Percutaneous coronary intervention of chronic total occlusions (CTO) is currently indicated for symptom improvement, as studies have inadequate randomization of data which hinders the assessment of hard outcomes. However, patient inclusion in randomized controlled trials has been challenging, especially for highly symptomatic and higher risk patients. This causes a selection bias in randomized studies on…
Longitudinal Deformation of a Stent with the POT Technique
The fractal geometry of coronary bifurcations offers a mismatch between the proximal diameter of the main branch and the distal branches that make up the bifurcation. Angioplasty in this area can be performed through different techniques depending on plaque distribution, and the particular geometry of each bifurcation. Overall, and regardless of the strategy used, there…
Progress-CTO Score: A Key New Tool to Plan CTO
Intervention of chronic total occlusions (CTO) through angioplasty (PCI) can cause complications, even in highly experienced centers. Plenty has been written on the probability of success for the treatment of CTOs using scores such as CL-SCORE, J-CTO, ORA, E-CTO, CASTLE-CTO, etc. (some of which are usually used when preparing these cases). However, besides estimating success…
Changes in Coronary Collateral Function Post CTO Intervention
In the last few years, we have seen significant growth of chronic total occlusion (CTO) percutaneous intervention, which has also been considered for patients with viable territory that remain symptomatic. Experienced centers present successful CTO intervention rates close to 90%, especially with a hybrid approach. However, it is still a complex procedure, and target vessel…
Three-Year Outcomes after CTA with 2-Stent Technique Vs. Provisional Stenting for Complex Bifurcation Lesions
The prevalence of coronary lesions with bifurcation involvement is about 20% in patients undergoing coronary angiography (CTA). While provisional stenting is overall the most accepted technique, the 2018 myocardial revascularization guidelines recommend the 2-stent technique for complex bifurcation lesions, defined as side branch with lesion >5mm, distal reference diameter of the side branch ≥2.75, or…
Coronary Bifurcation Lesions: MRS or PCI? 10-Year Mortality of the SYNTAX Study
Percutaneous treatment of coronary lesions affecting bifurcations has increased in recent decades. Coronary angioplasty (percutaneous coronary intervention, PCI) in these cases is associated with an increased rate of adverse events in patients with multivessel disease and left main coronary artery lesions. The SYNTAX score, which is a predictor of total mortality, is used to evaluate…
EuroPCR 2022 | The IMPROVED-CTO Trial
PCI success rate in chronic total occlusion (CTO), according to some registries, is below 80%. These failed revascularization procedures might lead to quality-of-life deterioration and shorter survival. This concern has driven the development of new techniques and technologies in an attempt to increase PCI success. Today, approximately 20% of CTOs are treated with a second…
Transfemoral vs Transradial Approach in the Percutaneous Treatment of CTO
Percutaneous treatment of chronic total occlusion (CTO) has traditionally been via the transfemoral approach (TFA). The use of the transradial approach (TRA) in complex coronary interventions has been increasing. A randomized study assessed the use of TRA vs TFA in complex PCI (58% CTO) and TRA saw favorable outcomes. The aim of this prospective, randomized,…
Can the Use of Intra Arterial Vasodilators Prevent Radial Artery Occlusion?
The incidence of post procedure radial occlusion (RAO) ranges from 1% to 12 % according to some studies. Different strategies to reduce RAO include the use of small caliber catheters, adequate anticoagulation and punction site care after procedure. Vasodilators are used to prevent radial spasm during procedure. However, using it after procedure should increase flow,…
Wire Jailing at Side Branch to Prevent Occlusion After Main Vessel Stenting: Should It Be the Standard of Care?
While the ideal treatment for coronary bifurcation is provisional stenting, this can be associated with side branch occlusion, which leads to severe adverse events. To prevent this complication, several treatments have been proposed. One of them is wire jailing at side branch before stent implantation in the main vessel. However, the actual benefit of this…
Provisional vs Dual Stenting in Left Main: An Endless Discussion?
True left main stem bifurcation patients have shown fewer adverse events with stepwise provisional stenting vs systematic dual stenting as first strategy, even though the difference was not significant. Usually, for any other vessel, the preferred technique is provisional stenting. However, when it comes to the left main, there is a randomized, dedicated, well designed…