Club, Circ Cardiovasc Interv. 2018;11:e006229
3.7
5.7
8.2
0.6 0.6 0.8
0
2
4
6
8
10
Antegrade wire escalation Antegrade Dissection Reentry Retrograde
Complicationrate(%)
Any periprocedural compication MACE
26. Periprocedural complication trend according to the recanalization approach (AWE, ADR, retrograde);
p for adopted strategy <0.001, p for operator <0.001, p for time >0.05.
Temporal Trends in Chronic Total Occlusion Interventions in Europe
17 626 Procedures From the European Registry of Chronic Total Occlusion
(17626 patients enrolled between 2008-2015, J-CTO score increased from 1.76±1.03 in 2008 to 2.17±0.91 in 2015 –
p<0.001, procedural success 79.7% in 2008 - 89.3% in 2015 - p<0.001, MACE 0.6%)
Konstantinidis et al, on behalf of the EuroCTO Club, Circ Cardiovasc Interv. 2018;11:e006229
4.9
4
3.5
2.3
4.8
8.6
4.1
6.7
7.8
8.1
7
9.7
0
1
2
3
4
5
6
7
8
9
10
2008-2009 2010-2011 2012-2013 2014-2015
Complicationrate(%)
Years
Antegrade wire escalation Antegrade Dissection Reentry Retrograde Approach
27. Tajti et al, J Am Coll Cardiol Intv 2018;11:1325–35
The Hybrid Approach to Chronic Total Occlusion Percutaneous
Coronary Intervention Update From the PROGRESS CTO Registry
(3055 patients enrolled between 2012-2017, 87% technical success rate, in-hospital MACE was 3.04% (death, 0.85%;
acute MI, 1.08%; stroke, 0.26%; emergency CABG, 0.16%; urgent repeat PCI, 0.36%; pericardial tamponade, 0.85%)
In-Hospital Major Complications Classified According to Final Successful Crossing Strategy
Use of the retrograde approach was associated with higher overall in-hospital MACE and risk for perforation
28. IVUS Analysis of Intraplaque Versus Subintimal Tracking in CTO PCI and
Association With Procedural Outcomes
(219 patients enrolled between 2014-2016, subintimal tracking in 52.1% of cases (86.7% dissection re-entry, 27.9% wire
escalation, success 89.5%, in hospital outcomes)
Song et al, J Am Coll Cardiol Intv 2017;10:1011–21
29. IVUS Analysis of Intraplaque Versus Subintimal Tracking in CTO PCI and
Association With Procedural Outcomes
(219 patients enrolled between 2014-2016, subintimal tracking in 52.1% of cases (86.7% dissection re-entry, 27.9% wire
escalation, success 89.5%, in hospital outcomes)
Song et al, J Am Coll Cardiol Intv 2017;10:1011–21
30. Procedural and longer-term outcomes of wire- versus device-based
antegrade dissection and re-entry techniques for the percutaneous
revascularization of coronary chronic total occlusions
(223 patient, J-CTO 2.3 ± 1.2, technical success 86%, procedural complications 2.7%)
Azzalini et al, Int J Cardiol 231 (2017)78-83
24-month MACE rates were higher in STAR (15.4%) and LAST (17.5%), as compared with
device-based ADR with CrossBoss/Stingray (4.3%, p = 0.02)
31. Tajti et al, J Am Coll Cardiol Intv 2019;12:346–58
Procedural Outcomes of Percutaneous Coronary Interventions for
Chronic Total Occlusions Via the Radial Approach
Insights From an International Chronic Total Occlusion Registry
(3790 patients enrolled between 2012-2018, 89% technical success rate, in-hospital major complication (2.47% vs. 3.40% vs.
2.18%; p . 0.830) were similar in all 3 groups, major bleeding was lower in the RA group (0.55% vs. 1.94% and 0.88%; p .0.013).
P:0.641 & P:0.009
32. One-Year Clinical Outcomes of the Hybrid CTO Revascularization
Strategy After Hospital Discharge: A Subanalysis of the Multicenter
RECHARGE Registry
(1253 patients enrolled between 2014-2015, 1067 analyzed post 1 year - MACE 8.7%)
Maeremans et al, J Invasive Cardiol 2018;30(2):62-70
Procedural parameters according to MACE events
33. In-hospital Outcomes of Attempting More Than One CTO Through
Percutaneous Intervention During the Same Procedure
(2955 patients enrolled between 2012-2017, 2% had more than one CTO lesions attempted during the same procedure -
70% in different major epicardial arteries, technical success was similar (86% vs 87%, p = 0.633), in-hospital major
complication rate was higher (10.3% vs 2.7%, p = 0.005))
Tajti et al, Am J Cardiol 2018;122:381 387
34. Early CTO PCI reports, initial perception
Contemporary series of CTO PCI
Randomized trials of CTO PCI
Revascularization approach and complication rates
Factors associated with CTO PCI complications
Predictive CTO Complication score
Published Data on CTO Complications
35. Procedural Outcomes of Chronic Total Occlusion Percutaneous
Coronary Intervention; A Report From the NCDR (National
Cardiovascular Data Registry)
(22.365 patients with CTO (of 594.510) enrolled between 2009-2013, technical success 59%, in hospital MACE 1.6%)
Brilakis et al, J Am Coll Cardiol Intv 2015;8:245–53
Operator CTO PCI Volume Association With Procedural Success and Complications
36. Patel et al, J Am Coll Cardiol Intv 2013;6:128–36
Angiographic Success and Procedural Complications in Patients
Undergoing Percutaneous Coronary CTO Interventions
A Weighted Meta-Analysis of 18,061 Patients From 65 Studies (published 2000-2011)
Temporal Trends in Cumulative Angiographic Success Rates and
Major Procedural Complication Rates
37. OPEN-CTO Registry
(1000 patients enrolled between 2014-2015, core-lab adjudicated, technical success 86%, in hospital MACE 7%)
Salisbury AC et al, 24 October 2017, Denver, Colorado, TCT 2017
Predictors of CTO PCI Complications
Age
Retrograde approach
High J-CTO score
38. Danek et al, Am J Cardiol 2017;120:1285–1292
Incidence, Treatment, and Outcomes of Coronary Perforation During
Chronic Total Occlusion Percutaneous Coronary Intervention
(2049 patients enrolled between 2012-2017, 88% technical success rate, in-hospital MACE was 2.64%; Coronary
perforation was 4.1%; Ellis class 1, 2, and 3 perforations were 21%, 26%, and 52%, respectively.
39. Tajti et al, Circ Cardiovasc Interv. 2019;12:e007338.
In-Hospital Outcomes of CTO PCI in Patients With Prior CABG Surgery
Insights From an International Multicenter Chronic Total Occlusion Registry
(3486 patients enrolled between 2012-2018, Prior CABG patients had lower technical (84% versus 89%; P<0.001) success,
but similar incidence of in-hospital major complications (3.1% versus 2.5%; P=0.287).
40. One-Year Clinical Outcomes of the Hybrid CTO Revascularization
Strategy After Hospital Discharge: A Subanalysis of the Multicenter
RECHARGE Registry
(1253 patients enrolled between 2014-2015, 1067 analyzed post 1 year - MACE 8.7%)
Maeremans et al, J Invasive Cardiol 2018;30(2):62-70
Demographic characteristics according to MACE events
41. Early CTO PCI reports, initial perception
Contemporary series of CTO PCI
Randomized trials of CTO PCI
Revascularization approach and complication rates
Factors associated with CTO PCI complications
Predictive CTO Complication score
Published Data on CTO Complications
42. Danek et al, J Am Heart Assoc. 2016;5: e004272
Development and Validation of a Scoring System for Predicting
Periprocedural Complications During PCI of CTOs
The PROGRESS CTO Complications Score
(1569 patients enrolled between 2012-2016, 90% success rate, In hospital MACE 2.8%)
43. Take home message
Contemporary well controlled series and RCTs report higher complication and MACE rates
compared to early CTO PCI reports
Expert operators consistently achieve success rates >90% and address lesions of increasing
complexity over time, while complication and MACE rates seem to remain unchanged
In-hospital MACE in CTO PCI is in the range of 3%
Perforation is the most common periprocedural complication (4%), responsible for the
majority of deaths (18% with Ellis III perforation)
Retrograde approach and ADR are associated with higher complication rate
Radial approach is associated with lower major bleeding and MACE rate (12 month FU)
PROGRESS-CTO complications score is a useful tool for estimating in-hospital complication
risk