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9. Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention

Author

Brilakis, ES, Mashayekhi, K, Tsuchikane, E, Abi Rafeh, N, Alaswad, K, Araya, M, Avran, A, Azzalini, L, Babunashvili, AM, Bayani, B, Bhindi, R, Boudou, N, Boukhris, M, Božinović, NŽ, Bryniarski, L, Bufe, A, Buller, CE, Burke, MN, Büttner, HJ, Cardoso, P, Carlino, M, Christiansen, EH, Colombo, A, Croce, K, Damas de Los Santos, F, De Martini, T, Dens, J, Di Mario, C, Dou, K, Egred, M, ElGuindy, AM, Escaned, J, Furkalo, S, Gagnor, A, Galassi, AR, Garbo, R, Ge, J, Goel, PK, Goktekin, O, Grancini, L, Grantham, JA, Hanratty, C, Harb, S, Harding, SA, Henriques, JPS, Hill, JM, Jaffer, FA, Jang, Y, Jussila, R, Kalnins, A, Kalyanasundaram, A, Kandzari, DE, Kao, H-L, Karmpaliotis, D, Kassem, HH, Knaapen, P, Kornowski, R, Krestyaninov, O, Kumar, AVG, Laanmets, P, Lamelas, P, Lee, S-W, Lefevre, T, Li, Y, Lim, S-T, Lo, S, Lombardi, W, McEntegart, M, Munawar, M, Navarro Lecaro, JA, Ngo, HM, Nicholson, W, Olivecrona, GK, Padilla, L, Postu, M, Quadros, A, Quesada, FH, Prakasa Rao, VS, Reifart, N, Saghatelyan, M, Santiago, R, Sianos, G, Smith, E, C Spratt, J, Stone, GW, Strange, JW, Tammam, K, Ungi, I, Vo, M, Vu, VH, Walsh, S, Werner, GS, Wollmuth, JR, Wu, EB, Wyman, RM, Xu, B, Yamane, M, Ybarra, LF, Yeh, RW, Zhang, Q, and Rinfret, S

Subjects
Percutaneous Coronary Intervention, Treatment Outcome, Coronary Occlusion, Chronic Disease, Practice Guidelines as Topic, Collateral Circulation, Humans, Coronary Angiography, Coronary Vessels
Abstract

Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.

Published
2019

12. Cardiopulmonary exercise testing and its application

Author

Albouaini, K., Egred, M., Alahmar, A., and Wright, D.J.

Subjects
Exercise tests -- Usage, Heart failure -- Diagnosis, Exercise -- Physiological aspects, Exercise -- Research, Health
Published
2007

21. Everolimus-eluting stents or bypass surgery for left main coronary artery disease

Author

Stone, Gw, Sabik, Jf, Serruys, Pw, Simonton, Ca, Généreux, P, Puskas, J, Kandzari, De, Morice, Mc, Lembo, N, Brown WM 3rd, Taggart, Dp, Banning, A, Merkely, B, Horkay, F, Boonstra, Pw, van Boven AJ, Ungi, I, Bogáts, G, Mansour, S, Noiseux, N, Sabaté, M, Pomar, J, Hickey, M, Gershlick, A, Buszman, P, Bochenek, A, Schampaert, E, Pagé, P, Dressler, O, Kosmidou, I, Mehran, R, Pocock, Sj, Kappetein, Ap, van Es GA, Leon, Mb, Gersh, B, Chaturvedi, S, Kint, Pp, Valgimigli, M, Colombo, A, Costa, M, Di Mario, C, Ellis, S, Fajadet, J, Fearon, W, Kereiakes, D, Makkar, R, Mintz, Gs, Moses, Jw, Teirstein, P, Ruel, M, Sergeant, P, Mack, M, Fontana, G, Mohr, Fw, Nataf, P, Smith, C, Boden, B, Fox, K, Maron, D, Steg, G, Blackstone, E, Juni, P, Parise, H, Wallentin, L, Bertrand, M, Krucoff, M, Turina, M, Ståhle, E, Tijssen, J, Brill, D, Atkins, C, Applegate, B, Argenziano, M, Faly, Rc, Dauerman, H, Davidson, C, Griffith, B, Reisman, M, Rizik, D, Sakwa, M, Shemin, R, Romano, M, Hamm, C, Gummert, J, Tamburino, C, Alfieri, O, Savina, C, de Bruyne, B, Machado, Fp, Uva, S, Moccetti, T, Siclari, F, Hildick Smith, D, Szekely, L, Erglis, A, Stradins, P, Abizaid, A, Bento Sousa LC, Belardi, J, Navia, D, Park, Sj, Lee, Jw, Meredith, I, Smith, J, Yehuda, Ob, Schneijdenberg, R, Ronden, J, Jonk, J, Jonkman, A, van Remortel, E, de Zwart, I, Elshout, L, de Vries, T, Andreae, R, Tol van, J, Teurlings, E, Balachandran, S, Breazna, A, Jenkins, P, Mcandrew, T, Marx, So, Connolly, Mw, Hong, Mk, Weinberger, J, Wong, Sc, Dizon, J, Biviano, A, Morrow, J, Wang, D, Corral, M, Alfonso, M, Sanchez, R, Wright, D, Djurkovic, C, Lustre, M, Jankovic, I, Sanidas, E, Lasalle, L, Maehara, A, Matsumura, M, Sun, E, Iacono, S, Greenberg, T, Jacobson, J, Pullano, A, Gacki, M, Liu, S, Cohen, Dj, Magnuson, E, Baron, Sj, Wang, K, Traylor, K, Worthley, S, Stuklis, R, Barbato, E, Stockman, B, Dubois, C, Meuris, B, Vrolix, M, Dion, R, Bento de Souza LC, Costantini, C, Woitowicz, V, Hueb, W, Stolf, N, Beydoun, H, Baskett, R, Curtis, M, Kieser, T, Doucet, S, Pellerin, M, Hamburger, J, Cook, R, Kutryk, M, Peterson, M, Madan, M, Fremes, S, Mehta, S, Cybulsky, I, Prabhakar, M, Peniston, C, Welsh, R, Macarthur, R, Berland, J, Bessou, Jp, Carrié, D, Glock, Y, Darremont, O, Deville, C, Grimaud, Jp, Soula, P, Lefèvre, T, Maupas, E, Durrleman, N, Silvestri, M, Houel, R, Pratt, A, Francis, J, Van Belle, E, Vicentelli, A, Luchner, A, Hilker, M, Endemann, Dh, Felix, S, Wollert, Hg, Walther, T, Erbel, R, Jacob, H, Kahlert, P, Kupatt, C, Näbauer, M, Schmitz, C, Scholtz, W, Börgermann, J, Schuler, G, Borger, M, Davierwala, P, Fontos, G, Székely, L, Bedogni, F, Panisi, P, Berti, S, Glauber, M, Marzocchi, A, Di Bartolomeo, R, Merlo, M, Guagliumi, G, Fenili, F, Napodano, M, Gerosa, G, Ribichini, F, Faggian, Giuseppe, Saccà, S, Giacomin, A, Mignosa, C, Tumscitz, C, Savini, C, Van Mieghem, N, von Birgelen, C, Grandjean, J, Kubica, J, Anisimowicz, L, Zmudka, K, Sadowski, J, Hernández García, J, Such, M, Macaya, C, Rodríguez Hernández JE, Maroto, L, Serra, A, Padro, J, Tenas, Ms, De Souza, A, Egred, M, Clark, S, Trivedi, U, Jain, A, Uppal, R, Redwood, S, Young, C, Stables, Rh, Pullan, M, Uren, N, Pessotto, R, Abu Fadel, M, Peyton, M, Allaqaband, S, O’Hair, D, Bachinsky, W, Mumtaz, M, Blankenship, J, Casale, A, Brott, B, Davies, J, Brown, D, Cannon, L, Talbott, J, Chang, G, Macheers, S, Choi, J, Henry, C, Cutlip, D, Khabbaz, K, Das, G, Liao, K, Diver, D, Thayer, J, Dobies, D, Fliegner, K, Fischbein, M, Feldman, T, Pearson, P, Foster, M, Briggs, R, Giugliano, G, Engelman, D, Gordon, P, Ehsan, A, Grantham, J, Allen, K, Grodin, J, Jessen, M, Gruberg, L, Taylor JR Jr, Gupta, S, Hermiller J., Jr, Heimansohn, D, Iwaoka, R, Chan, B, Kander, Nh, Duff, S, Brown, W, Karmpaliotis, D, Kini, A, Filsoufi, F, Kong, D, Lin, S, Kutcher, M, Kincaid, E, Leya, F, Bakhos, M, Liberman, H, Halkos, M, Lips, D, Eales, F, Mahoney, P, Rich, J, Barreiro, C, Cheng, W, Metzger, C, Greenfield, T, Moses, J, Palacios, I, Macgillivray, T, Perin, E, Del Prete, J, Pompili, V, Kilic, A, Ragosta, M, Kron, I, Rashid, J, Mueller, D, Riley, R, Reimers, C, Patel, N, Resar, J, Shah, A, Schneider, J, Landvater, L, Reardon, M, Shavelle, D, Baker, C, Singh, J, Maniar, H, Wei, L, Strain, J, Zapolanski, A, Taheri, H, Ad, N, Tannenbaum, M, Prabhakar, G, Waksman, R, Corso, P, Wang, J, Fiocco, M, Wilson, Bh, Steigel, Rm, Chadwick, S, Zidar, F, Oswalt, J., Stone, Gregg W., Sabik, Joseph F., Serruys, Patrick W., Simonton, Charles A., Généreux, Philippe, Puskas, John, Kandzari, David E., Morice, Marie Claude, Lembo, Nichola, Brown, W. Morri, Taggart, David P., Banning, Adrian, Merkely, Béla, Horkay, Ferenc, Boonstra, Piet W., Van Boven, Ad J., Ungi, Imre, Bogáts, Gabor, Mansour, Samer, Noiseux, Nicola, Sabaté, Manel, Pomar, José, Hickey, Mark, Gershlick, Anthony, Buszman, Pawel, Bochenek, Andrzej, Schampaert, Erick, Pagé, Pierre, Dressler, Ovidiu, Kosmidou, Ioanna, Mehran, Roxana, Pocock, Stuart J., Kappetein, A. Pieter, for the EXCEL Trial Investigators:, [. . ., Antonio, Marzocchi, DI BARTOLOMEO, Roberto, ], . ., and Cardiothoracic Surgery

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, law.invention, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Randomized controlled trial, law, Internal medicine, medicine, Clinical endpoint, Drug-Eluting Stent, Humans, Everolimus, 030212 general & internal medicine, cardiovascular diseases, Coronary Artery Bypass, Aged, Female, Middle Aged, Drug-Eluting Stents, business.industry, Coronary Artery Bypa, Medicine (all), Percutaneous coronary intervention, General Medicine, medicine.disease, Surgery, Cardiac surgery, Everolimu, surgical procedures, operative, Bypass surgery, Conventional PCI, Cardiology, business, medicine.drug, Human
Abstract

BACKGROUND: Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting (CABG). Randomized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease. METHODS: We randomly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was assessed at the sites and defined by a Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32 or lower (the SYNTAX score reflects a comprehensive angiographic assessment of the coronary vasculature, with 0 as the lowest score and higher scores [no upper limit] indicating more complex coronary anatomy). The primary end point was the rate of a composite of death from any cause, stroke, or myocardial infarction at 3 years, and the trial was powered for noninferiority testing of the primary end point (noninferiority margin, 4.2 percentage points). Major secondary end points included the rate of a composite of death from any cause, stroke, or myocardial infarction at 30 days and the rate of a composite of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. RESULTS: At 3 years, a primary end-point event had occurred in 15.4% of the patients in the PCI group and in 14.7% of the patients in the CABG group (difference, 0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage points; P=0.02 for noninferiority; hazard ratio, 1.00; 95% confidence interval, 0.79 to 1.26; P=0.98 for superiority). The secondary end-point event of death, stroke, or myocardial infarction at 30 days occurred in 4.9% of the patients in the PCI group and in 7.9% in the CABG group (P

Published
2017

22. P2693The long-term impact of post-procedural asymmetry and eccentricity of bioresorbable everolimus-eluting scaffold and metallic everolimus-eluting stent on clinical outcomes in the ABSORB II trial

Author

Katagiri, Y, primary, Serruys, P W S, additional, Macaya, C M, additional, Ormiston, J O, additional, Hill, J H, additional, Lang, I M L, additional, Egred, M E, additional, Fajadet, J F, additional, Lesiak, M L, additional, Wykrzykowska, J J W, additional, Piek, J J P, additional, Sabate, M S, additional, Windecker, S W, additional, and Chevalier, B C, additional

Published
2018
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24. P4636Coronary artery lesion phenotype in frail older patients with non-ST elevation acute coronary syndrome undergoing invasive care - ICON1 invasive study

Author

Gu, S Z, primary, Sinclair, H, additional, Batty, J, additional, Veerasamy, M, additional, Qiu, W, additional, Brugaletta, S, additional, Das, R, additional, Bagnall, A, additional, Zaman, A, additional, Edwards, R, additional, Egred, M, additional, Purcell, I, additional, Calvert, P, additional, Mintz, G, additional, and Kunadian, V, additional

Published
2018
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25. Arterial Remodeling After Bioresorbable Scaffolds and Metallic Stents

Author

Serruys, P.W., Katagiri, Y., Sotomi, Y., Zeng, Y., Chevalier, B., Schaaf, R.J. van der, Baumbach, A., Smits, P., Mieghem, N.M. van, Bartorelli, A., Barragan, P., Gershlick, A., Kornowski, R., Macaya, C., Ormiston, J., Hill, J., Lang, I.M., Egred, M., Fajadet, J., Lesiak, M., Windecker, S., Byrne, R.A., Raber, L., Geuns, R.J.M. van, Mintz, G.S., Onuma, Y., Serruys, P.W., Katagiri, Y., Sotomi, Y., Zeng, Y., Chevalier, B., Schaaf, R.J. van der, Baumbach, A., Smits, P., Mieghem, N.M. van, Bartorelli, A., Barragan, P., Gershlick, A., Kornowski, R., Macaya, C., Ormiston, J., Hill, J., Lang, I.M., Egred, M., Fajadet, J., Lesiak, M., Windecker, S., Byrne, R.A., Raber, L., Geuns, R.J.M. van, Mintz, G.S., and Onuma, Y.

Abstract

Item does not contain fulltext, BACKGROUND: Although previous observational studies have documented late luminal enlargement and expansive remodeling following implantation of a bioresorbable vascular scaffold (BVS), no comparison with metallic stents has been conducted in a randomized fashion. OBJECTIVES: This study sought to compare vessel remodeling patterns after either Absorb BVS or Xience metallic drug-eluting stent (DES) implantation (Abbott Vascular, Santa Clara, California) and determine the independent predictors of remodeling. METHODS: In the ABSORB II randomized trial, 383 lesions (n = 359) were investigated by intravenous ultrasound both post-procedure and at 3-year follow-up. According to vessel and lumen area changes over 3 years, we categorized 9 patterns of vessel remodeling that were beyond the reproducibility of lumen and vessel area measurements. RESULTS: The relative change in mean vessel area was significantly greater with the BVS compared to the DES (6.7 +/- 12.6% vs. 2.9 +/- 11.5%; p = 0.003); the relative change in mean lumen area was significantly different between the 2 arms (1.4 +/- 19.1% vs. -1.9 +/- 10.5%, respectively; p = 0.031). Multivariate analysis indicated that use of the BVS, female sex, balloon-artery ratio >1.25, expansion index >/=0.8, previous percutaneous coronary intervention, and higher level of low-density lipoprotein cholesterol were independent predictors of expansive remodeling. Furthermore, in the BVS arm, necrotic core pre-procedure was an independent determinant of expansive remodeling. CONCLUSIONS: Expansive vessel wall remodeling was more frequent and intense with the BVS than the metallic DES and could be determined by patient baseline characteristics and periprocedural factors. The clinical effect of the observed lumen and vessel remodeling must be investigated in further large clinical studies to optimize the clinical outcome of patients and lesions treated by bioresorbable scaffolds. (ABSORB II Randomized Controlled Trial; NCT01425281).

Published
2017

27. One-year outcomes after successful chronic total occlusion percutaneous coronary intervention: The impact of dissection re-entry techniques

Author

Wilson, W. M., primary, Walsh, S.J., additional, Bagnall, A., additional, Yan, A.T., additional, Hanratty, C.G., additional, Egred, M., additional, Smith, E., additional, Oldroyd, K.G., additional, McEntegart, M., additional, Irving, J., additional, Douglas, H., additional, Strange, J., additional, and Spratt, J.C., additional

Published
2017
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30. Hybrid approach improves success of chronic total occlusion angioplasty

Author

Wilson, W M, primary, Walsh, S J, additional, Yan, A T, additional, Hanratty, C G, additional, Bagnall, A J, additional, Egred, M, additional, Smith, E, additional, Oldroyd, K G, additional, McEntegart, M, additional, Irving, J, additional, Strange, J, additional, Douglas, H, additional, and Spratt, J C, additional

Published
2016
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31. Writing for the JRCPE

Author

Witham, MD, primary, Beveridge, AW, additional, Gloag, R, additional, Egred, M, additional, and Bracewell, RM, additional

Published
2015
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32. Impact of proctoring on success rates for percutaneous revascularisation of coronary chronic total occlusions

Author

Sharma, Vinoda, primary, Jadhav, S T, additional, Harcombe, A A, additional, Kelly, P A, additional, Mozid, A, additional, Bagnall, A, additional, Richardson, J, additional, Egred, M, additional, McEntegart, M, additional, Shaukat, A, additional, Oldroyd, K, additional, Vishwanathan, G, additional, Rana, O, additional, Talwar, S, additional, McPherson, M, additional, Strange, J W, additional, Hanratty, C G, additional, Walsh, S J, additional, Spratt, J C, additional, and Smith, W H T, additional

Published
2015
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33. 30-day Outcomes From The UK Hybrid CTO Registry

Author

Wilson, W., primary, Walsh, S., additional, Hanratty, C., additional, Douglas, H., additional, McEntegart, M., additional, Oldroyd, K., additional, Bagnall, A., additional, Egred, M., additional, Irving, J., additional, Smith, E., additional, Strange, J., additional, and Spratt, J., additional

Published
2015
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50. Long Term Outcome of Unprotected Left Main Stem Percutaneous Coronary Intervention, a Single Centre Experience.

Author

Egred, M., Ang, D. S. C., Edwards, R., Das, R., Bagnall, A. J., Purcell, I. F., Zaman, A. G., and Ahmed, J. M.

Subjects
*CORONARY disease, *HEALTH outcome assessment, *REVASCULARIZATION (Surgery), *CARDIAC patients, *MORTALITY, *ANGINA pectoris
Abstract

Percutaneous coronary intervention (PCI) is increasingly used for unprotected left main coronary artery disease (UPLMS) revascularization. Data regarding long-term mortality in this subset of patients remain sparse. We aim to present our outcome data on all comers who had UPLMS PCI. Methods: Retrospective dataset analysis of prospectively collected data evaluating all UPLMS PCI performed in a large tertiary cardiac centre, between September 2003 and December 2012. Long-term mortality data were available over a median duration of 21 months (IQR 10 months to 43 months). Results: In total there were 483 procedures performed. The cohort consisted of 58% with non ST elevation myocardial infarction (NSTEMI), 17% with STEMI and 25% with stable angina (SA). The overall in-hospital and long-term mortality were 7% and 22% respectively. The in-hospital mortality was 23%, 6%, and 1.6% in STEMI, NSTEMI, and SA respectively. Long-term mortality was 31% in STEMI patients, 26% in NSTEMI and 10% in SA. The use of drug eluting stents (DES) [adjusted RR 0.40 (95% CI, 0.23-0.69)] and Intravascular ultrasound (IVUS) [adjusted RR 0.17 (95% CI 0.04-0.72)] were independently associated with improved long-term survival. Conclusion: UPLMS PCI is associated with favourable long-term survival. The use of DES and IVUS guided PCI appear to be associated with improved long-term outcome and should be considered in the routine management of this cohort of patients. [ABSTRACT FROM AUTHOR]

Published
2014
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