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Background: Coronary artery perforation is a feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and often leads to serious adverse clinical events. Aims: We sought to develop a risk score to predict clinical coronary artery perforation in patients undergoing CTO PCI. Methods: We analysed clinical and angiographic parameters from 9,618 CTO PCIs in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO). Logistic regression prediction modelling was used to identify variables independently associated with clinical perforation, and the model was internally validated with bootstrapping. Clinical coronary artery perforation was defined as any perforation requiring treatment. Results: The incidence of clinical coronary perforation was 3.8% (n=367). Five factors were independently associated with perforation and were included in the score: patient age ≥65 years +1 point (odds ratio [OR] 1.79, 95% confidence interval [CI]: 1.37-2.33), moderate/severe calcification +1 point (OR 1.85, 95% CI: 1.41-2.42), blunt/no stump +1 point (OR 1.45, 95% CI: 1.10-1.92), use of antegrade dissection and re-entry +1 point (OR 2.43, 95% CI: 1.61-3.69), and use of the retrograde approach +2 points (OR 4.02, 95% CI: 2.95-5.46). The resulting score showed acceptable performance on receiver operating characteristic (ROC) curve (area under the curve [AUC]: 0.741, 95% CI: 0.712-0.773). The Hosmer-Lemeshow test indicated a good fit (p=0.991), and internal validation with bootstrapping demonstrated good agreement with the model with observed AUC: 0.736 (95% bias-corrected CI: 0.706-0.767). Conclusions: The PROGRESS-CTO perforation score may be a useful tool for predicting clinical coronary perforation during CTO PCI.

BackgroundSame day discharge (SDD) following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. MethodsWe evaluated the clinical, angiographic, and procedural characteristics of patients discharged the same day versus those kept for overnight observation in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO, NCT02061436). ResultsOf the 7181 patients who underwent CTO PCI, 943 (13%) had SDD. The SDD rate increased from 3% in 2015 to 21% in 2022. Patients with SDD were less likely to have a history of heart failure (21% vs. 26%, p = 0.005), chronic lung disease (10% vs. 15%, p = 0.001), or anemia (12% vs. 19%, p < 0.001). Technical success (87% vs. 88%, p = 0.289) was similar, but in-hospital major adverse cardiovascular events (0.0% vs. 0.4%, p = 0.041) were lower in SDD. In multivariable logistic regression analysis, prior myocardial infarction odds ratio (OR): 0.71 (95% confidence interval [CI]: 0.59-0.87, p = 0.001), chronic lung disease OR: 0.64 (95% CI: 0.47-0.88, p = 0.006), and increasing procedure time OR: 0.93 (95% CI: 0.91-0.95, p < 0.001, per 10-min increase) were associated with overnight observation, while radial-only access OR: 2.45 (95% CI: 2.03-2.96, p < 0.001) had the strongest association with SDD. In the SDD, 2 (0.4%) of 514 patients were readmitted, due to retroperitoneal bleeding (n = 1) and ischemic stroke (n = 1). ConclusionThe overall frequency of SDD after CTO PCI was 13% and has been increasing over time. SDD is feasible in select patients following CTO PCI, and radial-only access had the strongest association with SDD.

ÖZ : Amaç: Ciddi Aort Darlığı (AD) olan hastalarda TAVI , aort kapak obstrüksiyonunu ortadan kaldırarak kardiyak outputu arttırır. Sol ventrikülden çıkan akımın iyileşmesi, böbreklerin kan akımını artırarak renal perfüzyonu artırır ve bozulmuş renal fonksiyonun düzelmesini sağlayabilir. Bunun yanında, TAVI sırasında kontrast madde kullanımına bağlı ya da transfemoral kateterizasyon sırasında aterom plaklarının ve kolesterol kristallerinin saçılması sonucu alt ekstremite veya renal arter embolizasyonuna bağlı akut böbrek yetersizliği gelişebilir. Bu çalışmanın amacı; TAVI’nın böbrek fonksiyonları üzerine 1. aydaki etkisini belirlemek ve hastaların eşlik eden hastalıklarının sonuca etkisi olup olmadığını saptamaktı. Gereç ve Yöntemler: Bu çalışmaya, 2015-2019 yılları arasında ciddi AD ile takip edilip TAVI yapılan toplam 68 hasta dahil edildi. Tüm hastalarda işlem öncesi ve işlemden 1 ay sonra bakılan kreatinin ve GFR değerleri cinsiyete ve eşlik eden hastalıklara göre retrospektif olarak belirlendi ve değerlendirmeler bu temelde yapıldı. Bulgular: Hastaların ortalama yaşı 78,6+7,86, ortalama sol ventrikül ejeksiyon fraksiyonu ise (LVEF) %56,1+7,82 idi. Mevcut sonuçlar, AD’nın düzeltilmesinden sonra 1. ayda komorbiditesi bulunan hastaların böbrek fonksiyonlarında düzelme olmadığını aksine ek hastalığı olmayan hastalara göre anlamlı derecede kreatinin değerlerinde artma ve GFR değerinde düşme olduğunu göstermektedir. Diğer komorbidite durumlarının aksine işlem öncesi kronik böbrek hastalığı olanlarda ise 1. ayda kreatinin değerlerinde anlamlı bir artış saptanmamıştır. Sonuç: Çalışmamızda işlem öncesi kronik böbrek hastalığı olan hastalarda böbrek koruması açısından daha titiz olunduğunu ve bu hastalarda kronik böbrek hastalığına sebep olan majör etkenin ciddi AD olması sebebiyle ciddi AD' nın ortadan kalkması ve buna bağlı artan kardiyak debinin böbrek fonksiyonları üzerine olumlu etki yaratarak denge sağladığını düşünüyoruz., Aim: In patients with severe aortic stenosis (AS), TAVI increases cardiac output by eliminating aortic valve obstruction. Improvement of the outflow from the left ventricle increases renal perfusion by increasing blood flow to the kidneys and may improve impaired renal function. In addition, acute renal failure may develop due to lower extremity or renal artery embolization due to the use of contrast material during TAVI or as a result of scattering of atheroma plaques and cholesterol crystals during transfemoral catheterization. The aim of this study was to determine the effect of TAVI on kidney functions at 1 month and to determine whether comorbidities of the patients had an effect on the outcome. Material-methods : A total of 68 patients who were followed up with severe aortic stenosis and underwent TAVI between 2015 and 2019 were included in this study. The creatinine and GFR values measured before and 1 month after the procedure in all patients were determined retrospectively according to gender and concomitant diseases, and the evaluations were made on this basis. Results: The mean age of the patients was 78.6+7.86 years and the mean left ventricular ejection fraction (LVEF) was 56.1+7.82. Current results show that patients with comorbidity do not improve their renal function in the 1st month after AS correction, on the contrary, there is a significant increase in creatinine values and a decrease in GFR values compared to patients without comorbidity. Contrary to other comorbidities , there was no significant increase in creatinine values in the 1st month in patients with chronic kidney disease before the procedure . Conclusion: In our study, it was observed that patients with chronic kidney disease were more meticulous in terms of kidney protection before the procedure, and we think that the elimination of severe AS and the increased cardiac output due to the fact that the major factor causing chronic kidney disease in these patients was severe AS, creating a positive effect on kidney functions and providing a balance.

Objectives: The aim of this study was to compare transradial access (TRA) with transfemoral access (TFA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: TRA reduces the risk for vascular access complications but may make complex PCI, such as CTO PCI, more challenging. Methods: FORT CTO (Femoral or Radial Approach in the Treatment of Coronary Chronic Total Occlusion) (NCT03265769) was a prospective, noninferiority, randomized controlled study of TRA vs TFA for CTO PCI. The primary study endpoint was procedural success, defined as technical success without any in-hospital major adverse cardiovascular events. The secondary study endpoint was major access-site complications. Results: Between 2017 and 2021, 610 of 800 patients referred for CTO PCI at 4 centers were randomized to TRA (n = 305) or TFA (n = 305). Mean J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 0.1 vs 2.2 ± 0.1; P = 0.279), PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) (1.3 ± 0.9 vs 1.1 ± 1.0; P = 0.058) and PROGRESS CTO complication (2.4 ± 1.8 vs 2.3 ± 1.8; P = 0.561) scores and use of the retrograde approach (11% vs 14%; P = 0.342) were similar in the TRA and TFA groups. TRA was noninferior to TFA for procedural success (84% vs 86%; P = 0.563) but had fewer access-site complications (2.0% vs 5.6%; P = 0.019). There was no difference between TFA and TRA in procedural duration, contrast volume, or radiation dose. COnclusions: TRA was noninferior to TFA for CTO PCI but had fewer access-site complications.

Objective: Major setbacks with the use of stents, which are widely used in the treatment of coronary artery dis­ease, are development of acute thrombosis during early term and restenosis during the long term. No procedures have been able to completely prevent formation of early stent thrombosis (ST) and in-stent restenosis (ISR) up to now. The aim of the present study was to investigate the impact of intravascular ultrasonography (IVUS) guidance on angiographic outcomes of drug eluting stent (DES) im­plantation. Methods: In this study, we included 23 patients who re­ceived DES with the guidance of IVUS and 23 patients receiving the DES without IVUS. The patients were scru­tinized for their sixth month control angiographies. The angiographic results were compared between the groups. Results: The basic angiographic and clinical features were similar between the groups (p>0.05). The minimal luminal diameter after the percutaneous intervention was higher in Group I than Group 2 (3.2±0.3. 2.9±0.4, p=0.03). Acute ST, late lumen loss and stent restenosis rates were comparable between the groups (p>0.05). On the other hand, among the patients that did not receive IVUS three patients were presented with stent restenosis (SR) and one patient developed acute ST. Conclusion: The present results indicate that the use of IVUS for the implantation of DES can increase the suc­cess rate of the intervention. Consequently, IVUS can be considered as a complementary method during DES im­plantation. J Clin Exp Invest 2013; 4 (1): 84-89, Amaç: Koroner arter hastalığının tedavisinde yaygın olarak kullanılan stentlerle ilgili en büyük problem erken dönemde akut tromboz, geç dönemde ise restenoz geli­şimidir. Şimdiye kadar hiçbir girişim stent trombozu (ST) ve stent restenozu (SR) gelişimini tamamıyla engelleye­memiştir. Bu çalışmanın amacı ilaç kaplı stent (İKS) imp­lantasyonu sırasında intravasküler ultrasonografi (IVUS) kılavuzluğunun anjiyografik sonuçlar üzerine etkisini araştırmaktır. Yöntemler: Çalışmaya IVUS kılavuzluğunda İKS uygu­lanan 23 hasta ve IVUS yapılmaksızın direkt anjiyografi kılavuzluğunda İKS uygulanan 23 hasta alındı. Tüm has­taların altıncı ay kontrol anjiyografileri yapıldı. Anjiyografik sonuçlar gruplar arasında karşılaştırıldı. Bulgular: Gruplar arasında temel anjiyografik ve klinik özellikler benzerdi (p >0,05). İşlem sonrası stent içi mi­nimal lümen çapı (SİMLÇ) IVUS yapılanlarda, IVUS ya­pılmayanlardan daha büyüktü (3,2±03. 2,9±0,4, p=0,03). Akut ST, geç lümen kaybı ve SR oranları ise iki grup arasında benzerdi (p>0,05). İntravasküler ultrasonografi yapılanlarda bir olguda SR tespit edilirken, akut ST göz­lenmedi. IVUS yapılmayanlarda ise üç hastada SR ve bir hastada akut ST gözlendi. Sonuç: Mevcut çalışma ile gösterildi ki İKS implantasyo­nu sırasında IVUS kullanımı girişim başarısını artırabilir. İlaç salınımlı stent implantasyonu sırasında IVUS kullanı­mı işlemi tamamlayıcı bir fonksiyon görebilir.

Amaç: “Stent for Life” çalışmasının (SFL) temel amacı akut ST segment yükselmeli miyokart enfarktüsü (STYME) geçiren hastaların %70’inde primer perkütan koroner girişimin (PKG) kullanımını sağlamaktır. Akut STYME geçiren hastaların primer PKG’ye erişme yüzdesinin ülkemizde düşük oranlarda olması nedeniyle trombolitik tedavi, SFL projesi öncesi dominant reperfüzyon tedavisi olarak uygulanmaktaydı. Bu yazıda, SFL projesine katılan merkezlerdeki hastaların primer PKG’ye erişmelerindeki temel engeller değerlendirildi. Çalışma planı: 2009 ile 2011 yılları arasında SFL projesine katılan merkezlere akut STYME ile başvuran hastalar geriye dönük olarak incelendi. Bulgular: SFL projesi kapsamında seçilen pilot illerde, proje sonrası primer PKG yapılma oranı %90 olarak saptandı. Son beş yıl içerisinde ambulans ve acil istasyon merkezi sayısındaki artış ve 112 Acil Servis ile yapılan işbirliği sonrası birçok olgunun acil servis hizmetleri ile acil servise başvurduğu gözlendi. Pilot illerde ortalama kapı balon zamanı 54.7243.66 dk idi. Sonuç: Pilot illerde, SFL projesi uygulanmaya başlandıktan sonra primer PKG’nin STYME hastalarında tercih edilen tedavi yöntemi olduğu gözlenmiştir. Objectives: The Stent for Life (SFL) project’s main mission is to increase the use of primary percutaneous coronary intervention (PCI) in more than 70% of all acute ST segment elevation myocardial infarction (STEMI) patients. Previous to the SFL project, thrombolysis was the dominant reperfusion strategy since a low percentage of acute STEMI patients had access to primary PCI in our country. In this study, we present the main barriers of access to primary PCI in the centers that were involved with the SFL project. Study design: Patients with acute STEMI admitted to the centers that were involved in the SFL project between 2009 and 2011 were included in the analysis.Results: Since the inception of the SFL project, the primary PCI rate has reached over 90% in SFL pilot cities. In the last 5 years, the number of ambulances and emergency stations has increased. Since the collaboration with 112 Emergency Service, a great majority of cases were reached via the emergency medical system. The mean door-to-balloon time for the pilot cities was 54.72±43.66 minutes. Conclusion: After three years of the SFL project, primary PCI has emerged as the preferred reperfusion strategy for patients with STEMI in pilot cities.