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Vol.5 , No. 4, Publication Date: Jun. 7, 2018, Page: 86-89
 are encountered in 15 to 20% patients referred for CAG. The benefit of CTO revascularization are well established both in terms of improvement in patients’ symptoms as well as improvement in LVEF. We aim in this study to highlight a multitude of techniques that can significantly improve procedural success in this subset of “Uncrossable” CTO lesions. A total number of 436 patients over a period from June 2006 to January 2014 were included. These were patients having either symptomatic angina or documented myocardial ischemia. All patients received loading dose of DAPT Clopidogrel and Aspirin. The lesion was deemed “Uncrossable” if attempts to pass a low profile balloon 1.0 to 1.5 mm were unsuccessful. The failure rate of CTO PCI in our study was 46 cases. In 35 patients coronary guide wire could not able to cross the lesion. The balloon Uncrossable lesions 29 patients. The involved vessels were RCA in 14, LCX in 8 and LAD in 7cases. In 4 patients unable to deploy the stent due to long dissection; small vessels, diffuse disease, unyielding lesions and achieved flow less than TIMI III. We successfully facilitated the balloon and achieved adequate lesion dilatation in 22 patients out of 29 patients. In spite of all these various techniques, in 7 patient lesions were resistant to cross with the balloon. Among seven of these resistant balloon Uncrossable lesion cases, four cases were of LCX lesion, three of RCA lesion and none in case of LAD. The lesion site calcification was invariably present in all patients. The tortuosity at lesion site was noticed in 5, CTO PCI failure were observed in 7 cases. Guide catheters with large size, extra backup, Amplatz and other designed guide catheters provide maximum support. The use of long sheaths, armour guide catheter technique, mother and child technique Guide liner, buddy wire and balloon anchoring including distal anchoring wire technique further provide the strong back up support that is desired when tackling such lesions. In this study we observed Uncrossable lesions in 7.19% cases. The resistant balloon Uncrossable lesions still contributed in 1.59% cases of CTO PCI failure in spite of adaptation of multiple techniques.&picture=http://www.aascit.org/aascit/decorators/img/journal/906.jpg)
| [1] | Suryaprakasa Rao Vithala, Apollo Hospital, Hyderguda, Hyderabad, India. |
| [2] | Kapardhi Pannala Laxmi Narasimha, Apollo Hospital, Hyderguda, Hyderabad, India. |
| [3] | Priyen Kantilal Shah, Apollo Hospital, Hyderguda, Hyderabad, India. |
| [4] | Naraynana Rao Ankala Venkata Satya, Apollo Hospital, Hyderguda, Hyderabad, India. |
| [5] | Revanur Vishwanath, Apollo Hospital, Hyderguda, Hyderabad, India. |
| [6] | Arvind Kumar Srivastava, Apollo Hospital, Hyderguda, Hyderabad, India. |
| [7] | Satyajit Mehtre, Apollo Hospital, Hyderguda, Hyderabad, India. |
| [8] | Rama Kumari Nuthalapati, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India. |
It has been estimated that chronic total coronary occlusions (CTO) are encountered in 15 to 20% patients referred for CAG. The benefit of CTO revascularization are well established both in terms of improvement in patients’ symptoms as well as improvement in LVEF. We aim in this study to highlight a multitude of techniques that can significantly improve procedural success in this subset of “Uncrossable” CTO lesions. A total number of 436 patients over a period from June 2006 to January 2014 were included. These were patients having either symptomatic angina or documented myocardial ischemia. All patients received loading dose of DAPT Clopidogrel and Aspirin. The lesion was deemed “Uncrossable” if attempts to pass a low profile balloon 1.0 to 1.5 mm were unsuccessful. The failure rate of CTO PCI in our study was 46 cases. In 35 patients coronary guide wire could not able to cross the lesion. The balloon Uncrossable lesions 29 patients. The involved vessels were RCA in 14, LCX in 8 and LAD in 7cases. In 4 patients unable to deploy the stent due to long dissection; small vessels, diffuse disease, unyielding lesions and achieved flow less than TIMI III. We successfully facilitated the balloon and achieved adequate lesion dilatation in 22 patients out of 29 patients. In spite of all these various techniques, in 7 patient lesions were resistant to cross with the balloon. Among seven of these resistant balloon Uncrossable lesion cases, four cases were of LCX lesion, three of RCA lesion and none in case of LAD. The lesion site calcification was invariably present in all patients. The tortuosity at lesion site was noticed in 5, CTO PCI failure were observed in 7 cases. Guide catheters with large size, extra backup, Amplatz and other designed guide catheters provide maximum support. The use of long sheaths, armour guide catheter technique, mother and child technique Guide liner, buddy wire and balloon anchoring including distal anchoring wire technique further provide the strong back up support that is desired when tackling such lesions. In this study we observed Uncrossable lesions in 7.19% cases. The resistant balloon Uncrossable lesions still contributed in 1.59% cases of CTO PCI failure in spite of adaptation of multiple techniques.
Keywords
Chronic Coronary Occlusions (CTO), Dual Antiplatelet Drugs (DAPT), Percutaneous Coronary Intervention (PCI)
Reference
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