Rescue percutaneous coronary recanalization of right coronary artery by retrograde approach

We describe the case of a 62-year-old female patient in whom there was an occlusion of collaterals and acute inferior wall ischemia during the opening procedure of right coronary artery (RCA) chronic total occlusion. Rescue percutaneous coronary intervention (PCI) of RCA by the retrograde approach was performed preventing heart muscle damage. In this article we discuss the issue of PCI by the retrograde technique

Dedicated devices and techniques : a cornerstone in recanalisation of chronic total occlusions of coronary arteries

Recanalisation of chronic total occlusion (CTO) is still a challenge in invasive cardiology, requiring operator experience, equipment, and techniques dedicated to CTO. Due to difficulties in crossing the lesion by wire and by balloon (both responsible for 98% of the procedure’s failures), many helpful techniques have been described. We report the case of both Tornus system and anchor technique in successful recanalisation of a right coronary artery

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

Half of coronary patients are not instructed how to respond to symptoms of a heart attack

Background: The delayed treatment of acute coronary syndrome has a significant impact on survival. Due to improved organization and the use of reperfusion therapies, inhospital delay has been shortened in recent years. However, the time between the onset of chest pain and the call for medical help is still too long. The aim of this study was to assess the proportion of coronary patients instructed how to behave in case of chest pain and to find what factors relate to a lower probability of being counselled. Methods: Patients aged < 80 years, hospitalized due to coronary artery disease (CAD) were identified retrospectively on the basis of a medical records review and were invited for a follow-up examination. Two hundred and nineteen patients agreed to participate in the study. Data on the prehospital delay was obtained using a standard questionnaire. Results: The study group consisted of 149 men and 70 women. The mean time between discharge and the follow-up examination was 1.1 &#177; 0.4 years. Of 219 study participants, 106 (48.4%) declared they had been instructed about the symptoms of a heart attack and how to respond to it. Men, smokers, non-diabetics, and those with previously diagnosed CAD had been instructed more frequently. The independent predictors of being instructed were: percutaneous coronary intervention during the index hospitalization, diabetes, smoking, male sex and previously diagnosed CAD. Conclusions: About half of patients after hospitalization due to CAD are not instructed how to respond to heart attack symptoms. This has not changed over the last decade and may contribute to the lack of shortening of prehospital delay. (Cardiol J 2011; 18, 6: 668&#8211;674

Udrożnienia przewlekłych okluzji tętnic wieńcowych : rola wielorzędowej tomografii komputerowej : opis przypadku

Nieinwazyjne metody obrazowania serca pozwalają ocenić żywotność miokardium (ocena wskazań do zabiegu) oraz ułatwić wybór strategii zabiegu i sprzętu stosowanego podczas przezskórnej interwencji wieńcowej (ang. percutaneous coronary interventions, PCI). Przedstawiamy opis zabiegu u pacjenta poddanego PCI przewlekłej okluzji tętnicy wieńcowej po diagnostyce metodami nieinwazyjnymi, w tym po wykonaniu wielorzędowej tomografii komputerowej (multi-slice computed tomography, MSCT).Non-invasive diagnostics of the heart allow one to assess myocardium viability (indication for procedure) and facilitate the choice of strategy and tools used during percutaneous coronary intervention (PCI). We present a case of PCI of chronic total occlusion (CTO) after non-invasive diagnostics, including multi-slice computed tomography (MSCT)

Chronic total occlusion in ostium of right coronary artery : retrograde approach as the first-choice method of revascularization?

Recanalization of chronic total occlusion (CTO) located in the ostium may require the operator’s ability to use the retrograde approach. We present a case of opening a chronically occluded right coronary artery (RCA) by the retrograde approach after an unsuccessful attempt of recanalization by classic antegrade technique

Knowledge of chronic total occlusion among Polish interventional cardiologists

Introduction: Chronic total occlusion (CTO) recanalization is indicated in patients with symptoms and evidence of ischemia, but in most cases those types of lesions are still treated medically. In the last few years CTO angioplasty technique has changed dramatically due to considerable advances in techniques and dedicated equipment. Aim: An attempt to assess the state of knowledge of technical aspects of CTO angioplasty of coronary arteries among Polish interventional cardiologists. Material and methods: Questionnaire survey performed during two major Polish invasive cardiology workshops. Results: In the study there participated 113 physicians with an average length of work experience of 13 years, most of them cardiologists certified as independent primary operators. The majority of respondents recognized the need of prevention of thrombotic complications through control of activated coagulation time during the CTO procedures. Prevention of renal complications and X-ray protection are also recognized as a significant part of the procedures. The benefits from the use of over-the-wire microcatheters and balloons, the proper choice of dedicated guidewires, contralateral injections and retrograde technique are underestimated. Conclusions: Despite satisfactory knowledge about indications and qualification for the CTO procedure, the awareness of procedural aspects (particularly the retrograde technique) as well as the dedicated CTO equipment among Polish interventional cardiologists is still insufficient