35 results on '"CTO"'
Search Results
2. Prompt and consistent improvement of coronary flow velocity reserve following successful recanalization of the coronary chronic total occlusion in patients with viable myocardium
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Nikola Boskovic, Srdjan Aleksandric, Miloje Tomasevic, Stefan Juricic, Milan Nedeljkovic, Vladan Vukcevic, Milorad Tesic, Branko Beleslin, Vojislav Giga, Ana Djordjevic Dikic, Dejan Orlic, Milan Dobric, Jelena Rakocevic, Dragana Sobic Saranovic, Miodrag Ostojic, Goran Stankovic, Sinisa Stojkovic, D.V. Simic, Olga Petrovic, and I Jovanovic
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Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Time Factors ,medicine.medical_treatment ,Hemodynamics ,030204 cardiovascular system & hematology ,Total occlusion ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,CFVR ,030212 general & internal medicine ,Prospective Studies ,Angiology ,business.industry ,Research ,Percutaneous coronary intervention ,General Medicine ,Blood flow ,Recanalization ,Middle Aged ,Coronary Vessels ,Myocardial Contraction ,3. Good health ,Coronary flow velocity reserve ,Fractional Flow Reserve, Myocardial ,CTO ,medicine.anatomical_structure ,Coronary Occlusion ,Echocardiography ,lcsh:RC666-701 ,Coronary chronic total occlusion ,Conventional PCI ,Chronic Disease ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery ,Follow-Up Studies - Abstract
BackgroundCoronary chronic total occlusion (CTO) is characterized by the presence of collateral blood vessels which can provide additional blood supply to CTO-artery dependent myocardium. Successful CTO recanalization is followed by significant decrease in collateral donor artery blood flow and collateral derecruitment, but data on coronary hemodynamic changes in relation to myocardial function are limited. We assessed changes in coronary flow velocity reserve (CFVR) by echocardiography in collateral donor and recanalized artery following successful opening of coronary CTO.MethodsOur study enrolled 31 patients (60 ± 9 years; 22 male) with CTO and viable myocardium by SPECT scheduled for percutaneous coronary intervention (PCI). Non-invasive CFVR was measured in collateral donor artery before PCI, 24 h and 6 months post-PCI, and 24 h and 6 months in recanalized artery following successful PCI of CTO.ResultsCollateral donor artery showed significant increase in CFVR 24 h after CTO recanalization compared to pre-PCI values (2.30 ± 0.49 vs. 2.71 ± 0.45,p = 0.005), which remained unchanged after 6-months (2.68 ± 0.24). Baseline blood flow velocity of the collateral donor artery significantly decreased 24 h post-PCI compared to pre-PCI (0.28 ± 0.06 vs. 0.24 ± 0.04 m/s), and remained similar after 6 months, with no significant difference in maximum hyperemic blood flow velocity pre-PCI, 24 h and 6 months post-PCI. CFVR of the recanalized coronary artery 24 h post-PCI was 2.55 ± 0.35, and remained similar 6 months later (2.62 ± 0.26, p = NS).ConclusionsIn patients with viable myocardium, prompt and significant CFVR increase in both recanalized and collateral donor artery, was observed within 24 h after successful recanalization of CTO artery, which maintained constant during the 6 months.Trial registrationClinicalTrials.gov (NumberNCT04060615).
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- 2020
3. Myocardial blood flow assessment with myocardial perfusion scan in patients with coronary artery chronic total occlusion
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Ilona Samek, Marcin Pachowicz, and Magdalena Jańczyk
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medicine.medical_specialty ,business.industry ,Perfusion scanning ,Blood flow ,heart ,Total occlusion ,perfusion ,Education ,cto ,medicine.anatomical_structure ,Internal medicine ,GV557-1198.995 ,Cardiology ,Medicine ,scintigraphy ,In patient ,business ,Artery ,Sports - Abstract
Jańczyk Magdalena, Samek Ilona, Pachowicz Marcin. Myocardial blood flow assessment with myocardial perfusion scan in patients with coronary artery chronic total occlusion. Journal of Education, Health and Sport. 2020;10(6):275-285. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.06.030 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.06.030 https://zenodo.org/record/3923161 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 01.06.2020. Revised: 15.06.2020. Accepted: 30.06.2020. Myocardial blood flow assessment with myocardial perfusion scan in patients with coronary artery chronic total occlusion Magdalena Jańczyk (1), Ilona Samek (1), dr n. med. Marcin Pachowicz (2) 1) Students Scientific Association at the Chair and Department of Nuclear Medicine, Medical University of Lublin 2) Chair and Department of Nuclear Medicine, Medical University of Lublin *Address for correspodence: Smolniki 7/12, 18-520 Stawiski, telephone number: 662237472, e-mail address: magdajanczyk7@gmail.com ORCID ID and e-mail: Magdalena Jańczyk: https://orcid.org/0000-0002-4948-9463; magdajanczyk7@gmail.com Ilona Samek: https://orcid.org/0000-0002-5538-5396; samekilona@gmail.com Marcin Pachowicz: https://orcid.org/0000-0002-0714-2170; marcin.pachowicz.md@gmail.com Abstract Introduction and purpose: Coronary artery disease (CAD) is a leading cardiological problem in modern society. A special form of CAD is the Chronic Total Occlusion (CTO), which affects about 20% of visible coronary artery lesions. The aim of the study is to present the role of myocardial perfusion scintigraphy performed on patients with CTO, and scintigraphic findings in these patients. Material and method: It was a retrospective study. We analized studies in patients with CTO reported in medical history. We included studies performed between 2016 and 2019. 119 cases were found with the majority of men (M = 95, W = 24). The patients’ mean age was 65 years (M = 65, W = 66). In order to assess ischemia in these patients, the stress test was applied by means of physical exercise (cycloerometer) or pharmacological test. If patient's clinical condition did not allow a stress test, only a rest test was performed. Results: In the analyzed group the most common occluded vessel was the right coronary artery (59%). In this case, mean ischaemia was found to cover 18% of the myocardium. The second most frequent obstructed vessel was the circumflex (16%) with ischaemia of 15%. The next artery was left anterior descending artery with ischaemia of 30% and other vessel - 7%. 9 patients had more than one vessel closed. Conclusions: Myocardial perfusion imaging helps to choose optimal treatment in patients with CTO. Key words: heart; scintigraphy; perfusion; CTO
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- 2020
4. Predictors and outcomes of procedural failure of percutaneous coronary intervention of a chronic total occlusion—A subanalysis of the EXPLORE trial
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Dagmar M. Ouweneel, Pierfrancesco Agostoni, Matthijs Bax, Maarten Z.H. Kolk, Gert van Houwelingen, Truls Råmunddal, Ivo M. van Dongen, Erlend Eriksen, Bimmer E. Claessen, Loes P. Hoebers, Maarten J. Suttorp, Anna van Veelen, Joëlle Elias, Peep Laanmets, José P.S. Henriques, René J. van der Schaaf, Cardiology, Graduate School, ACS - Atherosclerosis & ischemic syndromes, ACS - Heart failure & arrhythmias, ACS - Microcirculation, and ACS - Pulmonary hypertension & thrombosis
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medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Revascularization ,Ventricular Function, Left ,STEMI ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Myocardial infarction ,cardiovascular diseases ,CMR ,Adverse effect ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,ECG ,Percutaneous coronary intervention ,Stroke Volume ,PCI ,General Medicine ,medicine.disease ,CTO ,Treatment Outcome ,medicine.anatomical_structure ,surgical procedures, operative ,Coronary Occlusion ,Chronic Disease ,Conventional PCI ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Objective To evaluate predictors of procedural success of percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) in a non-infarct-related artery following ST-segment elevation myocardial infarction (STEMI), and demonstrate the effect on left ventricular functionality (LVF), infarct size (IS), and pro-arrhythmic electrocardiogram (ECG) parameters. Background Predictors of unsuccessful revascularization of a CTO are numerous, although following STEMI, these are lacking. Besides, effects of failed CTO PCI (FPCI) on the myocardium are unknown. Methods This is a subanalysis of the EXPLORE trial, in which 302 STEMI patients with a concurrent CTO were randomized to CTO PCI (n = 147) or no-CTO PCI (NPCI, n = 154). For the purpose of this subanalysis, we divided patients into successful CTO PCI (SPCI, n = 106), FPCI (n = 41), and NPCI (n = 154) groups. Cardiac magnetic resonance imaging and angiographic data were derived from the EXPLORE database, combined with ECG parameters. To gain more insight, all outcomes were compared with patients that did not undergo CTO PCI. Results In multivariate regression, only CTO lesion length >20 mm was an independent predictor of procedural failure (OR 3.31 [1.49-7.39]). No significant differences in median left ventricular ejection fraction, left ventricular end-diastolic volume, IS, and the pro-arrhythmic ECG parameters such as QT-dispersion, QTc-time, and TpTe-intervals were seen between the SPCI and FPCI groups at 4 months follow-up. Conclusion This subanalysis of the EXPLORE trial has demonstrated that a CTO lesion length >20 mm is an independent predictor of CTO PCI failure, whereas procedural failure did not lead to any adverse effects on LVF nor pro-arrhythmic ECG parameters.
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- 2021
5. Collaboration, unexpected events and governance in complex temporary organisations
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Zuiderwijk, D. C., Jacobs, Gabriele, Suojanen, Ilona, Horton, Kate E., Bayerl, Petra Saskia, Organization Sciences, Jacobs, Gabriele, Suojanen, Ilona, Horton, Kate E., and Bayerl, Petra Saskia
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Governance ,Sociotechnical system ,Process management ,Scope (project management) ,Resilience ,media_common.quotation_subject ,Corporate governance ,Interconnectivity ,CTO ,Unexpected events ,Empirical research ,SDG 17 - Partnerships for the Goals ,Capital asset ,Temporary organisation ,Psychological resilience ,Business ,Adaptation ,Operational reliability ,media_common - Abstract
Sociotechnical systems are rapidly becoming more and more complex due to technological advancements and increasing interconnectivity. Today, many of these systems are embedded in temporary organisations (TO). The complex interconnectivity characterising a TO increases the risk of adverse work situations emerging in unexpected ways. This chapter focuses on TOs operating in high-hazard environments involving high capital assets and operations in which failure can have severe consequences—here referred to as complex temporary organisations (CTOs). Based on an empirical study aimed at understanding how these organisations sustain their operational reliability, this chapter discusses the everyday realities in a CTO with regard to collaboration, unexpected events and governance. The purpose of this chapter is to introduce the organising complexity in a CTO and illustrate that by focusing on how these organisations work rather than how they fail, a world of untapped learning opens up, offering generous scope for cross-sectoral learning.
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- 2021
6. The relationship between uric acid to high-density lipoprotein cholesterol ratio and collateral index in patients with chronic total occlusion
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Nadir Emlek, Cihan Aydın, RTEÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, and Emlek, Nadir
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medicine.medical_specialty ,Collateral Circulation ,Coronary Angiography ,chemistry.chemical_compound ,High-density lipoprotein ,High-density lipoprotein cholesterol ,Diabetes mellitus ,Internal medicine ,Coronary Circulation ,medicine ,Humans ,Hyperuricemia ,Aged ,medicine.diagnostic_test ,Cholesterol ,Unstable angina ,business.industry ,Cholesterol, HDL ,Middle Aged ,medicine.disease ,Collateral circulation ,Cardiovascular risk ,Uric Acid ,CTO ,chemistry ,Coronary Occlusion ,Angiography ,Cardiology ,Uric acid ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background High serum uric acid (UA) levels and low high-density lipoprotein cholesterol (HDL–C) levels are accepted as risk factors for cardiovascular mortality. Hyperuricemia and low HDL–C levels were associated with an increased risk of cardiovascular mortality and the development of diabetes and hypertension. However, the association of UA with cardiovascular (CV) mortality,collateral index are undetermined in patients with chronic total occlusion (CTO).Material and methods 124 patients who underwent coronary angiography with the diagnosis of stable or unstable angina pectoris and had chronic total occlusion were included in our study. Blood samples were collected from all patients before the angiography procedure. Coronary collateral circulation (CCC) was graded according to the Rentrop grading system of 0–3. Rentrop grades of 0 and 1 indicated low-grade CCC group, whereas grades 2 and 3 indicated high-grade CCC group. We divided our patients into two groups as low-grade CCC and high-grade CCC and examined these two groups in terms of uric acid / HDL ratios. Group 1: Rentrop classification grade 0–1 (mean age, 63,9±9,9), Group 2: Rentrop classification grade 2–3 (mean age, 62,1±9,4).Results The baseline characteristics were similar in both groups. Uric acid / High density lipoprotein-cholesterol ratios and uric acid levels were higher in group 1 with poor collateral circulation [group 1; 0,21 (0,07–0,39) vs. group 2; 0,16 (0,08–0,31), group 1; 8,2 (3,4–10,4) vs. group 2; 5,85 (3,5–7,7), pConclusions We found that high Uric acid / High-density lipoprotein-cholesterol ratios and high uric acid levels are associated with poor collateral circulation.
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- 2021
7. Optical Coherence Tomography and Stent Boost Imaging Guided Bioresorbable Vascular Scaffold Overlapping for Coronary Chronic Total Occlusion Lesion
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Dong Joo Oh, Hu Li, Cheol Ung Choi, and Seung-Woon Rha
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medicine.medical_specialty ,Cardiac & Cardiovascular Systems ,medicine.medical_treatment ,stent boost ,Case Report ,030204 cardiovascular system & hematology ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Optical coherence tomography ,medicine.artery ,medicine ,Fluoroscopy ,030212 general & internal medicine ,Bioresorbable vascular scaffold ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,Stent ,General Medicine ,Gold standard (test) ,equipment and supplies ,CTO ,BVS ,OCT ,Right coronary artery ,Radiology ,medicine.symptom ,business - Abstract
We report herein the optical coherence tomography (OCT) and stent boost imaging guided bioresorbable vascular scaffold (BVS) implantation for right coronary artery (RCA) chronic total occlusion (CTO) lesion. The gold standard for evaluating BVS expansion after percutaneous coronary intervention is OCT. However, stent boost imaging is a new technique that improves fluoroscopy-based assessments of stent overlapping, and the present case shows clinical usefulness of OCT and stent boost imaging guided 'overlapping' BVS implantation via antegrade approach for a typical RCA CTO lesion.
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- 2017
8. Transforming ETO Businesses with Enhanced PLM Capabilities
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Antti Pulkkinen, Jorma Papinniemi, Simo-Pekka Leino, Tampere University, and Mechanical Engineering and Industrial Systems
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0209 industrial biotechnology ,Engineering ,ta214 ,business.industry ,Case study ,020207 software engineering ,Context (language use) ,02 engineering and technology ,PLM ,Competitive advantage ,Business transformation ,Industrial and Manufacturing Engineering ,Manufacturing engineering ,214 Mechanical engineering ,Public–private partnership ,CTO ,020901 industrial engineering & automation ,Product lifecycle ,ETO ,Artificial Intelligence ,Order (business) ,0202 electrical engineering, electronic engineering, information engineering ,business - Abstract
This paper studies the specific Product Lifecycle Management (PLM) capabilities needed for the transformation of Engineered to Order (ETO) manufacturing towards Configure to Order business strategy. The material for the research comes from a project conducted with public private partnership. The four industrial companies that we studied engineer and/or manufacture highly customized products in low volumes with globally distributed networks. This is an industrial context, which requires specific PLM capabilities. The capabilities are essential for business transformation, broadening the utilization of PLM, and enhancing and maintaining the competitive edge of ETO manufacturing organizations.
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- 2017
9. IVUS in CTO Lesions
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Elias A. Sanidas
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IVUS ,CTO ,medicine.medical_specialty ,business.industry ,RC666-701 ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
10. Stent-Apposition Salvage of an Anterior Tibial Artery After Inadvertent Angioplasty Balloon Retention During CTO Revascularization
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Rashad G. Choudry, T. Dhir, E. Deutsch, and J. Durinka
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lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Complications ,medicine.medical_treatment ,lcsh:Surgery ,Case Report ,030204 cardiovascular system & hematology ,Balloon ,Revascularization ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Angioplasty ,medicine.artery ,medicine ,Stent ,Peroneal Artery ,Endovascular ,business.industry ,lcsh:RD1-811 ,Critical limb ischemia ,Surgery ,CTO ,lcsh:RC666-701 ,Dorsalis pedis artery ,Anterior tibial artery ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction Progressive improvement in the ability to treat complete total occlusions in the tibial level arterial circulation have made it possible to revascularize patients with critical limb ischemia. Report A 59 year old male presented with a complete total occlusion of his anterior tibial artery with distal reconstitution through peroneal artery collaterals. During attempted angioplasty a balloon was retained within the patent portion of the target vessel. Two 3.0 mm drug eluting coronary stents were deployed across the length of the balloon with excellent luminal preservation. Discussion Successful CTO revascularization was completed and a strong dorsalis pedis artery pulse was restored following intervention., Highlights • Improved treatment for tibial level arterial occlusions makes revascularization possible. • A balloon was retained in the target vessel and two coronary stents were deployed across the balloon. • CTO revascularization was successful with restoration of a strong dorsalis pedis pulse.
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- 2016
11. Language of CTO interventions – Focus on hardware
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Sundeep Mishra
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Psychological intervention ,Guidewire ,Finecross ,030204 cardiovascular system & hematology ,Coronary Angiography ,Field (computer science) ,Terminology ,RG3 ,0302 clinical medicine ,Navifocus ,030212 general & internal medicine ,Miracle ,Angioplasty, Balloon, Coronary ,Opticross ,Conquest ,Confusion ,Turnpike ,Stingray ,Sion ,PCI ,Equipment Design ,Fielder ,Variety (cybernetics) ,Treatment Outcome ,Editorial ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Computer hardware ,Tornus ,RD1-811 ,Total occlusion ,Corsair ,GeneralLiterature_MISCELLANEOUS ,03 medical and health sciences ,Hardware ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Focus (computing) ,Tip load ,CrossBoss ,business.industry ,Gaia ,Crusade ,CTO ,Coronary Occlusion ,RC666-701 ,Chronic Disease ,Key (cryptography) ,Surgery ,business - Abstract
The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.
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- 2016
12. Pattern of vascular remodeling of distal reference segment after recanalization of chronic total occlusion, long-term angiographic follow-up
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Wassam El Din Hadad El Shafey
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medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Necrosis ,Endothelium ,Lumen (anatomy) ,Case Report ,Vasodilation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Vascular remodeling ,030212 general & internal medicine ,Thrombus ,Endothelial dysfunction ,Distal reference segment ,business.industry ,Recanalization ,medicine.disease ,Endothelial stem cell ,CTO ,medicine.anatomical_structure ,lcsh:RC666-701 ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Ligation - Abstract
Chronic total occlusion (CTO) is probably caused by thrombus and lipid-rich cholesterol esters that are replaced over time by collagen and calcium deposition. Experimental models showed endothelial cell necrosis in response to vessel ligation, whereas more recent models suggest that the endothelium might retain viability guiding the subsequent development of CTO, including CTO neo-revascularization, which occurs within the lumen and in various layers of the vessel wall, by the release of paracrine substances. It is uncertain whether after CTO recanalization the recovery of anterograde reverses endothelial dysfunction, thus promoting vasodilation and positive remodeling.
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- 2017
13. Left Main Coronary Artery Disease and Outcomes after Percutaneous Coronary Intervention for Chronic Total Occlusions
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Catherine Gebhard, Miroslaw Ferenc, Aurel Toma, Stefan Aschauer, Georg Goliasch, Max-Paul Winter, Philipp E. Bartko, Mohamed Ayoub, Kambis Mashayekhi, Jolanta M. Siller-Matula, Klaus Distelmaier, Christian Hengstenberg, and University of Zurich
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medicine.medical_specialty ,medicine.medical_treatment ,lcsh:Medicine ,610 Medicine & health ,030204 cardiovascular system & hematology ,Revascularization ,Article ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,030212 general & internal medicine ,Circumflex ,chronic total occlusion ,Proportional hazards model ,business.industry ,lcsh:R ,Hazard ratio ,Percutaneous coronary intervention ,PCI ,10181 Clinic for Nuclear Medicine ,General Medicine ,medicine.disease ,CTO ,Concomitant ,Conventional PCI ,Cardiology ,business ,coronary artery disease - Abstract
Background: Concomitant left main coronary artery (LMCA) disease in patients with chronic total occlusions (CTO) commonly results in referral for coronary artery bypass grafting, although the impact of LMCA in CTO patients remains largely unknown. Nevertheless, patient selection for percutaneous coronary intervention of CTOs (CTO-PCI) or alternative revascularization strategies should be based on precise evaluation of the coronary anatomy to anticipate those patients that most likely benefit from a procedure and not on strict adherence to perpetual clinical practice. Therefore, the aim of this study was to assess the impact of LMCA disease on long-term outcomes in patients undergoing percutaneous coronary intervention for CTO. Methods: We enrolled 3860 consecutive patients undergoing PCI for at least one CTO lesion and investigated the predictive value of concomitant LMCA disease. All-cause mortality was defined as the primary study endpoint. Results: We observed that LMCA disease is significantly associated with mortality. In the Cox regression analysis, we observed a crude hazard ratio (HR) 1.59 (95% confidence interval (CI) 1.23&ndash, 2.04, p <, 0.001) for patients with LMCA disease as compared to patients without. Results remained unchanged after bootstrap- or clinical confounder-based adjustment. Conclusion: LMCA disease is associated with excess mortality in CTO patients. Specifically, anatomical features such as CTO of the circumflex artery represent a high risk patient population.
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- 2020
14. The IMPACTOR-CTO Trial
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Nataliya R. Obedinskaya, Marouane Boukhris, Zied Ibn Elhadj, Evgeny Kretov, Igor Grazhdankin, Sami Kasbaoui, Alexander G. Osiev, Alexey Biryukov, Alexey A. Prokhorikhin, Alfredo R. Galassi, Evgeny Pokushalov, Dmitry D. Zubarev, Anton A. Obedinskiy, Vitaly Baystrukov, Vladislav P. Kurbatov, Obedinskiy, Anton A., Kretov, Evgeny I., Boukhris, Marouane, Kurbatov, Vladislav P., Osiev, Alexander G., Ibn Elhadj, Zied, Obedinskaya, Nataliya R., Kasbaoui, Sami, Grazhdankin, Igor O., Prokhorikhin, Alexey A., Zubarev, Dmitry D., Biryukov, Alexey, Pokushalov, Evgeny, Galassi, Alfredo R., and Baystrukov, Vitaly I.
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medicine.medical_specialty ,business.industry ,Treatment outcome ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,CTO ,surgical procedures, operative ,0302 clinical medicine ,Chronic disease ,Quality of life ,Randomized controlled trial ,law ,Internal medicine ,Conventional PCI ,Cardiology ,medicine ,cardiovascular diseases ,030212 general & internal medicine ,Outcome data ,Cardiology and Cardiovascular Medicine ,business - Abstract
Despite concordant outcome data from a thousand registries comparing successful versus unsuccessful CTO PCI [(1)][1], recent randomized trials did not support the impact on survival of CTO PCI compared with OMT [(2)][2]. In contrast, more certainty exists about its importance in improving QoL [(2)][
- Published
- 2018
15. The everlasting dispute between coronary bypass and angioplasty in patients with multivessels coronary artery disease: results of the SYNTAX II study
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Daniele Torella, Annalisa Mongiardo, Carmen Spaccarotella, Salvatore De Rosa, Ciro Indolfi, Masakazu Yasuda, Indolfi, C., De Rosa, S., Mongiardo, A., Yasuda, M., Torela, D., and Spaccarotella, C.
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IVUS ,medicine.medical_specialty ,iFR/FFR ,Syntax (programming languages) ,business.industry ,medicine.medical_treatment ,Coronary arteriosclerosis ,PCI ,Articles ,medicine.disease ,Coronary artery disease ,Coronary artery bypass surgery ,CTO ,Angioplasty ,Internal medicine ,Conventional PCI ,medicine ,Cardiology ,In patient ,Instantaneous wave-free ratio ,Cardiology and Cardiovascular Medicine ,business ,CABG - Published
- 2019
16. Appropriateness of percutaneous revascularization of coronary chronic total occlusions: an overview
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Salvatore D. Tomasello, Marouane Boukhris, Emmanouil S. Brilakis, Nicolaus Reifart, Carlo Di Mario, Alfredo R. Galassi, Bradley H. Strauss, Masahisa Yamane, Gerald S. Werner, Osamu Katoh, Stéphane Rinfret, Georgios Sianos, Dimitri Karmpaliotis, Galassi A.R., Brilakis E.S., Boukhris M., Tomasello S.D., Sianos G., Karmpaliotis D., Di Mario C., Strauss B.H., Rinfret S., Yamane M., Katoh O., Werner G.S., and Reifart N.
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medicine.medical_specialty ,medicine.medical_treatment ,Coronary OcclusionTreatment Outcome ,Guideline ,030204 cardiovascular system & hematology ,Revascularization ,law.invention ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Randomized controlled trial ,Quality of life ,law ,CTO ,PCI ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Cardiovascular outcome ,Chronic total occlusion ,Guidelines ,Chronic Disease ,Quality of Life ,Treatment Outcome ,Coronary Occlusion ,Cardiology and Cardiovascular Medicine ,business.industry ,Percutaneous coronary intervention ,Evidence-based medicine ,Coronary occlusion ,Conventional PCI ,Cardiology ,Observational study ,business ,Human - Abstract
Coronary chronic total occlusions (CTOs) are commonly encountered in patients undergoing coronary angiography. Several observational studies have demonstrated that successful CTO revascularization is associated with better cardiovascular outcomes and enhanced quality of life (QOL). However, in the absence of randomized trials, its prognostic benefit for patients remains debated. Over the past decade, the interest of the interventional community in CTO percutaneous coronary intervention (PCI) has exponentially grown due to important developments in dedicated equipment and techniques, resulting in high success and low complication rates. Both European and American guidelines have assigned a class IIa (level of evidence B) recommendation for CTO PCI. In the current review, we focus on the impact of CTO revascularization on clinical outcomes and QOL and on appropriate patient selection, and we provide a critical assessment of the current guidelines and recommendations on CTO PCI.
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- 2015
17. The Many Faces of Risk: A Qualitative Study of Risk in Outpatient Involuntary Treatment
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Terry Carney, Michelle Cleary, Philip Boyce, Ian Kerridge, Nick O'Connor, Edwina Light, Michael Robertson, Glenn E. Hunt, Alan Rosen, and Chris Ryan
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Male ,Risk ,medicine.medical_specialty ,Bipolar Disorder ,Attitude of Health Personnel ,Interpersonal communication ,Violence ,involuntary psychiatric treatment ,Surveys and Questionnaires ,Ambulatory Care ,medicine ,Humans ,risk of harm ,Psychiatry ,Qualitative Research ,Risk management ,Depressive Disorder ,business.industry ,Mental Disorders ,Models, Theoretical ,Anxiety Disorders ,Mental health ,Community Mental Health Services ,CTO ,Psychiatry and Mental health ,Distress ,Treatment Outcome ,Harm ,Caregivers ,risk of harm to self or others ,risk-based mental health laws ,outpatient involuntary treatment ,Involuntary treatment ,outpatient ,Schizophrenia ,Commitment of Mentally Ill ,Female ,New South Wales ,business ,Psychology ,Attitude to Health ,Self-Injurious Behavior ,Stress, Psychological ,Clinical psychology ,Qualitative research ,Meaning (linguistics) - Abstract
Objective: This study aimed to derive a conceptualisation of risk in outpatient involuntary psychiatric treatment that has utility and meaning for stakeholders. Methods: Thirty-eight participants –patients, caregivers, clinicians and legal decision makers – participated in qualitative interviews about their experiences of outpatient involuntary psychiatric treatment. Interview data was analysed using a general inductive method. Results: Six types of risk were identified: ‘actual harm’, ‘social adversity’, ‘therapeutic outcome/compromised treatment’, ‘the system’, ‘interpersonal distress’, and ‘epistemic’. There were overlaps between the discourses on risk, but variation in how different aspects of risk were emphasised. Conclusions: Based on the findings, a comprehensive model of “risk” contextualized to outpatient involuntary treatment is proposed. It incorporates the domains of “risk of harm to self or others”; “risk of social adversity”; “risk of excess distress”; and, “risk of compromised treatment”. This model may have instrumental value in the implementation and the scrutiny of risk-based mental health laws. funded by a discretionary grant from the Mental Health, Drug and Alcohol Office of NSW Health
- Published
- 2015
18. Improved recovery of regional left ventricular function after PCI of chronic total occlusion in STEMI patients: a cardiovascular magnetic resonance study of the randomized controlled EXPLORE trial
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Joëlle Elias, Ivo M. van Dongen, Loes P. Hoebers, Dagmar M. Ouweneel, Bimmer E. P. M. Claessen, Truls Råmunddal, Peep Laanmets, Erlend Eriksen, René J. van der Schaaf, Dan Ioanes, Robin Nijveldt, Jan G. Tijssen, Alexander Hirsch, José P. S. Henriques, on behalf of the EXPLORE investigators, Cardiology, Graduate School, ACS - Amsterdam Cardiovascular Sciences, Other departments, ACS - Heart failure & arrhythmias, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, and Radiology & Nuclear Medicine
- Subjects
Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Time Factors ,medicine.medical_treatment ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Infarction ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,030218 nuclear medicine & medical imaging ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Myocardial infarction ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,PCI ,Middle Aged ,Magnetic Resonance Imaging ,Treatment Outcome ,surgical procedures, operative ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Randomization ,Collateral Circulation ,Total occlusion ,STEMI ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Predictive Value of Tests ,Coronary Circulation ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Aged ,Angiology ,LV function ,business.industry ,Research ,Percutaneous coronary intervention ,Magnetic resonance imaging ,Recovery of Function ,medicine.disease ,CTO ,Coronary Occlusion ,lcsh:RC666-701 ,Chronic Disease ,Conventional PCI ,ST Elevation Myocardial Infarction ,business - Abstract
Contains fulltext : 177042.pdf (Publisher’s version ) (Open Access) BACKGROUND: The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) trial did not show a significant benefit of percutaneous coronary intervention (PCI) of the concurrent chronic total occlusion (CTO) in ST-segment elevation myocardial infarction (STEMI) patients on global left ventricular (LV) systolic function. However a possible treatment effect will be most pronounced in the CTO territory. Therefore, we aimed to study the effect of CTO PCI compared to no-CTO PCI on the recovery of regional LV function, particularly in the CTO territory. METHODS: Using cardiovascular magnetic resonance (CMR) we studied 180 of the 302 EXPLORE patients with serial CMR (baseline and 4 months follow-up). Segmental wall thickening (SWT) was quantified on cine images by an independent core laboratory. Dysfunctional segments were defined as SWT < 45%. Dysfunctional segments were further analyzed by viability (transmural extent of infarction (TEI)
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- 2017
19. The Role for Adjunctive Image in Pre-procedural Assessment and Peri-Procedural Management in Chronic Total Occlusion Recanalisation
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Rodrigo Estévez-Loureiro, Pilar Agudo, Carlo Di Mario, Matteo Ghione, Kadriye Orta Kilickesmez, and Alistair C. Lindsay
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Coronary angiography ,medicine.medical_specialty ,medicine.medical_treatment ,Contrast Media ,Coronary Angiography ,Total occlusion ,Article ,Optical coherence tomography ,MSCT ,Intravascular ultrasound ,Occlusion ,Algorithms ,Chronic Disease ,Coronary Occlusion ,Humans ,Stents ,medicine ,IVUS ,medicine.diagnostic_test ,business.industry ,Stent ,General Medicine ,Reentry ,CTO ,PCI ,Angiography ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Non invasive coronary angiography with multislice computed tomography has exquisite sensitivity to detect calcium and even the faintest late contrast filling of the distal vessel. Calcium burden and occlusion length are still valuable markers of duration, complexity and success of the recanalisation procedure. The ability to visualise the vessel also in the occluded segment, especially if calcified, can also help the operator to understand where to pierce the proximal cap in stumpless occlusions and to predict unusual courses, especially in very tortuous arteries. Imaging side by side CT images and angiography during the recanalisation procedure is an established practice in many active CTO laboratories and algorithms for co-registration are designed to overcome the challenges of systo-diastolic and respiratory motion. Intravascular ultrasound is used in almost all cases by the experienced Japanese CTO operators but most of the times its main use is a better identification of the diseased segment after predilatation to ensure complete stent cover and appropriate stent expansion, an application similar to other complex non occlusive lesions. The specificity of IVUS during CTO recanalisation is the identification of the vessel path in stumpless occlusions and the guidance of wire reentry especially during reverse Controlled Retrograde Anterograde Tracking. Optical coherence tomography has limitations in the setting of CTO recanalisation because of the need of forceful contrast flushing to clear blood, contraindicated in the presence of anterograde dissections, and the limited penetration. The variability in the use of both non-invasive and invasive imaging during CTO recanalisation is immense, going from more than 90% in Japan to less than 20% in Europe and intermediate penetration in the USA. Probably the explanation is almost only in availability and cost because all countries see a progressive increase of use suggesting that these methods are becoming an established tool for guidance of CTO recanalisation.
- Published
- 2014
20. Bifurcation CTO recanalization with contemporary antegrade and retrograde techniques in a patient with two chronically occluded coronary arteries
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Georgios Sofidis, Vasileios Kolettas, Georgios Sianos, Haralambos Karvounis, and Nikolaos V. Konstantinidis
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Medicine(all) ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Collateral circulation ,J-CTO ,business.industry ,030204 cardiovascular system & hematology ,Coronary arteries ,CTO ,Chronic total occlusion ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,lcsh:RC666-701 ,Internal medicine ,Retrograde approach ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
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21. Changing strategies of the retrograde approach for chronic total occlusion during the past 7 years
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Lefeng Wang, Reiko Tsukahara, Robert de Winter, Yoshiaki Ito, Hai-chang Wang, Khaled Shokry, Jiyan Chen, Toshiya Muramatsu, Hiroshi Ishimori, Seung-Jung Park, Amsterdam Cardiovascular Sciences, and Cardiology
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Perforation (oil well) ,Collateral Circulation ,Prosthesis Design ,Radiography, Interventional ,Cardiac Catheters ,Percutaneous Coronary Intervention ,Coronary Circulation ,Occlusion ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Retrograde approach ,Aged ,E-Only: Coronary Artery Disease ,business.industry ,Percutaneous coronary intervention ,PCI ,Equipment Design ,General Medicine ,Middle Aged ,Collateral circulation ,Surgery ,CTO ,Dissection ,Treatment Outcome ,Coronary Occlusion ,Coronary occlusion ,Chronic Disease ,Conventional PCI ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective We reviewed the technical changes and results achieved with the retrograde approach since we introduced it 7 years ago. Subjects and Methods The subjects were 1,268 patients who were treated for CTO between January 2004 and December 2010. They were investigated with respect to the success rate, the frequency of employing the retrograde approach and its outcome, and other factors. Results The retrograde approach was employed in ∼30% of chronic total occlusion (CTO) patients (n = 281) and the retrograde guidewire success rate was 81.1%. The kissing wire technique was substituted for the retrograde approach in 126 of the 281 patients, with antegrade crossing of a guidewire being successful in 88 of them (70%). The retrograde approach was combined with the CART and reverse controlled antegrade retrograde tracking (CART) techniques in 22 and 21 patients, respectively. Among 83 patients treated with Corsair catheters, crossing of the CTO was achieved in 63. The overall procedural success rate was 79.7% (224 patients). Complications of the retrograde approach included collateral channel dissection (2.1%), channel perforation (1.7%), CTO perforation (1.7%), and donor artery occlusion (1.1%). Conclusion The success rate and safety of the retrograde approach are both satisfactory if the appropriate devices and techniques are selected. © 2012 Wiley Periodicals, Inc.
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- 2013
22. How shortcomings in the mental health system affect the use of involuntary community treatment orders
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Philip Boyce, Ian Kerridge, Michelle Cleary, Glenn E. Hunt, Alan Rosen, Terry Carney, Michael Robertson, Chris Ryan, Nick O'Connor, and Edwina Light
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Adult ,Male ,medicine.medical_specialty ,qualitative study ,Population health ,Health Services Accessibility ,Interviews as Topic ,03 medical and health sciences ,involuntary community treatment orders ,0302 clinical medicine ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Psychiatry ,Qualitative Research ,Government ,Health economics ,business.industry ,Health Policy ,Public health ,Mental Disorders ,Involuntary Treatment ,mental health system ,Mental health ,Community Mental Health Services ,030227 psychiatry ,CTO ,Involuntary treatment ,Health Policy & Services ,Female ,New South Wales ,business ,policy ,Qualitative research - Abstract
Objective The aim of the present study was to examine stakeholder perspectives on how the operation of the mental health system affects the use of involuntary community treatment orders (CTOs). Methods A qualitative study was performed, consisting of semi-structured interviews about CTO experiences with 38 purposively selected participants in New South Wales (NSW), Australia. Participants included mental health consumers (n = 5), carers (n = 6), clinicians (n = 15) and members of the Mental Health Review Tribunal of NSW (n = 12). Data were analysed using established qualitative methodologies. Results Analysis of participant accounts about CTOs and their role within the mental health system identified two key themes, namely that: (1) CTOs are used to increase access to services; and (2) CTOs cannot remedy non-existent or inadequate services. Conclusion The findings of the present study indicate that deficiencies in health service structures and resourcing are a significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntary and involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulating CTO implementation. What is known about this topic? Following the deinstitutionalisation of psychiatric services over recent decades, community settings are increasingly the focus for the delivery of mental health services to people living with severe and persistent mental illnesses. The rates of use of involuntary treatment in Australian community settings (under CTOs) vary between state and territory jurisdictions and are high by world standards; however, the reasons for variation in rates of CTO use are not well understood. What does this paper add? This paper provides an empirical basis for a link between the politics of mental health and the uptake and usefulness of CTOs. What are the implications for practitioners? This paper makes explicit the real-world demands on the mental health system and how service deficiencies are a significant determinant in the use of CTOs. Practitioners and policy makers need to be candid about system limitations and how they factor in clinical and legal justifications for using involuntary treatment. The results of the present study provide data to support advocacy to improve policy accountability and resourcing of community mental health services.
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- 2016
23. Balloon anchoring intraluminal tracking technique: a new application of an old technique for coronary artery chronic total occlusion percutaneous intervention
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Paolo Ravagnani, Giovanni Teruzzi, Hazem Khamis, Alessandro Lualdi, Antonio L. Bartorelli, Marouane Boukhris, Stefano Galli, Giovanni Monizzi, Alfredo R. Galassi, Daniela Trabattoni, Luca Grancini, and Piero Montorsi
- Subjects
Coronary angiography ,Male ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Balloon ,Coronary Angiography ,Radiography, Interventional ,Total occlusion ,Cardiac Catheters ,03 medical and health sciences ,0302 clinical medicine ,CTO ,PCI ,Angioplasty ,Medicine ,Humans ,030212 general & internal medicine ,Angioplasty, Balloon, Coronary ,business.industry ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,Coronary Vessels ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Coronary Occlusion ,Coronary occlusion ,Chronic Disease ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Artery - Published
- 2016
24. Predictive scores in chronic total occlusions percutaneous recanalization: only fashionable or really useful?
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Marouane Boukhris, Alfredo R. Galassi, Zied Ibn Elhadj, and Kambis Mashayekhi
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,General surgery ,MEDLINE ,Percutaneous coronary intervention ,Surgery ,CTO ,Correspondence ,Conventional PCI ,medicine ,business - Abstract
Chronic total occlusions (CTOs) remain one of the last challenges in percutaneous coronary intervention (PCI). During the last decade, following the Japanese pioneers, the interest of interventionalists’ community in CTO PCI has dramatically increased leading to an important development in equipment and techniques (1,2), and a growing expertise among dedicated operators, both resulting in increased success rates (3).
- Published
- 2016
25. Multimodality Imaging Evaluation of Functional and Clinical Benefits of Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion Lesion
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Feng Cao, Jie Tian, Joseph C. Wu, Chunhong Li, Yabing Wang, Dongjuan Wang, Haichang Wang, Kazim H. Narsinh, Chengxiang Li, Jing Wang, Xiaowei Ma, Dongdong Sun, and Yue Tian
- Subjects
Cardiac function curve ,medicine.medical_specialty ,medicine.medical_treatment ,Medicine (miscellaneous) ,Single-photon emission computed tomography ,Computed tomography coronary angiography ,Percutaneous coronary intervention ,Lesion ,CTCA ,Internal medicine ,medicine ,cardiovascular diseases ,Pharmacology, Toxicology and Pharmaceutics (miscellaneous) ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,PCI ,Coronary arteries ,Chronic total occlusion ,CTO ,surgical procedures, operative ,medicine.anatomical_structure ,SPECT ,Conventional PCI ,cardiovascular system ,Cardiology ,Radiology ,medicine.symptom ,business ,Research Paper ,Artery - Abstract
Aims: To determine the effects of percutaneous coronary intervention (PCI) on cardiac perfusion, cardiac function, and quality of life in patients with chronic total occlusion (CTO) lesion in left anterior descending (LAD) coronary artery. Methods and Results: Patients (n=99) with CTO lesion in the LAD coronary artery who had successfully undergone PCI were divided into three groups based on the SPECT/CTCA fusion imaging: (a) no severe cardiac perfusion defects (n=9); (b) reversible cardiac perfusion defects (n=40); or (c) fixed cardiac perfusion defects (n=50). No statistical difference of perfusion abnormality was observed at 6 months and 1 year after PCI in group (a). In group (b), SPECT/CTCA fusion imaging demonstrated that cardiac perfusion abnormality was significantly decreased 6 month and 1 year after PCI. Left ventricular ejection fraction (LVEF) increased significantly at 6 months and 1 year follow up. Quality of life improved at 6 months and 1 year after PCI procedure. Moreover, patients in group (c) also benefited from PCI therapy: a decrease in cardiac perfusion abnormality, an increase in LVEF, and an improvement in quality of life. PCI of coronary arteries in addition to LAD did not significantly affect cardiac function and quality of life improvement in each group. Conclusions: PCI exerts functional and clinical benefits in patients with CTO lesion in LAD coronary artery, particularly in patients with reversible cardiac perfusion defects. SPECT/CTCA fusion imaging may serve as a useful tool to evaluate the outcomes of patients with CTO lesion in LAD coronary artery.
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- 2012
26. Usefulness of SYNTAX score II in complex percutaneous coronary interventions in the setting of acute coronary syndrome
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Hazem Khamis, Marouane Boukhris, Hosam Mohamad Abdelbasset, Salvatore D. Tomasello, Rocco Giunta, Francesco Marzà, Alfredo R. Galassi, Marine Castaing, Simona Giubilato, and Azzarelli Salvatore
- Subjects
Acute coronary syndrome ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,Percutaneous coronary intervention ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,CTO ,PCI ,Internal medicine ,Full Length Article ,medicine ,030212 general & internal medicine ,Myocardial infarction ,education ,Stroke ,education.field_of_study ,business.industry ,Hazard ratio ,Syntax score II ,medicine.disease ,Conventional PCI ,Cardiology ,business ,Severe coronary artery disease - Abstract
BackgroundSYNTAX score II (SS II) integrates anatomical SS with clinical characteristics allowing an individualized prediction of long-term mortality.AimsWe sought to assess to evaluate the usefulness of SS II in a real-world acute coronary syndromes (ACS) population with severe coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).MethodsFrom August 2011 to May 2013, out of 1591 consecutive patients admitted for ACS, 217 (13.6%) showed severe CAD (three-vessel disease and/or left main involvement). Among the latter, 100 patients underwent PCI and were enrolled into the study. SS II was calculated in all patients. One-year clinical follow-up was performed; major adverse cardiac and cerebrovascular events (MACCE) were defined as a composite of death, nonfatal myocardial infarction, stroke, or repeat revascularization.ResultsThe median SS II was 29 (range, 14–59). Overall, MACCE occurred in 25% of patients (cardiac death 4%, myocardial infarction 4%, stroke 0%, and repeat revascularization 17%). The 1-year MACCE-free survival was significantly lower in patients with SS (⩾29), than in those with SS II (
- Published
- 2015
27. Challenges in coronary CTO intervention after TAVR: a case report and discussion
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Ashish Pershad and Shishir Murarka
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Male ,medicine.medical_specialty ,Transcatheter aortic ,RD1-811 ,medicine.medical_treatment ,Coronary ,Case Report ,TAVR ,Revascularization ,Coronary Angiography ,Transcatheter Aortic Valve Replacement ,Percutaneous Coronary Intervention ,Valve replacement ,Internal medicine ,Intervention (counseling) ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,business.industry ,PCI ,Aortic Valve Stenosis ,Middle Aged ,Coronary revascularization ,Coronary Vessels ,Coronary arteries ,Coronary ostium ,CTO ,medicine.anatomical_structure ,Coronary Occlusion ,Echocardiography ,RC666-701 ,Fluoroscopy ,Conventional PCI ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Progression of coronary arteries after transcatheter aortic valve replacement is an important issue. Coronary revascularization in these patients can be challenging because of potential hindrance posed by the artificial valve structure in getting access to the coronary ostium. This gets even more difficult in chronic total occlusions (CTOs) that represent the most complex subset of coronary lesions. We report the first case of coronary CTO revascularization in a patient who underwent TAVR a few months prior and discuss the complexities involved in intervening such lesions.
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- 2014
28. Retrograde recanalization of an in-stent ostial chronically occluded right coronary artery
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Corrado Tamburino, Luca Costanzo, Salvatore D. Tomasello, Alfredo R. Galassi, Galassi A.R., Tomasello S.D., Costanzo L., and Tamburino C.
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medicine.medical_specialty ,Surgical approach ,business.industry ,medicine.medical_treatment ,Stent ,PCI ,equipment and supplies ,Balloon ,Retrograde approach ,Surgery ,CTO ,Ostium ,surgical procedures, operative ,Right coronary artery ,medicine.artery ,Conventional PCI ,Guiding catheter ,Medicine ,cardiovascular diseases ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
We describe a case of a chronic proximal in-stent CTO extending up to the ostium of a right coronary artery where successful achievement of guidewire passage through the CTO was performed with a retrograde approach. Guidewire trapping into the right guiding catheter was performed thereafter and procedure was completed by retrograde balloon crossing and antegrade stenting. © 2009 Elsevier Ireland Ltd.
- Published
- 2010
29. Improvement of myocardial function and perfusion after successful percutaneous revascularization in patients with chronic total coronary occlusion
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Xavier Rossello, Antonio Barros, Xavier Alomar, Juan Cinca, Francesc Carreras, Manel Sabaté, Rubén Leta, Sandra Pujadas, Victoria Martin, and Guillem Pons-Lladó
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Male ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Ischemic heart disease ,Myocardial Ischemia ,Ischemia ,Magnetic Resonance Imaging, Cine ,Revascularization ,Coronary artery disease ,Myocardial perfusion ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Aged ,business.industry ,Percutaneous coronary intervention ,Stroke Volume ,Middle Aged ,medicine.disease ,CTO ,Treatment Outcome ,surgical procedures, operative ,Coronary Occlusion ,Coronary occlusion ,Chronic Disease ,Conventional PCI ,Cardiology ,Female ,Cardiovascular magnetic resonance ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,therapeutics ,Perfusion ,Follow-Up Studies - Abstract
Background: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of a coronary artery can provide benefits in terms of myocardial function and survival but the procedure is complex and the success rate is relatively low. To assess these benefits, myocardial function, ischemia and viability should be clearly determined by means of a reliable diagnostic test. This study aimed to assess ventricular function and myocardial ischemia before and after PCI for CTO using cardiac magnetic resonance (CMR). NYHA functional class was also assessed before and after PCI. Methods and results: CMR studies were performed in 43 consecutive patients (7 females; aged 64 +/- 9.6 y. o.) with CTO scheduled for PCI and repeated 6 months post-PCI. PCI was successful in 33 (77%) of them. In this group CMR had shown inducible perfusion defects in 26 (79%) before PCI, while they were observed in 10 (30%) post-PCI CMR study (p < 0.001). The number of segments showing inducible perfusion defect (3.4 +/- 2 prevs. 2.9 +/- 4.5 post-PCI, p = 0.002) was significantly reduced in this group. Regional contractile function of segments showing viability also improved significantly in the group with successful CTO PCI compared to the group with an unsuccessful procedure. NYHA functional class for angina also improved in patients with successful revascularization while it remained unchanged in the group with unsuccessful procedures. Conclusions: A successful CTO PCI leads to a reduction in inducible myocardial ischemia and to an improvement in regional wall motion, which results in clinical improvement. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
- Published
- 2013
30. Iterative Closest Curve: A Framework for Curvilinear Structure Registration Application to 2D/3D Coronary Arteries Registration
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Grégoire Malandain, Régis Vaillant, Thomas Benseghir, Analysis and Simulation of Biomedical Images (ASCLEPIOS), Inria Sophia Antipolis - Méditerranée (CRISAM), Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), General Electric Medical Systems [Buc] (GE Healthcare), General Electric Medical Systems, Morphologie et Images (MORPHEME), Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Institut de Biologie Valrose (IBV), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA)-Signal, Images et Systèmes (Laboratoire I3S - SIS), Laboratoire d'Informatique, Signaux, et Systèmes de Sophia Antipolis (I3S), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA)-Laboratoire d'Informatique, Signaux, et Systèmes de Sophia Antipolis (I3S), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA)-Centre National de la Recherche Scientifique (CNRS), Mori, Kensaku and Sakuma, Ichiro and Sato, Yoshinobu and Barillot, Christian and Navab, Nassir, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA)-Université Nice Sophia Antipolis (1965 - 2019) (UNS), and COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA)-Université Nice Sophia Antipolis (1965 - 2019) (UNS)
- Subjects
curvilinear structure ,Computer science ,Structure (category theory) ,02 engineering and technology ,030218 nuclear medicine & medical imaging ,X-ray ,03 medical and health sciences ,0302 clinical medicine ,registration ,[INFO.INFO-IM]Computer Science [cs]/Medical Imaging ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Computer vision ,chronic total occlusion ,coronary ,Computed tomography angiography ,Curvilinear coordinates ,CTA ,medicine.diagnostic_test ,business.industry ,Iterative closest point ,ICP ,Coronary arteries ,CTO ,medicine.anatomical_structure ,[INFO.INFO-TI]Computer Science [cs]/Image Processing [eess.IV] ,Pattern recognition (psychology) ,Angiography ,020201 artificial intelligence & image processing ,Artificial intelligence ,Tomography ,business ,computed tomography angiography - Abstract
International audience; Treatment coronary arteries endovascular involves catheter navigation through patient vasculature. The projective angiography guidance is limited in the case of chronic total occlusion where occluded vessel can not be seen. Integrating standard preoperative CT angiography information with live fluoroscopic images addresses this limitation but requires alignment of both modalities. This article proposes a structure-based registration method that intrinsically preserves both the geometrical and topological coherencies of the vascular centrelines to be registered, by the means of a dedicated curve-to-curve distance pairs of closest curves are identified, while pairing their points. Preliminary experiments demonstrate that the proposed approach performs better than the standard Iterative Closest Point method giving a wider attraction basin and improved accuracy.
- Published
- 2013
31. Prognostic value of exercise myocardial scintigraphy in patients with coronary chronic total occlusions
- Author
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Giombattista Barrano, Gerald S. Werner, Luca Costanzo, Alfredo R. Galassi, Corrado Tamburino, Salvatore Azzarelli, Mariabarbara Campisano, Davide Capodanno, Francesco Marzà, Salvatore D. Tomasello, Galassi A.R., Werner G.S., Tomasello S.D., Azzarelli S., Capodanno D., Barrano G., Marza' F., Costanzo L., Campisano M., and Tamburino C.
- Subjects
Male ,medicine.medical_specialty ,Heart Diseases ,medicine.medical_treatment ,Coronary Angiography ,Risk Assessment ,Myocardial perfusion imaging ,Organophosphorus Compounds ,Predictive Value of Tests ,Internal medicine ,Coronary Circulation ,medicine ,scintigraphy ,Humans ,cto ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Aged ,Proportional Hazards Models ,Tomography, Emission-Computed, Single-Photon ,Ejection fraction ,exercise ,medicine.diagnostic_test ,business.industry ,Unstable angina ,Incidence (epidemiology) ,Myocardial Perfusion Imaging ,Percutaneous coronary intervention ,myocardial ,Organotechnetium Compounds ,Middle Aged ,medicine.disease ,Prognosis ,Coronary Occlusion ,Conventional PCI ,Chronic Disease ,Cardiology ,Exercise Test ,Female ,Radiopharmaceuticals ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Follow-Up Studies - Abstract
Objectives: To evaluate the prognostic value of exercise myocardial scintigraphy in patients undergoing incomplete revascularization by means of percutaneous coronary intervention (PCI) with at least a residual chronic total occlusion (CTO) left untreated. Methods: Of 569 consecutive patients with multivessel disease undergoing myocardial scintigraphy after incomplete revascularization by PCI between March 1997 and December 2004, 126 (79% male, 64 ± 10 years) with ≥ 1 residual CTO fulfilled the eligibility criteria and entered in the study. Hard events defined as cardiac death and myocardial infarction, soft events defined as incidence of unstable angina and PCI procedures, and their composite were assessed at a median follow-up period of 44 months. Results: Hard events were observed in six patients (4.8%). All of them had severely abnormal perfusion defects detected by myocardial scintigraphy. Soft events occurred in 0 (0%), 10 (7.9%), and 15 (11.9%) patients with normal, mildly abnormal, and severely abnormal perfusion, respectively. In the Kaplan-Meier analysis, the log-rank test was statistically significant across patients stratified by summed stress score either in terms of hard, soft and hard, or soft events. Univariate and multivariate Cox proportional-hazards showed an incremental significant information when the scintigraphic variables were added to clinical, angiographic, left ventricular ejection fraction, and Duke treadmill score, for prediction of the composite of hard and soft cardiac events (P < 0.006). Conclusions: Among patients with a residual CTO left untreated after PCI, myocardial perfusion imaging provides significant independent information concerning the subsequent risk of cardiac events. (J Interven Cardiol 2010;23:139-148) © 2010, Wiley Periodicals, Inc.
- Published
- 2010
32. Highlights and essentials from the first 'experts-live' course of the EuroCTO club
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Salvatore D. Tomasello, Hans Bonnier, Luca Costanzo, George Sianos, Gerald S. Werner, Alfredo R. Galassi, Nicolaus Reifart, Galassi A.R., Werner G.S., Sianos G., Bonnier H., Tomasello S.D., Costanzo L., and Reifart N.
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,High radiation ,CTO ,Conventional PCI ,medicine ,Club ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Confusion - Abstract
Chronic total occlusions (CTOs) are frequently encountered during diagnostic coronary catheterisation. However, there is still confusion regarding the indication for percutaneous coronary intervention (PCI) in this lesion subset, mainly because it is cumbersome and the prognostic impact of revascularisation in these patients remains unclear. Many studies have now shown the long term clinical benefits after CTO PCI1-3; still, with procedural complexity, high radiation exposure to both the patient and the operator, high costs and lower procedural success rates, most patients with CTO are managed medically or referred for bypass graft surgery – regardless of the severity of symptoms and extent of ischaemia4.
- Published
- 2010
33. Recanalization of complex coronary chronic total occlusions using high-frequency vibrational energy CROSSER catheter as first-line therapy: A single center experience
- Author
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Alfredo R. Galassi, Corrado Tamburino, Luca Costanzo, Salvatore D. Tomasello, Maria Barbara Campisano, Francesco Marzà, Galassi A.R., Tomasello S.D., Costanzo L., Campisano M.B., MarzA F., and Tamburino C.
- Subjects
Male ,medicine.medical_specialty ,Percutaneous ,Time Factors ,medicine.medical_treatment ,Perforation (oil well) ,Contrast Media ,Revascularization ,Vibration ,Catheterization ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Aged ,Ejection fraction ,Dose-Response Relationship, Drug ,business.industry ,Percutaneous coronary intervention ,Equipment Design ,Recanalization ,Middle Aged ,medicine.disease ,CROSSER ,Surgery ,Catheter ,CTO ,Treatment Outcome ,Coronary Occlusion ,Fluoroscopy ,Chronic Disease ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
Background: Several studies have illustrated the safety and the procedural outcome of high-frequency vibrational energy in guidewire refractory chronic total occlusions (CTOs). Aim: To evaluate the advantage of high-frequency vibrational energy device (CROSSER Catheter) use in coronary complex CTO revascularization as primary strategy. Methods: CROSSER was used as a primary approach if four or more unfavorable angiographic features were observed in the CTO lesions. Results: From May 2007 to February 2009, a CTO percutaneous intervention attempt was performed in 178 lesions of 171 patients (60.1 ± 8.9 age with 49.4 ± 7.2% in ejection fraction). Among these, the CROSSER was used in 46 complex CTO lesions of 45 patients (25.8% of cases) and in the remaining cases, typical CTO percutaneous coronary intervention techniques were employed. Clinical success was 84.8% in CROSSER group. Moreover, in the CROSSER group, no periprocedural myocardial infarction, perforation, or 30 days MACE was observed. In addition, the use of CROSSER was associated with lower time of procedure, time of fluoroscopy, and contrast load administration as compared with conventional techniques [88 ± 27 minutes vs 109 ± 38 minutes (P = 0.045), 39 ± 12 minutes vs 50 ± 27 minutes (P = 0.032), and 334 ± 122cc vs 408 ± 198cc (P = 0.05), respectively]. Conclusion: In the present study, the CROSSER System was safe and obtained a high rate of success in complex CTO similar to conventional dedicated guidewire techniques for noncomplex CTO; however, the CROSSER Catheter obtained CTO recanalization with lower contrast load administration, less time of procedure, and lower fluoroscopy exposure. (J Interven Cardiol 2010;23:130-138)
- Published
- 2010
34. Success in chronic total occlusion: 'benefit for the patient' or 'satisfaction for the operator'?
- Author
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Vedat Aytekin
- Subjects
lcsh:Internal medicine ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Attitude of Health Personnel ,lcsh:Medicine ,Total occlusion ,cto ,Percutaneous Coronary Intervention ,Operator (computer programming) ,Internal medicine ,new devices ,medicine ,Humans ,success rate ,lcsh:RC31-1245 ,business.industry ,lcsh:R ,medicine.disease ,Treatment Outcome ,Coronary Occlusion ,Patient Satisfaction ,lcsh:RC666-701 ,Practice Guidelines as Topic ,Cardiology ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business - Published
- 2013
35. 'Putting it all together': Highlighting the global approach to chronic total occlusion revascularization
- Author
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Ashish Pershad, Divya Ratan Verma, Mohamad Lazkani, and Michael F. Morris
- Subjects
Coronary angiography ,Male ,medicine.medical_specialty ,Time Factors ,RD1-811 ,medicine.medical_treatment ,Case Report ,030204 cardiovascular system & hematology ,Revascularization ,Coronary Angiography ,Total occlusion ,Coronary artery disease ,Percutaneous coronary intervention ,03 medical and health sciences ,0302 clinical medicine ,Imaging, Three-Dimensional ,Internal medicine ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,030212 general & internal medicine ,CORG ,Coronary bypass grafts ,Ultrasonography, Interventional ,Aged ,Practice patterns ,business.industry ,Follow up studies ,medicine.disease ,Coronary Vessels ,CTO ,Coronary Occlusion ,Coronary occlusion ,RC666-701 ,Chronic Disease ,Cardiology ,Surgery ,business ,Cardiology and Cardiovascular Medicine ,Tomography, X-Ray Computed ,Follow-Up Studies - Abstract
Preprocedural planning and advanced imaging is vital to achieve a consistent and high level of success for complex coronary chronic total occlusion (CTO) revascularization. Various practice patterns exist around the world when performing coronary artery CTO revascularization. This case report highlights a fusion of global practices in CTO intervention and integration of advanced imaging to achieve successful revascularization.
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