A prospective evaluation of a redefined version of the "minimalistic hybrid approach" algorithm for percutaneous coronary chronic total occlusion revascularization.
chronic coronary total occlusion
radial
stable angina
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
16
06
2020
received:
16
05
2020
accepted:
09
07
2020
pubmed:
6
8
2020
medline:
21
10
2021
entrez:
6
8
2020
Statut:
ppublish
Résumé
Aim of this study is to prospectively assess the feasibility of the "Minimalistic Hybrid Approach" (MHA) algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We recently described the MHA, with focus on the classic hybrid strategies (antegrade wire escalation [AWE] or retrograde wire escalation [RWE], antegrade dissection-re-entry [ADR] or retrograde dissection-re-entry [RDR]), and also on access site (favoring "wrist" approach: radial, ulnar, and distal radial), introducer French size (favoring 6 French catheters) and nonroutine initial use of dual injection. The MHA was prospectively attempted in 56 consecutive CTO PCI in 54 patients. Technical success was defined as the achievement of TIMI 3 antegrade flow with residual stenosis <30%, procedural success was defined as technical success without in-hospital major adverse cardiovascular events. Mean Japanese-CTO (J-CTO) score was 2.04 ± 0.95(J-CTO score ≥ 3 in 30.4%). The lesion-based technical and procedural success were 94.6%(53/56:three failures, two in the same patient) and 91.1%(51/56:three failures, one tamponade requiring pericardiocentesis and one periprocedural infarction), the patient-based successes were: technical 98.1%(53/54) and procedural 94.4%(51/54). In 34 procedures (60.7%), the approach was single catheter (always trans-wrist besides one femoral). Out of the 22(39.3%) lesions approached with dual catheters, one was bi-femoral, the rest was bi-wrist. In 29 cases (51.8%) AWE represented the successful technique, ADR in 5(8.9%) and retrograde in 19(33.9%); 3(5.4%) were failures. The current study shows that the MHA algorithm is feasible in almost every CTO lesion and it can lead to extremely successful results once applied by operators well acquainted with the wrist approach and with established experience using the full spectrum of the hybrid algorithm techniques.
Sections du résumé
OBJECTIVES
Aim of this study is to prospectively assess the feasibility of the "Minimalistic Hybrid Approach" (MHA) algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
BACKGROUND
We recently described the MHA, with focus on the classic hybrid strategies (antegrade wire escalation [AWE] or retrograde wire escalation [RWE], antegrade dissection-re-entry [ADR] or retrograde dissection-re-entry [RDR]), and also on access site (favoring "wrist" approach: radial, ulnar, and distal radial), introducer French size (favoring 6 French catheters) and nonroutine initial use of dual injection.
METHODS
The MHA was prospectively attempted in 56 consecutive CTO PCI in 54 patients. Technical success was defined as the achievement of TIMI 3 antegrade flow with residual stenosis <30%, procedural success was defined as technical success without in-hospital major adverse cardiovascular events.
RESULTS
Mean Japanese-CTO (J-CTO) score was 2.04 ± 0.95(J-CTO score ≥ 3 in 30.4%). The lesion-based technical and procedural success were 94.6%(53/56:three failures, two in the same patient) and 91.1%(51/56:three failures, one tamponade requiring pericardiocentesis and one periprocedural infarction), the patient-based successes were: technical 98.1%(53/54) and procedural 94.4%(51/54). In 34 procedures (60.7%), the approach was single catheter (always trans-wrist besides one femoral). Out of the 22(39.3%) lesions approached with dual catheters, one was bi-femoral, the rest was bi-wrist. In 29 cases (51.8%) AWE represented the successful technique, ADR in 5(8.9%) and retrograde in 19(33.9%); 3(5.4%) were failures.
CONCLUSIONS
The current study shows that the MHA algorithm is feasible in almost every CTO lesion and it can lead to extremely successful results once applied by operators well acquainted with the wrist approach and with established experience using the full spectrum of the hybrid algorithm techniques.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
617-625Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Brilakis ES, Grantham JA, Rinfret S, et al. A percutaneous treatment algorithm for crossing coronary chronic total occlusions. JACC Cardiovasc Interv. 2012;5:367-379.
Harding SA, Wu EB, Lo S, et al. A new algorithm for crossing chronic total occlusions from the Asia Pacific chronic total occlusion club. JACC Cardiovasc Interv. 2017;10:2135-2143.
Galassi AR, Werner GS, Boukhris M, et al. Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club. EuroIntervention. 2019;15:198-208.
Maeremans J, Walsh S, Knaapen P, et al. The hybrid algorithm for treating chronic total occlusions in Europe: The RECHARGE Registry. J Am Coll Cardiol. 2016;68:1958-1970.
Brilakis ES, Mashayekhi K, Tsuchikane E, et al. Guiding principles for chronic total occlusion percutaneous coronary intervention. Circulation. 2019;140:420-433.
Helfrich CD, Tsai TT, Rao SV, et al. Perceptions of advantages and barriers to radial-access percutaneous coronary intervention in VA cardiac catheterization laboratories. Cardiovasc Revasc Med. 2014;15:329-333.
Zivelonghi C, van Kuijk JP, Suttorp MJ, et al. Implementing a minimally invasive approach (combining radial approach, small guiding catheters and minimization of double access) for coronary chronic total occlusion intervention according to the hybrid algorithm: the minimalistic hybrid algorithm. Int J Cardiol. 2019;283:84-87.
Zivelonghi C, van Kuijk JP, Poletti E, et al. A "minimalistic hybrid algorithm" in coronary chronic total occlusion revascularization: procedural and clinical outcomes. Catheter Cardiovasc Interv. 2020;95:97-104.
Azzalini L, Agostoni P, Benincasa S, et al. Retrograde chronic Total occlusion percutaneous coronary intervention through ipsilateral collateral channels: A multicenter registry. JACC Cardiovasc Interv. 2017;10:1489-1497.
Galassi AR, Brilakis ES, Boukhris M, et al. Appropriateness of percutaneous revascularization of chronic total occlusions: an overview. Eur Heart J. 2016;37:2692-2700.
Maeremans J, Kayaert P, Bataille Y, et al. Assessing the landscape of percutaneous coronary chronic total occlusion treatment in Belgium and Luxembourg: the Belgian working group on chronic total occlusions (BWGCTO) registry. Acta Cardiol. 2018;73:427-436.
Morino Y, Abe M, Morimoto T, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (multicenter CTO registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011;4:213-221.
Christopoulos G, Kandzari DE, Yeh RW, et al. Development and validation of a novel scoring system for predicting technical success of chronic total occlusion percutaneous coronary interventions: the PROGRESS CTO (prospective global Registry for the study of chronic total occlusion intervention) score. JACC Cardiovasc Interv. 2016;9:1-9.
Szijgyarto Z, Rampat R, Werner GS, et al. Derivation and validation of a chronic Total coronary occlusion intervention procedural success score from the 20,000-patient EuroCTO Registry: The EuroCTO (CASTLE) Score. JACC Cardiovasc Interv. 2019;12:335-342.
Azzalini L, Dautov R, Ojeda S, et al. Procedural and long-term outcomes of percutaneous coronary intervention for in-stent chronic Total occlusion. JACC Cardiovasc Interv. 2017;10(9):892-902.
Bakker EJ, Maeremans J, Zivelonghi C, et al. Fully transradial versus transfemoral approach for percutaneous intervention of coronary chronic total occlusions applying the hybrid algorithm: insights from RECHARGE Registry. Circ Cardiovasc Interv. 2017;10:e005255.
Megaly M, Karatasakis A, Abraham B, et al. Radial versus femoral access in chronic Total occlusion percutaneous coronary intervention. Circ Cardiovasc Interv. 2019;12:e007778.