Embolization of a septal branch perforation using subcutaneous fat during a percutaneous coronary intervention of chronic total occlusion by retrograde approach

We describe a case of septal branch perforation during percutaneous coronary intervention of a right coronary artery chronic total occlusion. The septal branch perforation was treated with administration of autologous fat into the septal branch with significant reduction of extravasation. This treatment was followed by prolonged balloon inflation at the exit point of the septal branch in the donor artery which definitively sealed the perforation.     

Successful coronary intervention for chronic total occlusion in an anomalous right coronary artery using the retrograde approach via a collateral vessel

We report the first case in the literature of successful coronary intervention in a totally occluded anomalous right coronary artery originating from the left sinus of Valsalva using several techniques, including the retrograde approach via a collateral vessel, the anchoring technique and the five-in-six system.     

Transradial percutaneous coronary intervention for chronic total occlusion using sheathless technique and retrograde approach

The use of 5 or 6 Fr sheath in transradial (TR) approach is often required due to the relative small radial artery size. A sheathless approach may overcome the limitation of small radial size which limits the TR approach. Our case showed successful angioplasty of the right coronary artery chronic total occlusion (CTO) by bilateral TR approaches, utilizing a 7‐Fr guide (7 Fr BL 3.5, 85 cm) for a retrograde sheathless approach, and a 6‐Fr Ikari 3.5 guide catheter for an antegrade approach. The sheathless TR technique can minimize vascular trauma and increase back‐up support for successful coronary intervention in CTO.© 2013 Wiley Periodicals, Inc.     

多层螺旋CT指导下慢性闭塞病变的介入治疗

目的探讨多层螺旋CT(MDCT)对于慢性闭塞(CTO)病变PCI结果有无指导作用。方法选择在我院行冠状动脉MDCT证实为冠状动脉CTO,并在我院心内科行择期PCI的冠心病患者35例。根据CT图像判断CTO病变的位置、性质及钙化程度,闭塞血管远段血流分级以及闭塞近段管腔直径等指标是否对PCI结果及操作时间有预测及指导意义。结果 35例患者中有37支闭塞血管,其中21支(56.8%)获得再通,未再通血管中43.8%位于右冠状动脉,56.2%位于血管近段,钙化斑块占56.2%,80.0%的血管在CT图像上无法看到闭塞远段造影剂渗漏。TIMI血流(P=0.0128)及闭塞部位血管病变的性质(P=0.0703)是CTO病变再通的影响因素。闭塞血管所处节段(P=0.0157)以及闭塞血管所处位置(P=0.0704)是开通CTO病变操作时间的影响因素。结论MDCT可以准确判断CTO病变的走行,评价其斑块的性质及分布。闭塞病变远段有无血流及斑块的性质是PCI是否成功的预测因素。闭塞血管的不同以及所处节段的不同是PCI操作时间长短的预测因素。     

Percutaneous coronary intervention of a circumflex chronic total occlusion using an epicardial collateral retrograde approach.

Antegrade disobliteration of a chronic total coronary occlusion (CTO) may be technically difficult in spite of the use of customized equipment. Retrograde approaches via intramyocardial septal or bypass grafts have been described. We report a successful Percutaneous intervention of a proximal circumflex CTO using a retrograde approach via an epicardial collateral.     

CT coronary angiography-guided percutaneous coronary intervention for chronic total occlusion combined with retrograde approach

Percutaneous coronary intervention was performed for chronic total occlusion (CTO) of the right coronary artery (RCA) in a 55-year-old man. CT coronary angiography (CTCA) with a 64-slice scanner showed a large calcified plaque at the entrance to the CTO. A stent that had been implanted at the RCA ostium 10 years earlier was angled toward a side branch, suggesting that the guidewire would not reach the true lumen via the antegrade approach. Therefore, we attempted the retrograde approach via a septal collateral with the kissing wire technique. However, the guidewire failed to cross the CTO because of obstruction by the implanted stent. We next attempted the controlled antegrade and retrograde subintimal tracking technique and 2 stents were successfully deployed. In this patient, CTCA provided useful information for management of a difficult CTO.     

Percutaneous coronary intervention of a circumflex artery chronic total occlusion using the retrograde approach via ipsilateral collateral circulation from the left anterior descending artery

Retrograde recanalization techniques have markedly improved success rates of attempts to open chronic coronary occlusions in symptomatic patients. A contralateral artery with a collateral channel to the distal segment of the occluded artery is traversed and the vessel is then wired and dilated retrogradely. Occasionally only an ipsilateral collateral is available. We describe the first case of retrograde recanalization of a dominant circumflex artery via a septal collateral channel and discuss the issues surrounding the use of the ipsilateral collateral approach to recanalization of a chronically occluded artery.     

Successful coronary intervention for chronic total occlusion using a retrograde approach with biradial arteries

A retrograde approach is one of the new techniques of percutaneous coronary intervention (PCI) for the treatment of chronic total occlusions (CTO). We present 4 cases of successful PCI for CTO via a retrograde approach using both radial arteries. There were no complications in these cases. We found that, selected cases, a retrograde approach using the biradial arteries in the treatment of CTO appears to be feasible.     

The prognostic value of collateral circulation in coronary chronic total occlusion underwent percutaneous coronary intervention

BACKGROUND The prognostic value of coronary collateral circulation(CC) in patients undergoing chronic total occlusion(CTO) percutaneous coronary intervention(PCI) is underdetermined. The purpose of the study was to assess the prognostic value of current two CC grading systems and their association with long-term outcomes in patients with CTO underwent PCI.METHODS We consecutively enrolled patients with single-vessel CTO underwent PCI between January 2010 and December2013. All patients were categ...     

Finecross微导管在冠状动脉慢性完全闭塞病变介入治疗中的应用

目的 了解Finecmss微导管在慢性完全闭塞（chronic total occlusion,CTO）病变介入治疗中的有效性和安全性.方法 对56例在茂名市人民医院行冠状动脉造影发现CTO病变并对其进行介入治疗的患者的临床资料和手术过程进行回顾性分析.结果 56例CTO病变闭塞时间为（6.8±3.2）个月;闭塞段长度（32 ±22） mm.介入治疗成功43例,其中正向33例,逆向10例.13例失败患者中,正向6例,原因为导丝不能进入血管真腔内;逆向7例中4例导丝不能穿过病变（2例微导管和1例导丝不能通过侧支循环而终止）,2例微导管不能通过闭塞病变,1例患者术中生命体征不稳定.所有患者术后住院期间无主要心血管事件发生.结论 Finecmss微导管在CTO病变的介入治疗中是安全和有效的.     

冠状动脉慢性完全闭塞病变介入治疗成功的影响因素探讨

目的 探讨冠状动脉慢性完全闭塞(CTO)病变患者经皮冠状动脉介入治疗(PCI)后院内结果以及介入治疗成功的影响因素.方法 连续收集2004年1月至2008年12月冠状动脉造影示完全闭塞病变1485例,其中CTO病变638例.对接受介入治疗的447例CTO患者的临床、病变影像特征、介入治疗资料以及院内结果进行分析.结果 CTO病变的PCI成功率为85.5%(382/447).术中出现C-F型冠状动脉夹层或冠状动脉穿孔27例(6.0%),心包填塞6例(1.3%),术后再次靶病变血运重建2例(0.4%),院内死亡2例(0.4%).与PCI成功患者比较,PCI失败患者年龄较大[(62.9±10.4)岁比(65.9±9.9)岁,P＜0.05],近端血管中重度迂曲(16.2%比38.5%,P＜0.01)、闭塞端缺如(47.1%比80.0%,P＜0.01)和中重度钙化(36.9%比72.3%,P＜0.01)的比例较高.多元逐步logistic回归分析(后退法)显示,中重度钙化(OR:3.866,P＜0.01)、闭塞端缺如(OR:3.346,P＜0.05)以及病变近端血管中重度迂曲(OR:3.055,P＜0.01)与CTO病变介入治疗成功呈负相关.结论 CTO介入治疗安全、可行,其成功率与闭塞病变特点相关.

Abstract：

Objective To evaluate the in-hospital outcome and determinants relating to success rate of percutaneous coronary intervention(PCI)for patients with chronic total occlusion(CTO)using contemporary techniques. Methods A total of 1485 patients with total occluded coronary artery were identified from January 2004 to December 2008 in Zhongshan hospital. Of them, 638 patients were affirmed as CTO and 447 patients underwent PCI. The clinical data and the in-hospital outcome of patients underwent PCI were retrospectively analyzed. Results Procedure success was achieved in 382 patients(85.5%).Coronary perforation(C-F type dissection or coronary perforation)occurred in 27 patients(6. 0%), cardiac tamponade developed in 6 out of the 27 patients, 2 patients(0.4%)received in-hospital repeat revascularization. Two patients(0. 4%)died post PCI: one died of acute stent thromobosis and the other one died of refractory heart and respiratory failure. Compared with patients of successful recanalization,patients failure to recanalization were more aged[(62.9 ± 10.4)years vs.(65.9 ± 9.9)years, P ＜ 0.05]and excessive tortuosity(16.2% vs. 38.5% ,P ＜0.01),absence stump(47.1% vs. 80. 0% ,P ＜0. 01)and excessive calcification(36.9% vs. 72.3%, P ＜0.01)were more common. Multiple logistic regression analysis revealed that excessive calcification(OR: 3. 866, P ＜ 0. 01), absence stump(OR: 3. 346, P ＜0.05)and excessive tortuosity(OR:3.055, P ＜ 0.01)were independent predictors for the procedural failure. Conclusions PCI for patients with CTO is safe and effective. Apart from progress on the equipment development, procedural success rates are closely related with the clinical and angiographic features of CTO.     

Progress in the retrograde approach for chronic total coronary artery occlusion

After the introduction of the retrograde approach in percutaneous coronary intervention for chronic total occlusion (CTO), different kinds of strategies and techniques have been developed in order to achieve final success. However, it has not been fully demonstrated whether these strategies and techniques can really improve the final result. We observed one case, for which the initial attempt of the retrograde approach for a CTO lesion was unsuccessful despite the successful approach of a retrograde guidewire to the lesion, and with the second retrograde approach 3 years later being eventually successful by using various kinds of strategies and techniques. This case clearly demonstrates how the final success through the retrograde approach can be achieved by using a combination of the improved strategies and techniques for CTO lesions. © 2008 Wiley‐Liss, Inc.     

Drug-eluting stent-supported percutaneous coronary intervention for chronic total coronary occlusion.

OBJECTIVES: This study sought to determine the clinical and angiographic outcomes after drug-eluting stent (DES)-supported percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO). BACKGROUND: There are few data about the efficacy of DES-supported PCI for CTO. METHODS: All consecutive patients who had a sirolimus-eluting stent or a paclitaxel-eluting stent implanted for CTO from December 2003 to December 2004 were analyzed. Clinical and angiographic outcomes of patients treated with DES were compared with a case-matched control group of patients treated with bare metal stents (BMS) in the 12 months before the routine use of DES. RESULTS: Successful DES-supported PCI was performed in 92 patients and 104 CTO. The case-matched control group consisted of 26 patients and 27 CTO successfully treated with BMS. There were no differences between groups in baseline clinical and angiographic characteristics. Stent length in the DES group was higher as compared with that of BMS group (51+/-28 mm vs. 40+/-19 mm, P=0.073). The 6-month major adverse cardiac event (MACE) rate was lower in the DES group as compared with that of BMS group (9.8% vs. 23%, P=0.072). The angiographic follow-rate was 80% in the DES group and 81% in the BMS group. The 6-month restenosis rate was 19% in the DES group and 45% in the BMS group (P<0.001). By multivariate analysis, it was found that in the DES group, the only predictors of restenosis were stented segment length (OR 1.031, 95% CI 1.01-1.06, P=0.009) and a target vessel reference diameter<2.5 mm (OR 6.48, 95% CI 1.51-27.83, P=0.012), while the only predictor of MACE was stent length (OR 1.04, 95% CI 1.01-1.08, P=0.006). CONCLUSIONS: DES implantation for CTO decreases the risk of mid-term restenosis and MACE. Small vessels and diffuse disease requiring the implantation of multiple stents and very long stents for full coverage of the target lesion are still associated with a relatively high risk of restenosis.     

冠心病慢性闭塞病变经皮冠状动脉介入治疗的展望

1977年Gruentzig进行了世界上第一例经皮冠状动脉腔内成形术（PTCA）,由此拉开了冠心病介入治疗的序幕。近30年来冠心病经皮冠状动脉介入治疗取得了飞速的发展。随着冠状动脉介入器械设计和制造工艺的改进、相关药物治疗的发展以及其他一些辅助设备的进步,原来复杂危险的冠状动脉介入操作过程,今天已经成为简单安全的冠心病治疗手段之一。尽管如此,冠心病慢性闭塞病变（chronic total occlusion,CTO）仍然是介入治疗的难题之一。     

经皮冠状动脉介入术治疗冠状动脉慢性完全闭塞性病变疗效

目的总结经皮冠状动脉介入术治疗冠状动脉慢性完全闭塞（chronic total occlusion，CTO）的疗效。方法回顾性分析2006年12月前施行经皮冠状动脉介入术的临床资料。结果冠状动脉慢性完全闭塞233例．共有靶血管251支，闭塞时间（20±10）个月。226例（226／251，96．9％）的237处靶病变（237／251，94．4％）行经皮冠状动脉介入术成功。共植入冠状动脉支架266枚。因导丝不能通过CTO病变未成功7例：造影提示病变类型均为旁路侧支血管丰富型或多处长的弯曲病变，其中2例闭塞时间有5年以上，另5例未开通患者中有2例因心功能不全不能耐受长时间手术而终止操作。术中及术后均无严重并发症。术后心绞痛症状缓解率85．4％，心功能改善率79．6％，5年生存率88．9％。结论冠状动脉慢性完全闭塞行经皮冠状动脉介入术成功关键在于熟练的操作技术、合理的器材选择及仔细评估病人和动脉闭塞病变状况；开通闭塞动脉可显著改善患者临床症状，提高生活质量。