ABSTRACT
Background: computed tomography coronary angiography[CTCA] can be useful in procedure planning for CTO PCI by identifying factors known to influence PCI success rates, such as calcification, severe tortuosity and length of the occluded segment. Percutaneous coronary intervention for CTO is considered to be one of the most challenging procedures of interventional cardiology, and in the earlier studies, successful recanalization rates of CTO ranged from 51% to 74%. However, with improved operator experience and the development of novel equipment and techniques, procedural success rates have been increased, which brings an increasing number of CTO into a treatable category
Patients and Methods: an exploratory pilot study was conducted on 40 patients using retrograde wire approach with various strategies by highly experienced CTO operators in Ain Shams University hospitals and in Kobry Elkobba Military hospital from August 2015 to 2017
Results: according to the results CTOs were divided into two groups, group1 with successful retrograde PCI in 32 pts. [80%], and group 2 with failed-retrograde PCI in 8 pts. [20%] All CTOs were correctly identified by MIP, MPR, cMPR images. Most of the CTOs were located in the proximal 21 patients 52.5% then mid 14 patients 35% ostial 3 patients 7.5% and lastly distal 2 patients 5%. In failed group there were more calcified plaques. There was more calcification in the CTOs segments [p=0.005]. Ten arc-calcified and two circular-calcified lesions were identified only 4 from ten patients [40%] had arc calcified Plaques which were successfully recanalized and 6 patients 60% failed. In circular-calcified lesions one patient [50%] succeeded and one failed. Proximal artery tortuosity between two groups showed a significant difference [p=0.000]
Conclusion: complex CTO lesion morphology is still an important issue for CTO-PCI procedural success, and further improvement of technologies [MDCT] and medical devices, such as guide wires and catheters are required to improve the success rate
ABSTRACT
The rapid progress in the field of interventional cardiology in the last few years necessitates a continuous search for the most safe and effective methods to gain an optimum results, either equipments or drugs. to examine the use of enoxaparin as an anticoagulant in elective PCI, and compare it with unfractionated heparin regarding the acute procedural complications and the immediate 24-hour post-PCI events. The study was conducted on 84 patients who were classified independently into 2 groups. 50 patients represent group [A], received IV single bolus of enoxaparin in a dose of 0.5mg/kg at the start of the procedure and 34 patients represent group [B], received the usual traditional dose of unfractionated heparin [10000-15000 units].All patients were prepared by clopidogrel or ticlopidin before PCI in addition to aspirin 150 mg daily.Follow up was done for all patients during the immediate 24 hours after PCI for death, myocardial infarction, myocardial ischemia requiring urget coronary intervention and cerobrovascular stroke. There was no statistical significant difference between the two groups regarding the type of vessels treated or number of stents placed. None of the patients of both groups experienced any of the following complications during the procedure or 24 hours after: major bleeding, myocardial infarction, myocardial ischemia requiring urgent surgical or repeat percutaneous coronary revascularization or death. The major difference between the two groups was the immediate sheath removal in the enoxaparin group, without sheath site complication [minor haematoma] which was observed in 9% of the UFH group. Angiographic complications were coronary artery dissection [in one patient in group A [2%] and 3 patients in group B [9%]] and acute closure of the culprit vessel [occurred in one patient in group A [2%] and none in group B. The results were quite encouraging, with no statistical differences between the two arms of the study regarding the acute complications and the clinical outcome. The use of enoxaparin in this reduced dose is feasible in elective PCI with adequate level of anticoagulation without need for monitoring its anticoagulant effect. The early sheath removal in group A necessitates further studies to assess its impact on the duration of hospital stay and the possibility of early discharge of the patients