Treatment of coronary chronic total occlusion by transradial approach: Current trends and expert recommendations

The aim of this review is to highlight the technical details and the scientific data on percutaneous coronary interventions (PCIs) in chronic total occlusion (CTO) performed by transradial approach (TRA). Transfemoral approach (TFA) is commonly regarded as the standard for CTO PCI, but there is a growing number of CTO recanalization procedures performed by TRA. We discuss the relevant technical details to approach a CTO by transradial access, especially the compatibility of various CTO recanalization techniques with specific guiding catheter sizes. Randomized prospective trials in this field are lacking and only data from observational studies are available. We can conclude that transradial access for CTO PCI is feasible and could be very useful in selected patients. In our opinion, transradial access in CTO PCIs should be limited to operators and centers highly experienced in CTO recanaliza¬tion and in TRA

Poziom wiedzy o przewlekłych okluzjach tętnic wieńcowych wśród polskich lekarzy

Wstęp: Przewlekłe okluzje tętnic (CTO) stwierdza się w ok. 30% angiogramów pacjentów z chorobą niedokrwienną serca. W ostatnich latach skuteczność zabiegów przezskórnej rewaskularyzacji CTO wzrasta, ale jednocześnie udrożnienia CTO stanowią coraz niższy odsetek wszystkich interwencji wieńcowych. Jednym z czynników zniechęcających do podejmowania tych wymagających technicznie zabiegów może być brak wiedzy na temat CTO. Cel: Próba określenia stanu wiedzy na temat przewlekłych okluzji tętnic wieńcowych wśród polskich lekarzy. Metody: W badaniu wzięli udział lekarze zainteresowani zagadnieniami przewlekłych okluzji tętnic wieńcowych. Zostało ono przeprowadzone przy użyciu ankiety zawierającej pytania dotyczące podstawowych informacji na temat przewlekłych okluzji tętnic wieńcowych. Wyniki: W badaniu wzięło udział 115 osób, w większości kardiolodzy nieinwazyjni. Jedynie 36,5% uczestników badania potrafiło prawidłowo określić częstość występowania CTO. W 62,5% respondenci jako preferowaną formę terapii wskazali leczenie zachowawcze. Większość uczestników badania (77,4%) dostrzega konieczność wykazania niedokrwienia i żywotności mięśnia sercowego zaopatrywanego przez zamknięte naczynie przed rewaskularyzacją przewlekłej niedrożności tętnicy wieńcowej. Wnioski: Poziom wiedzy na temat CTO wśród polskich lekarzy jest niewystarczający. Konieczne są dalsze działania edukacyjne w tym zakresie skierowane nie tylko do kardiologów interwencyjnych, ale też pozostałych lekarzy zajmujących się pacjentami z chorobą wieńcową.Background: Chronic total occlusions (CTO) are diagnosed in about 30% of angiograms in patients with coronary artery disease. In recent years the efficacy of percutaneous revascularisation of CTO has been on rise but simultaneously has constituted increasingly smaller percentage of all coronary interventions. One of the causes discouraging from such technically demanding procedures may be the lack of knowledge of CTO. Aim: An attempt to assess the state of knowledge of coronary CTO among Polish physicians. Methods: In the study participated physicians with an interest in the subject of CTO. Study was performed with a questionnaire including questions regarding basic knowledge of coronary CTO. Results: In the study participated 115 physicians , most of them were non-invasive cardiologists. Only 36.5% of responders could provide incidence of CTO correctly. 62.5% of responders chose medical therapy as a preferable method of treatment. A majority of participants (77.4%) appreciated the need to demonstrate ischaemia and myocardial viability in the region supplied by the occluded artery before revascularisation of a CTO. Conclusions: The level of knowledge about coronary CTO among Polish physicians is not sufficient. Further education in this subject is necessary not only among interventional cardiologist but also among other doctors providing care for patients with coronary artery disease

Does the effectiveness of recanalization of chronic occlusion depend on the location of the obstruction?

Introduction: In past studies, it has been questioned whether success of recanalization of chronic total occlusion (CTO) depends on the location of the occlusion – the circumflex artery (Cx) was considered as the most difficult to open. Aim: To determine whether the effectiveness of recanalization of CTO depends on the location of the obstruction. Material and methods: From January 2011 to January 2016, a single operator dedicated to chronic total occlusions performed in our center 357 procedures on 337 patients. Results: Among 337 patients included in the study, 83.4% were male. Mean age was 62.8 ±9.3 years. Most of the patients had hypertension (86.4%) and hyperlipidemia (99.4%), and 28.8% of them had diabetes. The most frequently opened artery was the right coronary artery (RCA; 52.4%), followed by the left anterior descending artery (LAD; 29.4%), and last the Cx (18.2%). The mean J-CTO score was comparable between the three groups. The success rate of recanalization of CTO was similar for all arteries: 84.5% in the RCA, 81.9% in the LAD and 89.2% in the Cx (overall p = 0.437). Neither procedural complications nor adverse events depended on the location of the CTO. Conclusions: Our study shows the same efficacy of CTO procedures of all epicardial arteries. We did not observe that effectiveness of recanalization of CTO depends on the location of the obstruction

Extensive Dissection to the Coronary Sinus of Valsalva During Percutaneous Intervention in Right Coronary Artery—A Case Report and Literature Review

Severe retrograde dissection extending into the sinus of Valsalva is a rare complication during percutaneous coronary intervention (PCI), but life threatening. There is some literature about this complication, but this particular complication has not been previously reported in China. We present a case of coronary artery dissection during a PCI in which progressively extended retrogradely into the sinus of valsalva, and was successfully treated with stenting without an operation