TY - JOUR
T1 - Contemporary outcomes of percutaneous intervention in chronic total coronary occlusions due to in-stent restenosis
AU - Abdel-karim, Abdul rahman R
AU - Lombardi, William B.
AU - Banerjee, Subhash
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
Dr. Banerjee: Speaker honoraria from St. Jude Medical, Medtronic, and Johnson & Johnson and research support from Boston Scientific and The Medicines Company
PY - 2011/5
Y1 - 2011/5
N2 - Background: Limited data exist on the treatment of chronic total occlusions (CTO) due to in-stent restenosis (ISR). Methods: We reviewed the procedural techniques and outcomes of 21 consecutive interventions in CTOs due to ISR. Results: Mean age was 60±8 years, and all patients were men. The target lesion was located in the right coronary artery in 38%, left anterior descending or diagonal in 48%, or circumflex/obtuse marginal in 14%. One CTO lesion was treated in each patient. Two patients (10%) had prior unsuccessful attempt for CTO intervention and 14% had prior coronary artery bypass graft surgery. The average CTO age was 6.3±4.6 years. The overall ISR CTO procedural success rate was 71%. Procedural failure was due to inability to cross the CTO lesion in all unsuccessful cases. Failure to cross in CTOs located in the left anterior descending artery was due to the presence of a large side branch proximal to the CTO, whereas in the right coronary artery it was due to tortuosity. Retrograde interventions were attempted in four patients and were successful in one. Conclusion: Success rates for ISR CTO interventions remain relatively low due to failure to cross the lesion. Several factors, such as long occlusion time, tortuosity, and presence of a large side branch proximal to the CTO may be associated with ISR CTO crossing failure.
AB - Background: Limited data exist on the treatment of chronic total occlusions (CTO) due to in-stent restenosis (ISR). Methods: We reviewed the procedural techniques and outcomes of 21 consecutive interventions in CTOs due to ISR. Results: Mean age was 60±8 years, and all patients were men. The target lesion was located in the right coronary artery in 38%, left anterior descending or diagonal in 48%, or circumflex/obtuse marginal in 14%. One CTO lesion was treated in each patient. Two patients (10%) had prior unsuccessful attempt for CTO intervention and 14% had prior coronary artery bypass graft surgery. The average CTO age was 6.3±4.6 years. The overall ISR CTO procedural success rate was 71%. Procedural failure was due to inability to cross the CTO lesion in all unsuccessful cases. Failure to cross in CTOs located in the left anterior descending artery was due to the presence of a large side branch proximal to the CTO, whereas in the right coronary artery it was due to tortuosity. Retrograde interventions were attempted in four patients and were successful in one. Conclusion: Success rates for ISR CTO interventions remain relatively low due to failure to cross the lesion. Several factors, such as long occlusion time, tortuosity, and presence of a large side branch proximal to the CTO may be associated with ISR CTO crossing failure.
KW - Chronic total occlusion
KW - In-stent restenosis
KW - Percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=79957853899&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79957853899&partnerID=8YFLogxK
U2 - 10.1016/j.carrev.2010.08.002
DO - 10.1016/j.carrev.2010.08.002
M3 - Article
C2 - 21640935
AN - SCOPUS:79957853899
SN - 1553-8389
VL - 12
SP - 170
EP - 176
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
IS - 3
ER -