Double Chronic Total Occlusion Recanalisation with Antegrade and Retrograde Techniques and the Use of a Novel Drug-eluting Stent with Biodegradable Polymer

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Abstract

Percutaneous recanalisation of coronary chronic total occlusions (CTOs) has proved an efficient and safe treatment option with steadily ascending success rates, especially since the advent and constant refinement of the retrograde approach. Uptake remains low, even though experienced operators have in the last five years reached an unprecedented maturity level, producing success rates in the range of 90 %, clearly comparable to non-occlusive coronary artery disease treatment. Antegrade and retrograde techniques are currently considered complementary components of a CTO procedure, rather than discrete treatment strategies. We report on the case of a successful CTO recanalisation procedure on a young patient with two chronically occluded coronary arteries and a large ischaemic burden. Both CTOs were addressed in the same session employing a range of dedicated CTO recanalisation techniques, without compromising on safety issues related to contrast dye consumption and radiation exposure. A novel drug-eluting stent (DES) with biodegradable polymer was used to treat the lesions.

Disclosure
The authors have no conflicts of interest to declare.
Correspondence
Georgios Sianos, Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, 54636, Thessaloniki, Greece. E: gsianos@auth.gr
Support
The publication of this article was supported by Alvimedica.
Received date
12 March 2013
Accepted date
27 March 2013
Citation
Interventional Cardiology Review 2013;8(1):46–9
DOI
http://dx.doi.org/10.15420/icr.2013.8.1.46
References
  1. Kahn JK, Hartzler GO, Retrograde coronary angioplasty of isolated arterial segments through saphenous vein bypass grafts, Cathet Cardiovasc Diagn, 1990;20:88–93.
    Crossref | PubMed
  2. Cohen HA, Williams DO, Holmes DR Jr, et al., Impact of age on procedural and 1-year outcome in percutaneous transluminal coronary angioplasty: a report from the NHLBI Dynamic Registry, Am Heart J, 2003;146:513–9.
    Crossref | PubMed
  3. Hoye A, van Domburg RT, Sonnenschein K, Serruys PW, Percutaneous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992-2002, Eur Heart J, 2005;26:2630–6.
    Crossref | PubMed
  4. Suero JA, Marso SP, Jones PG, et al., Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience, J Am Coll Cardiol, 2001;38:409–14.
    Crossref | PubMed
  5. Shaw LJ, Berman DS, Maron DJ, et al., Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy, Circulation, 2008;117:1283–91.
    Crossref | PubMed
  6. Ivanhoe RJ, Weintraub WS, Douglas JS Jr, et al., Percutaneous transluminal coronary angioplasty of chronic total occlusions. Primary success, restenosis, and long-term clinical follow-up, Circulation, 1992;85:106–15.
    Crossref | PubMed
  7. Werner GS, Surber R, Kuethe F, et al., Collaterals and the recovery of left ventricular function after recanalization of a chronic total coronary occlusion, Am Heart J, 2005;149:129–37.
    Crossref | PubMed
  8. Serruys PW, Hamburger JN, Koolen JJ, et al., Total occlusion trial with angioplasty by using laser guidewire. The TOTAL trial, Eur Heart J, 2000;21:1797–805.
    Crossref | PubMed
  9. Olivari Z, Rubartelli P, Piscione F, et al., Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE), J Am Coll Cardiol, 2003;41:1672–8.
    Crossref | PubMed
  10. Abbott JD, Kip KE, Vlachos HA, et al., Recent trends in the percutaneous treatment of chronic total coronary occlusions, Am J Cardiol, 2006;97:1691–6.
    Crossref | PubMed
  11. Surmely JF, Tsuchikane E, Katoh O, et al., New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique, J Invasive Cardiol, 2006;18:334–8.
    PubMed
  12. Rathore S, Katoh O, Matsuo H, et al., Retrograde percutaneous recanalization of chronic total occlusion of the coronary arteries: procedural outcomes and predictors of success in contemporary practice, Circ Cardiovasc Interv, 2009;2:124–32.
    Crossref | PubMed
  13. Sianos G, Werner GS, Galassi AR, et al., Recanalisation of chronic total coronary occlusions: 2012 consensus document from the EuroCTO club, EuroIntervention, 2012;8:139–45.
    Crossref | PubMed
  14. Werner GS, Ferrari M, Heinke S, et al., Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions, Circulation, 2003;107:1972–7.
    Crossref | PubMed
  15. Sianos G, CTO PCI at the crossroads, EuroIntervention, 2010;6:303–7.
    Crossref | PubMed
  16. Colmenarez HJ, Escaned J, Fernández C, et al., Effiacy and safety of drug-eluting stents in chronic total coronary occlusion recanalization: a systematic review and metaanalysis, J Am Coll Cardiol, 2010;55:1854–66.
    Crossref | PubMed
  17. Kandzari DE, Rao SV, Moses JW, et al., Clinical and angiographic outcomes with sirolimus-eluting stents in total coronary occlusions: the ACROSS/TOSCA-4 (Approaches toChronic Occlusions With Sirolimus-Eluting Stents/Total Occlusion Study of Coronary Arteries-4) trial, JACC Cardiovasc Interv, 2009;2:97–106.
    Crossref | PubMed
  18. De Felice F, Fiorilli R, Parma A, et al., Five-Year Outcomes in Patients With Chronic Total Coronary Occlusion Treated With Drug-Eluting vs Bare-Metal Stents: A Case-Control Study, Can J Cardiol, 2012 [Epub ahead of print].
  19. Masahiro N, One-Year Outcome of a Trial Comparing Second Generation Drug-eluting Stents Using Either Biodegradable Polymer or Durable Polymer. The NOBORI Biolimus-Eluting versus XIENCE/PROMUS Everolimus-eluting Stent Trial (next), American College of Cardiology Scientifi Session, 2013. Available at: http://my.americanheart.org/idc/ groups/ahamah-public/@wcm/@sop/@scon/documents/ downloadable/ucm_450001.pdf (accessed 26 March 2013).
  20. Reifart N, Hauptmann KE, Rabe A, et al., Short and long term comparison (24 months) of an alternative sirolimus-coated stent with bioabsorbable polymer and a bare metal stent of similar design in chronic coronary occlusions: The CORACTO trial, EuroIntervention, 2010;6:356–60.
    Crossref | PubMed
  21. Sianos G, Barlis P, Di Mario C, et al., European experience with the retrograde approach for the recanalisation of coronary artery chronic total occlusions. A report on behalf of the euroCTO club, EuroIntervention, 2008;4:84–92.
    Crossref | PubMed