Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention

Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions

TCT-319 Use of Limited Antegrade Subintimal Tracking Technique in Chronic Total Occlusion Percutaneous Coronary Intervention

Background: There are limited data on the limited antegrade subintimal tracking (LAST) crossing technique for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We analyzed the frequency of use and outcomes of LAST among 2,003 CTO PCIs performed with antegrade dissection and re-entry (ADR) in the PROGRESS-CTO Registry between 2012 and 2021 at 39 centers. Results: LAST was used in 144 cases (7.2%), primary LAST in 113 (5.6%), and secondary LAST in 31 cases (1.5%). The Stingray system was used in 905 cases (45.2%), subintimal tracking and re-entry (STAR) in 333 cases (16.6%), and contrast-guided STAR in 29 cases (1.4%). The mean patient age was 64.2 ± 10 years, 86% were men, and 34.9% had prior coronary artery bypass graft surgery. Cases in which LAST was used were less complex with a lower J-CTO score (2.50 ± 1.32 vs. 2.95 ± 1.10, P \u3c 0.001). There was no difference in technical (75.0% vs 78.4%, P = 0.337) and procedural success (72.2% vs 75.5%, P = 0.384) and major cardiac adverse events (MACEs) (2.08% vs 3.55%, P = 0.352) between LAST and non-LAST cases. However, cases in which the LAST technique was used required less procedure and fluoroscopy time (Figure 1A). A primary LAST technique was associated with higher technical and procedural success rates and a similar MACE rate compared with a secondary LAST technique (Figure 1B). Conclusion: LAST is used in 7.2% of ADR CTO PCI cases and is associated with similar technical and procedural success rates and major complication rates but lower procedural and fluoroscopy time compared with ADR cases that did not use LAST

In-Stent CTO Percutaneous Coronary Intervention: Individual Patient Data Pooled Analysis of 4 Multicenter Registries

OBJECTIVES: The authors sought to examine the outcomes of percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) chronic total occlusions (CTOs). BACKGROUND: The outcomes of PCI for ISR CTOs have received limited study. METHODS: The authors examined the clinical and angiographic characteristics and procedural outcomes of 11,961 CTO PCIs performed in 11,728 patients at 107 centers in Europe, North America, Latin America, and Asia between 2012 and 2020, pooling patient-level data from 4 multicenter registries. In-hospital major adverse cardiovascular events (MACE) included death, myocardial infarction, stroke, and tamponade. Long-term MACE were defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization. RESULTS: ISR represented 15% of the CTOs (n = 1,755). Patients with ISR CTOs had higher prevalence of diabetes (44% vs. 38%; p \u3c 0.0001) and prior coronary artery bypass graft surgery (27% vs. 24%; p = 0.03). Mean J-CTO (Multicenter CTO Registry in Japan) score was 2.32 ± 1.27 in the ISR group and 2.22 ± 1.27 in the de novo group (p = 0.01). Technical (85% vs. 85%; p = 0.75) and procedural (84% vs. 84%; p = 0.82) success was similar for ISR and de novo CTOs, as was the incidence of in-hospital MACE (1.7% vs. 2.2%; p = 0.25). Antegrade wiring was the most common successful strategy, in 70% of ISR and 60% of de novo CTOs, followed by retrograde crossing (16% vs. 23%) and antegrade dissection and re-entry (15% vs. 16%; p \u3c 0.0001). At 12 months, patients with ISR CTOs had a higher incidence of MACE (hazard ratio: 1.31; 95% confidence intervals: 1.01 to 1.70; p = 0.04). CONCLUSIONS: ISR CTOs represent 15% of all CTO PCIs and can be recanalized with similar success and in-hospital MACE as de novo CTOs

Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention

Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p \u3c 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p \u3c 0.001) and diabetes mellitus (50% vs. 42%, p \u3c 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p \u3c 0.001), moderate/severe calcification (68% vs. 40%, p \u3c 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p \u3c 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p \u3c 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p \u3c 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p \u3c 0.001) and procedural (88% vs. 96%, p \u3c 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p \u3c 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions

Use of Intravascular Imaging During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry

Background: Intravascular imaging can facilitate chronic total occlusion (CTO) percutaneous coronary intervention. Methods and Results: We examined the frequency of use and outcomes of intravascular imaging among 619 CTO percutaneous coronary interventions performed between 2012 and 2015 at 7 US centers. Mean age was 65.4±10 years and 85% of the patients were men. Intravascular imaging was used in 38%: intravascular ultrasound in 36%, optical coherence tomography in 3%, and both in 1.45%. Intravascular imaging was used for stent sizing (26.3%), stent optimization (38.0%), and CTO crossing (35.7%, antegrade in 27.9%, and retrograde in 7.8%). Intravascular imaging to facilitate crossing was used more frequently in lesions with proximal cap ambiguity (49% versus 26%, P<0.0001) and with retrograde as compared with antegrade‐only cases (67% versus 31%, P<0.0001). Despite higher complexity (Japanese CTO score: 2.86±1.19 versus 2.43±1.19, P=0.001), cases in which imaging was used for crossing had similar technical and procedural success (92.8% versus 89.6%, P=0.302 and 90.1% versus 88.3%, P=0.588, respectively) and similar incidence of major cardiac adverse events (2.7% versus 3.2%, P=0.772). Use of intravascular imaging was associated with longer procedure (192 minutes [interquartile range 130, 255] versus 131 minutes [90, 192], P<0.0001) and fluoroscopy (71 minutes [44, 93] versus 39 minutes [25, 69], P<0.0001) time. Conclusions: Intravascular imaging is frequently performed during CTO percutaneous coronary intervention both for crossing and for stent selection/optimization. Despite its use in more complex lesion subsets, intravascular imaging was associated with similar rates of technical and procedural success for CTO percutaneous coronary intervention. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436

TiO2/WO3/Au nanoarchitectures' photocatalytic activity "from degradation intermediates to catalysts' structural peculiarities" Part II: Aerogel based composites - fine details by spectroscopic means

The "build-up" methodology of a composite photocatalyst is a critical issue regarding the showed photocatalytic performance, including the formation of intermediates. To investigate this issue TiO2/WO3/Au aerogel composites were obtained by sal-gel method and subsequent photoreduction (Au) with UV or visible light. The obtained composites' photocatalytic activity and intermediate formation profiles were evaluated using phenol as a model pollutant. XPS/UPS, XAFS and DRS were used to uncover local coordination, surface chemistry (of the different types of atoms (Ti, W, O and Au) and the band-structure (band-gap, possible electron transitions) of the obtained nanomaterials. The intermediates' evolution profile and structural peculiarities were successfully correlated and it was shown that each minor structural (bulk or surface) change has a significant impact on the photocatalytic activity and intermediate formation dynamics. (c) 2013 Elsevier B.V. All rights reserved

Temporal Trends in Retrograde Crossing of Epicardial Collaterals in Chronic Total Occlusion Percutaneous Coronary Intervention

BACKGROUND: The use of retrograde crossings in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) provides higher technical success rates in CTO-PCI. However, the use of epicardial collaterals carries a higher complication risk. METHODS AND RESULTS: In this study, we aimed to investigate the temporal trends in retrograde crossing of epicardial collaterals, introduction of new guidewires, in-hospital major adverse cardiovascular events (MACE), and technical success rates in a large, multinational registry. We demonstrate that technical success rates increased substantially from about 5%-10% to 76% in the past decade without a concomitant increase in MACE rate (~3% to 4%), likely associated with increased operator experience and introduction of new guidewires. In addition, we show that while high-volume centers have higher technical success, they also have higher perforation rates

β-Lactones Inhibit N-acylethanolamine Acid Amidase by S-Acylation of the Catalytic N-Terminal Cysteine

The cysteine amidase N-acylethanolamine acid amidase (NAAA) is a member of the N-terminal nucleophile class of enzymes and a potential target for anti-inflammatory drugs. We investigated the mechanism of inhibition of human NAAA by substituted β-lactones. We characterized pharmacologically a representative member of this class, ARN077, and showed, using high-resolution liquid chromatography–tandem mass spectrometry, that this compound forms a thioester bond with the N-terminal catalytic cysteine in human NAAA