ABSTRACT
Introdução: As mais novas técnicas de intervenção coronária percutânea em oclusões crônicas podem melhorar o sucesso técnico. Os objetivos deste estudo foram descrever a segurança e a eficácia da técnica de dissecção/reentrada anterógrada como estratégia inicial de revascularização. Métodos: Registro multicêntrico de países latino-americanos (LATAM Chronic Total Occlusion). Analisamos as características iniciais e os desfechos dos casos em que foi empregada dissecção/ reentrada anterógrada como estratégia primária ou de resgate após escalonamento de fios por via anterógrada. Foram excluídos os casos de abordagem retrógrada. Os médicos usaram dissecção anterógrada convencional e técnica de reentrada. Resultados: Dos 1.875 pacientes analisados, em 50 foi planejada a dissecção/reentrada anterógrada, e, em 1.825, foi planejado o escalonamento de fios por via anterógrada primário. Deu-se preferência à dissecção/reentrada anterógrada em pacientes mais idosos e com história de revascularização (revascularização do miocárdio: dissecção/ reentrada anterógrada em 33,3% e escalonamento de fios por via anterógrada primário em 13,4%, com p<0,001; intervenções coronárias percutâneas em 66,6 e 48,8%, respectivamente, com p=0,012). Oclusões crônicas mais longas (30mm [22-41] e 21mm [15-30], p<0,001) e calcificações moderadas ou graves (62 e 42,6%, com p=0,008) foram associadas à seleção da dissecção/reentrada anterógrada primária, ao invés do escalonamento de fios por via anterógrada primário. Houve correlação significativa entre o aumento do escore J-CTO (X2=37, df=5; p<0,001) e o uso da dissecção/ reentrada anterógrada. O escalonamento de fios por via anterógrada primário teve taxa de sucesso de 88,4%, e a dissecção/reentrada anterógrada, de 76,7%. Para o escalonamento de fios por via anterógrada primário e dissecção/reentrada anterógrada de resgate, o uso do dispositivo CrossBoss® foi relacionado às maiores taxas de sucesso (92,3 e 82,7%, respectivamente). Os desfechos a curto prazo foram semelhantes nos grupos. Conclusão: Na América Latina, a técnica de dissecção/ reentrada anterógrada foi segura e efetiva, tanto como estratégia primária quanto de resgate, mesmo quando utilizada em lesões de maior complexidade. O uso de dispositivos específicos foi relacionado a uma maior taxa de sucesso.
Background: The newest techniques of percutaneous coronary interventions for chronic total occlusion may improve technical success. The objectives were to describe safety and efficacy of antegrade dissection and reentry technique as initial revascularization strategy. Methods: A multicenter registry from Latin American countries (LATAM Chronic Total Occlusion). Baseline characteristics and outcomes of cases using antegrade dissection and reentry as primary strategy or bailout of antegrade wire escalation were analyzed. Retrograde approach cases were excluded. Physicians used conventional antegrade dissection and reentry technique. Results: Out of 1,875 patients analyzed, 50 were planned primary antegrade dissection and reentry and 1,825 planned primary antegrade wire escalation. Primary antegrade dissection and reentry was preferred in older patients, with a history of revascularization (coronary artery bypass graft: primary antegrade dissection and reentry in 33.3% and primary antegrade wire escalation in 13.4%; p<0.001; percutaneous coronary interventions in 66.6% and 48.8%, respectively; p=0.012). Longer chronic total occlusions (30mm [22-41] and 21mm [15-30]; p<0.001), moderate or severe calcification (62% and 42.6%; p=0.008) were associated with the selection of primary antegrade dissection and reentry, instead of primary antegrade wire escalation. There was a significant correlation between increasing J-CTO score (X2=37, df=5; p<0.001), and use of primary antegrade dissection and reentry. Primary antegrade wire escalation had a success rate of 88.4%, and primary antegrade dissection and reentry of 76.7%. For primary antegrade wire escalation and bailout antegrade dissection and reentry, the use of the CrossBoss® device was related to the highest rates of success (92.3 and 82.7%, respectively). Short-term outcomes were similar in both groups. Conclusion: In Latin America, antegrade dissection and reentry was safe and effective, both as primary or bailout strategy, even when used for higher complexity lesions. The use of dedicated devices was related to a higher success rate.
ABSTRACT
OBJECTS: To show all cardiac evaluations multislice computed tomography (MSCT) can perform. METHODS: MSCTs were performed on an MSCT scanner (Mx8000; Philips Medical Systems) with enhanced contrast acquisition. The reconstructed images were sent to a workstation for multiplanar reconstruction, volume rendering, and 3-D reconstruction. A total of 140 patients were studied with MSCT and conventional angiography (CA) to assess coronary artery stenosis. 30 of these patients were also evaluated by intravascular ultrasound (IVUS) for plaque characterization. A group of 20 patients were studied with MSCT, gated single-photon emission computed tomography (SPECT), and echocardiography for myocardial perfusion test and volumetric analysis. RESULTS: The results of MSCT versus CA showed a sensitivity of 79.2% and a specificity of 93.7%, whereas for MSCT versus IVUS the sensitivity was 84.4% and the specificity 91.6%. A total of 156 plaques were detected by both methods. 105 (67%) were soft, 14 (24%) were fibrous and 37 (9%) were calcified. In the evaluation of myocardial perfusion, the cardiac software showed a sensitivity of 55% and a specificity of 80%. However, general evaluation disclosed a sensitivity of 88.5% and a specificity of 96.4%. The volumetric analysis showed a good correlation between MSCT and echocardiography for end-systolic volume (ESV), rS = 0.874, and end-diastolic volume (EDV), rS = 0.828. There was also a good correlation for the evaluation of the left ventricular anatomy: septal wall rS = 0.96, posterior wall rS = 0.81, and diameter of left ventricle rS = 0.69. CONCLUSION: Nowadays, MSCT allows different cardiologic evaluations with the same acquisition as that for the coronary arteries. These data show a general view of the patient providing information that is obtained by the hand of multiple cardiologic methods such as DA, IVUS, gated SPECT, and echocardiography.
