1) Radiation Exposure in Chronic Total Occlusions
Even in the hands of experienced operators, rechanneling and angioplasty of a chronic total occlusion (CTO) results in patients and the whole cath lab team receiving high doses of radiation, according to this registry presented at the American Heart Association 2017 Scientific Sessions.
2) Should We Begin to Use IVUS in CTO?
Currently, chronic total occlusions (CTO) are one of the obstacles that coronary angioplasties must overcome, particularly with the development of drug-eluting stents (DES) and new devices and strategies for these challenging lesions. However, there is little information on the safety, efficacy, and real clinical benefit of implanting stents of over 60 mm (known as full metal jackets, FMJ).
3) Clinical Significance of Collaterals in Chronic Total Occlusions
Collateral circulation develops during the gradual progression of coronary occlusions in order to replace the original artery and supply blood to areas jeopardized by ischemia. However, the relevance of collaterals has remained controversial for many years.
4) In which patients should we attempt chronic total occlusion rechanneling?
Although chronic total occlusion (CTO) is a common finding, there is little consensus as to when such lesions should be treated routinely with angioplasty. Benefits of successful rechanneling include relief of symptoms, resolution of ischemia, improvement in ventricular function, and avoidance of myocardial revascularization surgery.
5) Successful angioplasty in elderly patients with chronic total occlusion reduces mortality
Nowadays, the number of coronary angioplasties carried out on patients with chronic total occlusion (CTO) is increasing due to many studies showing that it improves ventricular function, reduces symptoms, and improves survival. However, most of these works do not include patients of over 75 years old due to their frailty and the presence of comorbidities. In consequence, data available on this population are extremely limited.
6) PRISON IV: DES with resorbable polymer vs. DES with permanent polymer in total occlusions
The PRISON IV trial compared the sirolimus eluting stent with ultra-thin struts and biodegradable polymer vs. the second-generation everolimus-eluting stent with thin struts and durable polymer in successfully recanalized chronic total occlusions. This is a sub-study with optical coherence tomography (OCT).
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