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Objective To demonstrate the efficiency and safety of the modified reverse controlled antegrade and retrograde subintimal tracking(CART)technique for chronic total occlusion(CTO)recanalization.Methods Thirteen patients with CTO underwent this modified reverse CART technique.Based on the traditional reverse CART,the technology advocated the use of antegrade guidewire Knuckle technology to promote access to the subintimal space.With the use of a strong penetrating and well controllable retrograde guidewire,balloon was inflated in the CTO lesion in favor of advancing the retrograde guidewire through the lesion to reach the proximal true lumen.Results The occlusion site was located in the RCA in 10 patients and in the LAD in 3 patients.Among the 13 lesions,2 had J-CTO score = 1,4 had J-CTO score = 2,6 had J-CTO score = 3,and 1 had J-CTO score=4.Nine cases were considered as the Werner`s Collateral Connection grade 1 and other 4 cases were grade 2.All 13 cases had achieved technical success.1 case needed pericardiocentesis due to collateral branch perforation.Conclusions CTO lesions can be efficiently and safely recanalized using this modified reverse CART technique.
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Objective To evaluate the feasibility and efficacy of Guidezilla TM guide extension catheter in retrograde technique for chronic total occlusion (CTO) recanalization. Methods We retrospectively collected 119 CTO cases from the 2nd Cardiology Department of Guangdong General Hospital who had received retrograde percutaneous coronary intervention( PCI). The Guidezilla TMguide extension catheters were applied in 39 cases from October 2015 to November 2016. 80 CTO cases without using the Guidezilla TMguide extension catheter during PCI admitted between January 2015 and October 2015 were collected as the control. Results The overal success rate of the 2 group was 84.0%. The group using the Guidezilla TMguide extension catheter had a higher success rate(100% vs.76.2%,P<0.05).The baseline clinical characteristics of the two groups showed no statistical diff erence. In terms of CTO crossing diffi culty by J-CTO score, patient in the Guidezilla TMguide extension catheter group had higher percentage of diffi cult lesions(35.9% vs.15.0%,P<0.001)and very difficult lesions(61.5% vs.32.5%,P<0.001).Patients in the Guidezilla TMguide extension catheter group had more longer lesions(89.7% vs.72.5%,P=0.035),blunt proximal occlusion(53.8% vs.32.5%,P=0.030)and tortuosity lesions(84.6% vs.63.8%,P=0.020). More cases in the control group needed a second operation(63.8% vs.25.6%,P<0.001)and more ostial/bifurcation lesions(62.5% vs.30.8%,P=0.002).All cases had no target vessel revascularization or in-hospital death. Conclusions Guidezilla TMguide extension catheter is convenient and safe for complicated CTO retrograde PCI.
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<p><b>OBJECTIVE</b>To develop a new technique of bilateral angiography in a single radial access (BASiRalA) which can reduce a puncture site.</p><p><b>METHODS</b>From March 2011 to February 2012, 13 cases of coronary heart disease patients with chronic total occlusion (CTO) were treated (6 CTOs in right coronary artery and 7 in left anterior descending artery). All patients underwent percutaneous coronary intervention (PCI) via the right radial artery access and 6 F guiding catheters were delivered to the diseased artery. Once the wires crossed the CTO lesions and were uncertain if the wires were in true lumen or not, BASiRalA was performed. The Finecross microcatheters were advanced out of the 6 F guiding catheter, then withdraw 6F guiding catheter to the opening of diseased artery, the soft wires were manipulated into the middle portion of opposite coronary artery. After that, the microcatheters were advanced to this segment or the branches relative to the collateral vessels connected with CTOs. After pulling out the wires, microcatheter injections can be performed for contralateral angiography. BASiRalA related complications were observed after the procedure.</p><p><b>RESULTS</b>BASiRalA technique was applied to 13 CTOs and 10 procedures succeeded (76.92%). BASiRalA failed in 3 cases and the wires and microcatheters could not be advanced to the opposite coronary arteries within 20 minutes. Alternatively, contralateral angiography via femoral arteries was performed in these 3 patients. The average time of BASiRalA technique was 7 (5 - 13) minutes and the shortest time of wires crossing to the opposite coronary artery was 5 seconds. There was no procedure induced complication during procedure or post procedure.</p><p><b>CONCLUSION</b>BASiRalA technique is feasible in treating CTO patients by PCI.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Cardiac Catheterization , Methods , Coronary Angiography , Methods , Coronary Occlusion , Therapeutics , Radial Artery , Retrospective StudiesABSTRACT
<p><b>BACKGROUND</b>Tumor necrosis factor-alpha (TNF-α) is a pleiotropic proinflammatory cytokine and contributes to many kinds of cardiovascular diseases via its receptors (TNFR1/TNFR2). We hypothesize that TNF-α plays a role in the pathogenesis of chronic atrial fibrillation (AF).</p><p><b>METHODS</b>Sixty-seven consecutive patients who were scheduled to have cardiac surgery were enrolled into the study. Thirty-one patients with rheumatic heart disease (RHD) and AF were enrolled as study group (AF group). The sinus rhythm (SR) control groups consisted of 20 patients with RHD and 16 patients with coronary artery disease (CAD). Peripheral blood sample was collected before the operation. About 5 mm(3) left atrial tissue was disserted during the operation and was separated into three parts for Western blotting, real time polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC) analysis.</p><p><b>RESULTS</b>Compared with the controls (RHD SR and CAD SR), the levels of TNF-α ((14.40 ± 5.45) pg/ml vs. (4.20 ± 3.19) pg/ml vs. (2.68 ± 2.20) pg/ml, P = 0.000) and its soluble receptor 1 (sTNFR1) ((1623.9 ± 558.6) pg/ml vs. (1222.3 ± 175.6) pg/ml vs. (1387.5 ± 362.2) pg/ml, P = 0.001) in plasma were higher in patients with AF. TNF-α level had positive correlation with the left atrial diameter (LAD) (r = 0.642, P = 0.000). Western blotting analysis showed that the protein levels of TNF-α (0.618 ± 0.236 vs. 0.234 ± 0.178 vs. 0.180 ± 0.103, P = 0.000) were higher in patients with AF. The RT-PCR analysis results demonstrated that the mRNA expression of TNF-α (0.103 ± 0.047 vs. 0.031 ± 0.027 vs. 0.023 ± 0.018, P = 0.000) increased in patients with AF. IHC analysis displayed that, comparing to the SR, the expression of TNF-α (0.125 ± 0.025 vs. 0.080 ± 0.027 vs. 0.070 ± 0.023, P = 0.000) increased in the AF group. The protein level and mRNA expression of TNF-α also had positive correlation with left atrium diameter (LAD) (r = 0.415, P = 0.000 and r = 0.499, P = 0.000).</p><p><b>CONCLUSIONS</b>The results revealed that TNF-α elevated in the plasma and left atrial tissue and had positive correlation with LAD in patients of chronic AF. TNF-α might involve in the pathogenesis of chronic AF.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Atrial Fibrillation , Blood , Metabolism , Blotting, Western , Heart Atria , Metabolism , Immunohistochemistry , Real-Time Polymerase Chain Reaction , Tumor Necrosis Factor-alpha , Blood , Genetics , MetabolismABSTRACT
<p><b>OBJECTIVE</b>to explore the feasibility of percutaneous recanalization by retrograde approach via epicardial collaterals.</p><p><b>METHODS</b>retrograde percutaneous coronary intervention (PCI) via epicardial collaterals was performed in 5 patients with previously failed antegrade PCI from April 2009 to November 2009. 7 F guiding catheters were engaged in donor artery. Hydrophilic wires and microcatheters were crossed to the distal ends of chronic total occlusion (CTO) lesions via epicardial collaterals. Four retrograde wires were exchanged into stiffer wires and further crossed the CTO, eventually went into the 6 F antegrade guiding catheters and were jailed by a 2.5 mm balloon. After dilatations of retrograde balloons, the lesions were crossed by antegrade wires, and finalized by conventional PCI method. One case was recanalized with retrograde wire trapping technique and another case was recanalized by reverse CART technique.</p><p><b>RESULTS</b>the epicardial collaterals were reached from left anterior descending branch (LAD) to distal right coronary artery (RCA) via apex in 3 patients, from left circumflex branch via left atrium branch to posterior descending artery and RCA in 1 patient and from obtuse marginal artery to diagonal artery and LAD in 1 patient. CTO was successfully recanalized and stents were implanted in 4 patients and failed in 1 patient despite successful wire positioning to the distal end of CTO. There was no procedure-induced cardiovascular event in all cases.</p><p><b>CONCLUSIONS</b>epicardial collaterals may not be used as a routine route in retrograde approach PCI due to the potential risk of myocardial rupture and pericardial tamponade. In some cases with unavailable or unsuitable septal collaterals, epicardial collaterals may be used as an alternative route for CTO recanalization.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Methods , Arteriosclerosis Obliterans , Therapeutics , Collateral Circulation , Coronary Artery Disease , Therapeutics , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To evaluate the impact of radiofrequency catheter ablation on left atrial (LA) size and function in patients with paroxysmal atrial fibrillation (PAF) and whether there is any difference between segmental pulmonary vein ostial isolation (SPVI) and circumferential pulmonary vein ablation (CPVA).</p><p><b>METHODS</b>Sixty-six patients with highly symptomatic atrial fibrillation were assigned to undergo either SPVI or CPVA. Transthorax echocardiography was performed before, 1 day, 1 months and 3 months after the procedure. LA dimension, LA area, late diastolic peak velocity of mitral valve inflow (A) and peak atrial systolic mitral annulus velocity (A') were recorded.</p><p><b>RESULTS</b>Of 66 consecutive patients with symptomatic PAF, 30 patients underwent SPVI and 36 underwent CPVA. After a mean follow-up of (315 +/- 153) days, 21 patients (70%) after SPVI and 28 patients (75%) after CPVA were free of atrial tachyarrhythmia. As compared with the baseline, LA area decreased at 1-month after ablation in SPVI group and at 3-month in CPVA group. LA dimension decreased also in SPVI group, but did not in CPVA group. A velocity and A' velocity declined remarkably 1 day after CPVA, and restored 3 months later. The former went back to the level of baseline, and the latter exceeded it apparently. In SPVI group, A velocity increased at 1-month, and maintained in 3-month after ablation. A' velocity increased at 3-month after ablation. No reduction of A velocity or A' velocity was found after SPVI.</p><p><b>CONCLUSIONS</b>This study demonstrated a decrease in LA area and an improvement in LA systolic function 3 months after ablation for PAF. The LA damage by CPVA was more than that by SPVI, which was characterized by the reduction of LA function 1 day after procedure and the delayed improvement of LA size and functional parameters.</p>