Percutaneous coronary intervention of chronic total occlusion – to whom, when and why
Authors:
Roman Štípal; Martin Poloczek; Marek Sůva; Petr Kala
Authors‘ workplace:
Interní kardiologická klinika FN Brno a LF MU
Published in:
Vnitř Lék 2021; 67(E-4): 17-25
Category:
Review Articles
Overview
Chronic total occlusion is characterised by total discontinuation of a blood flow in coronary vessel present for at least three months. Typical finding involves filling of the distal arterial segments by collateral flow. Well developed collaterals usually provide sufficient supply to preserve myocardial viability, but frequently are not capable of preventing excercise ischemia in the occluded territory. Percutaneous intervention of a CTO is focused on ischemia reduction, improvement of excercise capacity and quality of life. A succesful recanalization of a CTO leads to an improvement of left ventricular systolic function. Patients presenting with acute coronary syndromes and a coincident CTO in non-infarct related artery show worse short and long-term outcomes as compared to patients without a CTO. Technolocigal and procedural evolvement over past decades with implementation of novel techniques used by experienced operators lead to a substantial succes rate imprevement with acceptable complications rate in contemporary CTO interventions.
Keywords:
percutaneous coronary intervention – chronic total occlusion – ischemia – viability
Sources
1. Azzalini L, Jolicoeur EM, Pighi M et al. Epidemiology, Management Strategies, and Outcomes of Patients With Chronic Total Coronary Occlusion. Am J Cardiol 2016; 118: 1128–35.
2. Fefer P, Knudtson ML, Cheema AN et al. Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol. 2012; 59(11): 991–997. doi:10.1016/j.jacc.2011.12.007.
3. Råmunddal T, Hoebers LP, Henriques JP et al. Chronic total occlusions in Sweden--a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) [published correction appears in PLoS One. 2014; 9(10): e112370. Hoebers, Loes [corrected to Hoebers, Loes P]]. PLoS One. 2014; 9(8): e103850. Published 2014 Aug 12. doi:10.1371/journal. pone.0103850.
4. Habib GB, Heibig J, Forman SA et al. Influence of coronary collateral vessels on myocardial infarct size in humans. Results of phase I thrombolysis in myocardial infarction (TIMI) trial. The TIMI Investigators. Circulation. 1991; 83(3): 739–746. doi:10.1161/01.cir.83.3.739.
5. Tomasello SD, Boukhris M, Giubilato S et al. Management strategies in patients affected by chronic total occlusions: results from the Italian Registry of Chronic Total Occlusions. Eur Heart J. 2015; 36(45): 3189–3198. doi:10.1093/eurheartj/ehv450.
6. Stuijfzand WJ, Driessen RS, Raijmakers PG et al. Prevalence of ischaemia in patients with a chronic total occlusion and preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging. 2017; 18(9): 1025–1033. doi:10.1093/ehjci/jew188.
7. Strauss BH, Shuvy M, Wijeysundera HC. Revascularization of chronic total occlusions: time to reconsider?. J Am Coll Cardiol. 2014; 64(12): 1281–1289. doi:10.1016/j.jacc.2014.06.1181.
8. Cetin M, Zencir C, Cakici M et al. Effect of a successful percutaneous coronary intervention for chronic total occlusion on parameters of ventricular repolarization. Coron Artery Dis. 2014; 25(8): 705–712. doi:10.1097/MCA.0000000000000138.
9. Nombela-Franco L, Iannaccone M, Anguera I et al. Impact of Chronic Total Coronary Occlusion on Recurrence of Ventricular Arrhythmias in Ischemic Secondary Prevention Implantable Cardioverter-Defibrillator Recipients (VACTO Secondary Study): Insights From Coronary Angiogram and Electrogram Analysis. JACC Cardiovasc Interv. 2017; 10(9): 879– 888. doi:10.1016/j.jcin.2017.02.008.
10. Sachdeva R, Agrawal M, Flynn SE, et al. The myocardium supplied by a chronic total occlusion is a persistently ischemic zone. Catheter Cardiovasc Interv 2014; 83: 9–16.
11. Kayaert P, Coeman M, Drieghe B et al. iFR uncovers profound but mostly reversible ischemia in CTOs and helps to optimize PCI results [published online ahead of print, 2020 Jun 17]. Catheter Cardiovasc Interv. 2020;10.1002/ccd.29072. doi:10.1002/ccd.29072.
12. Werner GS, Martin-Yuste V, Hildick-Smith D, et al. A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions. Eur Heart J. 2018; 39(26): 2484–2493. doi:10.1093/eurheartj/ehy220
13. Obedinskiy AA, Kretov EI, Boukhris M et al. The IMPACTOR-CTO Trial. JACC Cardiovasc Interv. 2018; 11(13): 1309–1311. doi:10.1016/j.jcin.2018.04.017.
14. Brilakis ES, Mashayekhi K, Burke MN. How DECISION-CTO Can Help Guide the Decision to Perform Chronic Total Occlusion Percutaneous Coronary Intervention. Circulation. 2019; 139(14): 1684–1687.
15. Neumann FJ, Sousa-Uva M, Ahlsson A et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroIntervention. 2019; 14(14): 1435–1534. doi:10.4244/EIJY19M01_01.
16. Alaswad K, Menon RV, Christopoulos G et al. Transradial approach for coronary chronic total occlusion interventions: Insights from a contemporary multicenter registry. Catheter Cardiovasc Interv. 2015; 85(7): 1123–1129. doi:10.1002/ccd.25827.
17. Muramatsu T, Tsuchikane E, Oikawa Y et al. Incidence and impact on midterm outcome of controlled subintimal tracking in patients with successful recanalisation of chronic total occlusions: J-PROCTOR registry. EuroIntervention. 2014; 10(6): 681–688.
18. Claessen BE, Dangas GD, Godino C et al. Impact of target vessel on long-term survival after percutaneous coronary intervention for chronic total occlusions. Catheter Cardiovasc Interv. 2013; 82(1): 76–82. doi:10.1002/ccd.24579.
19. Galassi AR, Sianos G, Werner GS, et al. Retrograde Recanalization of Chronic Total Occlusions in Europe: Procedural, In-Hospital, and Long-Term Outcomes From the Multicenter ERCTO Registry. J Am Coll Cardiol. 2015; 65(22): 2388–2400.
20. Morino Y, Kimura T, Hayashi Y et al. In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J-CTO Registry (Multicenter CTO Registry in Japan). JACC Cardiovasc Interv. 2010;3(2):143–151. doi:10.1016/j.jcin.2009.10.029.
21. Megaly M, Saad M, Tajti P et al. Meta-analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling. J Interv Cardiol. 2018; 31(5): 562–571. doi:10.1111/joic.12538.
22. Stuijfzand WJ, Biesbroek PS, Raijmakers PG et al. Effects of successful percutaneous coronary intervention of chronic total occlusions on myocardial perfusion and left ventricular function. EuroIntervention. 2017; 13(3): 345–354. doi:10.4244/EIJ-D-16–01014.
23. Patel MR, Calhoon JH, Dehmer GJ et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons [published correction appears in J Am Coll Cardiol. 2018 Apr 13;:]. J Am Coll Cardiol. 2017; 69(17): 2212–2241. doi:10.1016/j.jacc.2017.02.001.
24. Claessen BE, Dangas GD, Weisz G, et al. Prognostic impact of a chronic total occlusion in a non-infarct-related artery in patients with ST-segment elevation myocardial infarction: 3-year results from the HORIZONS-AMI trial. Eur Heart J. 2012; 33(6): 768–775. doi:10.1093/eurheartj/ehr471.
25. Gierlotka M, Tajstra M, Gąsior M et al. Impact of chronic total occlusion artery on 12-month mortality in patients with non-ST-segment elevation myocardial infarction treated by percutaneous coronary intervention (from the PL-ACS Registry). Int J Cardiol. 2013; 168(1): 250–254. doi:10.1016/j.ijcard.2012.09.086.
26. Watanabe H, Morimoto T, Shiomi H et al. Chronic total occlusion in a non-infarct-related artery is closely associated with increased five-year mortality in patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention (from the CREDO-Kyoto AMI registry). EuroIntervention. 2017; 12(15): e1874– e1882. doi:10.4244/EIJ-D-15–00421.
27. Fujii T, Sakai K, Nakano M et al. Impact of the origin of the collateral feeding donor artery on short-term mortality in ST-elevation myocardial infarction with comorbid chronic total occlusion. Int J Cardiol. 2016; 218: 158–163. doi:10.1016/j.ijcard.2016.05.023.
28. Henriques JP, Hoebers LP, Råmunddal T et al. Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI: The EXPLORE Trial. J Am Coll Cardiol. 2016; 68(15): 1622–1632. doi:10.1016/j.jacc.2016.07.744.
29. Hachamovitch R, Hayes SW, Friedman JD et al. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003; 107(23): 2900–2907. doi:10.1161/01. CIR.0000072790.23090.41.
30. Galassi AR, Brilakis ES, Boukhris M et al. Appropriateness of percutaneous revascularization of coronary chronic total occlusions: an overview. Eur Heart J. 2016;37(35):2692– 2700. doi:10.1093/eurheartj/ehv391.
31. Galassi AR, Werner GS, Boukhris M et al. Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club. EuroIntervention. 2019; 15(2): 198–208. doi:10.4244/EIJ-D-18–00826.
32. Schumacher SP, Kockx M, Stuijfzand WJ et al. Ischaemic burden and changes in absolute myocardial perfusion after chronic total occlusion percutaneous coronary intervention. EuroIntervention. 2020; 16(6): e462–e471. Published 2020 Aug 7. doi:10.4244/EIJ-D-19–00631.
33. Galassi AR, Werner GS, Tomasello SD et al. Prognostic value of exercise myocardial scintigraphy in patients with coronary chronic total occlusions. J Interv Cardiol. 2010; 23(2): 139–148. doi:10.1111/j.1540–8183.2010.00527.
34. Löffler AI, Kramer CM. Myocardial Viability Testing to Guide Coronary Revascularization. Interv Cardiol Clin. 2018; 7(3): 355–365. doi:10.1016/j.iccl.2018.03.005.
35. Bucciarelli-Ducci C, Auger D, Di Mario C et al. CMR Guidance for Recanalization of Coronary Chronic Total Occlusion. JACC Cardiovasc Imaging. 2016; 9(5): 547–556. doi:10.1016/j. jcmg.2015.10.025
36. Gerbay A, Youssof E, Vola M et al. Prediction of recovery after revascularization in chronic Coronary Total Occlusion (CTO) patients. Adenosine or low-dose dobutamine stress with LGE CMR: which is the best combination? J Cardiovasc Magn Reson. 2015; 17(Suppl 1): P114. Published 2015 Feb 3. doi:10.1186/1532–429X-17-S1-P114.
37. Pica S, Di Giovine G, Bollati M et al. Cardiac magnetic resonance for ischaemia and viability detection. Guiding patient selection to revascularization in coronary chronic total occlusions: The CARISMA_CTO study design. Int J Cardiol. 2018; 272: 356–362. doi:10.1016/j. ijcard.2018.08.061.
38. Okamura A, Yamane M, Muto M et al. Complications during retrograde approach for chronic coronary total occlusion: Sub-analysis of Japanese multicenter registry. Catheter Cardiovasc Interv. 2016; 88(1): 7–14. doi:10.1002/ccd.26317.
39. Galassi AR, Sianos G, Werner GS et al. Retrograde Recanalization of Chronic Total Occlusions in Europe: Procedural, In-Hospital, and Long-Term Outcomes From the Multicenter ERCTO Registry. J Am Coll Cardiol. 2015; 65(22): 2388–2400. doi:10.1016/j.jacc.2015.03.566
40. Mashayekhi K, Behnes M, Akin I, Kaiser T, Neuser H. Novel retrograde approach for percutaneous treatment of chronic total occlusions of the right coronary artery using ipsilateral collateral connections: a European centre experience. EuroIntervention. 2016;11(11):e1231-e1236. doi:10.4244/EIJV11I11A244.
41. Brilakis ES, Grantham JA, Rinfret S et al. A percutaneous treatment algorithm for crossing coronary chronic total occlusions. JACC Cardiovasc Interv. 2012; 5(4): 367–379. doi:10.1016/j.jcin.2012.02.006.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2021 Issue E-4
Most read in this issue
- Percutaneous coronary intervention of chronic total occlusion – to whom, when and why
- Aortic stenosis and right ventricular dysfunction
- Lymphangiomatosis – very rare disease of the lymphatic vessels
- Pancytopenia as the main manifestation of human immunodeficiency virus infection in the AIDS stage The authors present a case