Database : MEDLINE
Search on : C14.280.647.250.272 [DeCS Category]
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  1 / 2130 MEDLINE  
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PMID:28460777
Author:Mishra S
Address:All India Institute of Medical Sciences, Department of Cardiology, Ansari Nagar, New Delhi 110029, India. Electronic address: sundeepmishraihj@gmail.com.
Title:Unraveling the mystique of CTO Interventions: Tips and techniques of using hardware to achieve success.
Source:Indian Heart J; 69(2):266-276, 2017 Mar - Apr.
ISSN:0019-4832
Country of publication:India
Language:eng
Abstract:The scientific discourse of chronic total occlusions interventions is mired in a technical jargon so confusing that it prevents an average interventional cardiologist from pursuing this field so much so that it has become a domain of a few. This review attempts to simplify this vernacular and present it in a manner that this procedure comes within the scope of a mainstream interventionist.
Publication type:EDITORIAL


  2 / 2130 MEDLINE  
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PMID:28470330
Author:Ajayi NO; Vanker EA; Satyapal KS
Address:Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa.
Title:The role of coronary artery collaterals in the preservation of left ventricular function: a study to address a long-standing controversy.
Source:Cardiovasc J Afr; 28(2):81-85, 2017 Mar/Apr.
ISSN:1680-0745
Country of publication:South Africa
Language:eng
Abstract:INTRODUCTION: The functional significance of coronary artery collateral (CAC) vasculature in humans has been debated for decades and this has been compounded by the lack of a standard, systematic, objective method of grading and documenting CAC flow in man. CACs serve as alternative conduits for blood in obstructive coronary artery disease. This study aimed to evaluate the impact of CACs on left ventricular function in the presence of total coronary arterial occlusion. METHODS: The study group included the coronary angiographic records of 97 patients (mean age: 59 ± 8 years). CACs were graded from 0-3 based on the collateral connection between the donor and recipient arteries. Left ventricular function was computed from the ventriculogram and expressed as ejection fraction (EF). RESULTS: The mean EF of the patients with grades 0, 1, 2 and 3 CACs were calculated as 50.4, 47, 60.5 and 70%, respectively. A significant difference was recorded in the mean EF calculated for the different CAC grades (p = 0.001). There was a significant positive correlation (p < 0.001; r = 0.478) between the mean EF and the CAC grades. CONCLUSION: The patients with better coronary collateral grades had a higher mean EF. Therefore, as the grade of CACs increased, there was an improvement in their ability to preserve left ventricular function.
Publication type:JOURNAL ARTICLE


  3 / 2130 MEDLINE  
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PMID:28456814
Author:Palmers PJ; Maeremans J; Meyer-Gessner M; Bataille Y; Dens J
Address:Department of Cardiology, Hospital East Limburg, Genk, Belgium.
Title:Telescopic Corsair in 5F Guidion for Retrograde Recanalization of Complex Chronic Total Occlusions (CTOs).
Source:Am J Case Rep; 18:472-477, 2017 Apr 30.
ISSN:1941-5923
Country of publication:United States
Language:eng
Abstract:BACKGROUND Retrograde advancement of microcatheters through septal/epicardial connectors can be challenging. Although several tricks might help to do so (e.g., balloon trap of retro wire in second guiding, balloon trap of retro wire in native coronary artery, and use of antegrade extension to approximate the antegrade conduit to the retrograde gear), these tricks cannot always be applied, especially in patients with poor access. Also, puncturing, knuckling, and crossing of the distal CTO cap (or the aorta as described in 1 of the cases) sometimes needs a lot of backup of the microcatheter. CASE REPORT We describe 3 cases in which we used a novel telescopic technique with 5F Guidion (IMDS®) supported retrograde Corsair (Asahi®) advancement in complex CTO lesions. CONCLUSIONS The telescopic Corsair in 5F Guidion may offer the support needed to end successfully in these situations.
Publication type:CASE REPORTS; JOURNAL ARTICLE


  4 / 2130 MEDLINE  
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PMID:29049164
Author:Li Q; Wang DZ; Chen BX
Address:Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Title:Electrocardiogram in patients with acute inferior myocardial infarction due to occlusion of circumflex artery.
Source:Medicine (Baltimore); 96(42):e6095, 2017 Oct.
ISSN:1536-5964
Country of publication:United States
Language:eng
Abstract:To investigate the diagnostic value of electrocardiographic (ECG) ST-segment in acute inferior myocardial infarction (AIMI) caused by the left circumflex branch (LCX).A total of 240 clinical cases with AIMI in our hospital were retrospectively analyzed. All of them had received percutaneous coronary intervention (PCI) within 12 hours after symptom onset. The clinical features, ECG manifestations, and coronary artery lesion characteristics of the patients were collected.The right coronary artery (RCA) was shown to be the infarct-related artery (IRA) in 177 patients, while LCX was responsible for AIMI in 63 cases. There was no significant difference in the risk factors of coronary heart disease (CHD) (P > .05 for all) between the 2 groups. ST-segment elevation in lead II, III, and AVF could be found in all patients. Moreover, ST-segment depression in lead I (STD I), ST-segment elevation in lead III (STE III), STE III-STE II, STE AVF, STD AVL, STD AVL-STD I and STE v6 lead ST-segment deviation exhibited significant difference in 2 groups (P < .05 for all). The changes of STD I, STE III < STEII, STD AVL < STD I could discriminate between LCX and RCA in AIMI patients with high sensitivity and specificity.ECG may be an effective tool to predict the IRA in patient with AIMI.
Publication type:EVALUATION STUDIES; JOURNAL ARTICLE


  5 / 2130 MEDLINE  
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PMID:28966325
Author:Shiraishi J; Shoji K; Yanagiuchi T; Yashige M; Shikuma A; Ito D; Kimura M; Kishita E; Nakagawa Y; Hyogo M; Sawada T
Address:Department of Cardiology, Kyoto First Red Cross Hospital.
Title:Rotational Atherectomy Followed by Drug-Coated Balloon Dilation for Left Main In-Stent Restenosis in the Setting of Acute Coronary Syndrome Complicated with Right Coronary Chronic Total Occlusion.
Source:Int Heart J; 58(5):806-811, 2017 Oct 21.
ISSN:1349-3299
Country of publication:Japan
Language:eng
Abstract:An 83-year-old man presented with recurrent acute coronary syndrome (ACS) at the left main coronary artery (LMCA) complicated with ostial chronic total occlusion (CTO) in the right coronary artery (RCA) (RCA-CTO). At the first LMCA-ACS approximately 1 year earlier, he had undergone LMCA-crossover stenting with a biolimus-eluting stent in the presence of RCA-CTO. At the second LMCA-ACS, we angiographically confirmed severe in-stent restenosis in the distal LMCA, in addition to angled severe stenosis in the just proximal LCx, and performed primary PCI for the LMCA bifurcation lesion under intra-aortic balloon pumping support. Because of difficulty in crossing a guidewire through the just proximal LCx lesion, we first performed rotational atherectomy against the LMCA in-stent eccentric lesion. After successfully crossing the guidewire into the LCx, we added balloon dilation with kissing balloon inflation followed by alternate drug-coated balloon dilation. An eight-month follow-up coronary angiography revealed no further vessel narrowing in the LMCA bifurcation lesion.
Publication type:CASE REPORTS; JOURNAL ARTICLE
Name of substance:0 (Coated Materials, Biocompatible)


  6 / 2130 MEDLINE  
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PMID:28867129
Author:Abela GS; Kalavakunta JK; Janoudi A; Leffler D; Dhar G; Salehi N; Cohn J; Shah I; Karve M; Kotaru VPK; Gupta V; David S; Narisetty KK; Rich M; Vanderberg A; Pathak DR; Shamoun FE
Address:Department of Medicine, Michigan State University, East Lansing, Michigan; Division of Cardiology, Michigan State University, East Lansing, Michigan; Division of Pathology, Department of Physiology, Michigan State University, East Lansing, Michigan. Electronic address: george.abela@ht.msu.edu.
Title:Frequency of Cholesterol Crystals in Culprit Coronary Artery Aspirate During Acute Myocardial Infarction and Their Relation to Inflammation and Myocardial Injury.
Source:Am J Cardiol; 120(10):1699-1707, 2017 Nov 15.
ISSN:1879-1913
Country of publication:United States
Language:eng
Abstract:Cholesterol crystals (CCs) have been associated with plaque rupture through mechanical injury and inflammation. This study evaluated the presence of CCs during acute myocardial infarction (AMI) and associated myocardial injury, inflammation, and arterial blood flow before and after percutaneous coronary intervention. Patients presenting with AMI (n = 286) had aspiration of culprit coronary artery obstruction. Aspirates were evaluated for crystal content, size, composition, and morphology by scanning electron microscopy, crystallography, and infrared spectroscopy. These were correlated with inflammatory biomarkers, cardiac enzymes, % coronary stenosis, and Thrombolysis in Myocardial Infarction (TIMI) blush and flow grades. Crystals were detected in 254 patients (89%) and confirmed to be cholesterol by spectroscopy. Of 286 patients 240 (84%) had CCs compacted into clusters that were large enough to be measured and analyzed. Moderate to extensive CC content was present in 172 cases (60%). Totally occluded arteries had significantly larger CC clusters than partially occluded arteries (p <0.05). Patients with CC cluster area >12,000 µm had significantly elevated interleukin-1 beta (IL-1ß) levels (p <0.01), were less likely to have TIMI blush grade of 3 (p <0.01), and more likely to have TIMI flow grade of 1 (p <0.01). Patients with recurrent AMI had smaller CC cluster area (p <0.04), lower troponin (p <0.02), and IL-1ß levels (p <0.04). Women had smaller CC clusters (p <0.04). Macrophages in the aspirates were found to be attached to CCs. Coronary artery aspirates had extensive deposits of CCs during AMI. In conclusion, presence of large CC clusters was associated with increased inflammation (IL-1ß), increased arterial narrowing, and diminished reflow following percutaneous coronary intervention.
Publication type:JOURNAL ARTICLE
Name of substance:0 (Cytokines); 9007-41-4 (C-Reactive Protein); 97C5T2UQ7J (Cholesterol)


  7 / 2130 MEDLINE  
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PMID:28867125
Author:Toma A; Stähli BE; Gick M; Gebhard C; Kaufmann BA; Mashayekhi K; Ferenc M; Buettner HJ; Neumann FJ
Address:Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany. Electronic address: toma.aurel@gmail.com.
Title:Comparison of Benefit of Successful Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients With Versus Without Reduced (≤40%) Left Ventricular Ejection Fraction.
Source:Am J Cardiol; 120(10):1780-1786, 2017 Nov 15.
ISSN:1879-1913
Country of publication:United States
Language:eng
Abstract:Successful recanalization of chronic total occlusions (CTO) has been associated with improved survival. Data on outcomes in patients with left ventricular (LV) systolic dysfunction undergoing percutaneous coronary intervention for CTO, however, are scarce. Between January 2005 and December 2013, a total of 2,002 consecutive patients undergoing elective CTO percutaneous coronary intervention at a tertiary care center were divided into patients with (LV ejection fraction ≤ 40%) and without (LV ejection fraction > 40%) LV systolic dysfunction as defined by transthoracic echocardiography. The primary end point was all-cause mortality. Median follow-up was 2.6 (1.1 to 3.1) years. A total of 348 (17.4%) patients had LV dysfunction. All-cause mortality was higher in patients with LV dysfunction (30.2%) than in those with normal LV function (8.2%, p <0.001), and associations remained significant after adjustment for baseline differences (adjusted hazard ratio [HR] 3.39, 95% confidence interval [CI] 2.57 to 4.47, p <0.001). Successful CTO recanalization was independently associated with reduced all-cause mortality, with similar relative risk reductions in both the preserved (6.6% vs 16.9%, adjusted HR 0.48, 95% CI 0.34 to 0.70, p <0.001) and the reduced LV function groups (26.2% vs 45.2%, adjusted HR 0.63, 95% CI 0.41 to 0.98, p = 0.04, interaction p = 0.28). In conclusion, irrespective of LV function, successful CTO recanalization is associated with a clear survival benefit.
Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE


  8 / 2130 MEDLINE  
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PMID:28842146
Author:Vives-Borrás M; Moustafa AH; Álvarez-García J; Ferrero-Gregori A; Balcells J; García-Picart J; Serra-Peñaranda A; Sionis A; Cinca J
Address:Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, CIBERCV, Universidad Autónoma de Barcelona, Barcelona, Spain.
Title:Clinical and Prognostic Value of the Electrocardiogram in Patients With Acute Occlusion of the Left Circumflex Coronary Artery.
Source:Am J Cardiol; 120(9):1487-1494, 2017 Nov 01.
ISSN:1879-1913
Country of publication:United States
Language:eng
Abstract:The utility of the electrocardiogram (ECG) in patients with acute left circumflex (LC) coronary occlusion is not established. This study aimed at determining the clinical, angiographic, and prognostic characteristics associated with the different patterns of ST-segment changes in patients with LC occlusion. A cohort of 314 patients with LC occlusion was categorized according to the admission ECG: (1) ST-segment elevation (ST-E, n=208), (2) isolated ST-segment depression in precordial leads (ST-D, n=62), and (3) negligible ST-segment changes (No-ST, n=44). Clinical variables, coronary angiography, and 30-day major adverse cardiac event (MACE) (in-hospital ventricular fibrillation, 1-month mortality, or heart failure) were compared among the three groups. As compared with No-ST, patients with ST-E or ST-D presented more advanced Killip class, higher troponin peak, lower LV ejection fraction, and were independently associated with MACE (odds ratio 5.43, 95% confidence interval 1.09 to 27.20 and odds ratio 3.39, 95% confidence interval 0.66 to 17.50, respectively). Patients with ST-D were tardily reperfused, had more often mitral regurgitation (23.1% vs 9.3% in ST-E and 3.3% in No-ST, p=0.03), and presented ST-segment elevation in leads V7 to V9 in 12 of 16 cases with available recordings. Culprit proximal LC predominated in ST-D (41.9%), distal LC in ST-E (42.8%), and obtuse marginal in No-ST (59.1%) (all p<0.01). The No-ST had smaller coronary vessels and more collaterals. In conclusion, the three ST-segment patterns of LC occlusion identify patients with different clinical, angiographic, and prognostic characteristics. Patients with ST-depression pattern require a prompt reperfusion therapy and could be better recognized by recording leads V7 to V9.
Publication type:JOURNAL ARTICLE


  9 / 2130 MEDLINE  
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PMID:28826896
Author:Danek BA; Karatasakis A; Tajti P; Sandoval Y; Karmpaliotis D; Alaswad K; Jaffer F; Yeh RW; Kandzari DE; Lembo NJ; Patel MP; Mahmud E; Choi JW; Doing AH; Lombardi WL; Wyman RM; Toma C; Garcia S; Moses JW; Kirtane AJ; Hatem R; Ali ZA; Parikh M; Karacsonyi J; Rangan BV; Khalili H; Burke MN; Banerjee S; Brilakis ES
Address:VA North Texas Healthcare System/UT Southwestern Medical Center, Dallas, Texas.
Title:Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention.
Source:Am J Cardiol; 120(8):1285-1292, 2017 Oct 15.
ISSN:1879-1913
Country of publication:United States
Language:eng
Abstract:Coronary perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,097 CTO PCIs performed in 2,049 patients from 2012 to 2017. Patient age was 65 ± 10 years, 85% were men, and 36% had prior coronary artery bypass graft surgery. Technical and procedural success were 88% and 87%, respectively. A major periprocedural adverse cardiovascular event occurred in 2.6%. Coronary perforation occurred in 85 patients (4.1%); The frequency of Ellis class 1, 2, and 3 perforations was 21%, 26%, and 52%, respectively. Perforation occurred more frequently in older patients and those with previous coronary artery bypass graft surgery (61% vs 35%, p < 0.001). Cases with perforation were angiographically more complex (Multicenter CTO Registry in Japan score 3.0 ± 1.2 vs 2.5 ± 1.3, p < 0.001). Twelve patients (14%) with perforation experienced tamponade requiring pericardiocentesis. Patient age, previous PCI, right coronary artery target CTO, blunt or no stump, use of antegrade dissection re-entry, and the retrograde approach were associated with perforation. Adjusted odds ratio for periprocedural major periprocedural adverse cardiovascular events among patients with perforation was 15.04 (95% confidence interval 7.35 to 30.18). In conclusion, perforation occurs relatively infrequently in contemporary CTO PCI performed by experienced operators and is associated with baseline patient characteristics and angiographic complexity necessitating use of advanced crossing techniques. In most cases, perforations do not result in tamponade requiring pericardiocentesis, but they are associated with reduced technical and procedural success, higher periprocedural major adverse events, and reduced procedural efficiency.
Publication type:CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY


  10 / 2130 MEDLINE  
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PMID:28728719
Author:Schwann TA
Address:Department of Surgery, University of Toledo College of Medicine & Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA. Electronic address: Thomas.Schwann@utoledo.edu.
Title:The Surgical Treatment of Coronary Artery Occlusive Disease: Modern Treatment Strategies for an Age Old Problem.
Source:Surg Clin North Am; 97(4):835-865, 2017 Aug.
ISSN:1558-3171
Country of publication:United States
Language:eng
Abstract:Coronary artery disease remains a formidable challenge to clinicians. Percutaneous interventions and surgical techniques for myocardial revascularization continue to improve. Concurrently, in light of emerging data, multiple practice guidelines have been published guiding clinicians in their therapeutic decisions. The multidisciplinary Heart Team concept needs to be embraced by all cardiovascular providers to optimize patient outcomes.
Publication type:JOURNAL ARTICLE; REVIEW



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