Evaluating the frequency of successful guidewire crossing through a complex lesion in coronary artery disease patients having chronic total occlusion.

Objectives: To determine the frequency of successful guidewire crossing through chronic total occlusion (CTO) in patients having a J-CTO Score = 2 (difficult lesion). Methods: A prospective, cross-sectional study was conducted at the Armed Forces Institute of Cardiology (AFIC) in Rawalpindi. Patients with high calcium score on CT-angiogram were sent for elective coronary angiogram out of which patients diagnosed with chronic total occlusion (CTO) were selected and J-CTO Score was assessed. Those with a J-CTO score = 2 (difficult lesion) were enrolled for percutaneous coronary intervention (PCI). Guidewire that can cross the lesion within 30 minutes was considered successful. Results: A total of 158(95.8%) cases had successful guidewire crossing, while in 7(4.2%) patients, the procedure was unsuccessful. No significant association between the success rate of guidewire crossing and age (p = 0.21). Furthermore, there was no statistically significant relationship between guidewire crossing and LV function (p = 0.559) i.e. 32.2% and 42.9% of those with LV function between 25-35% had successful and unsuccessful guidewire crossing, respectively. While 67.7% and 57.1% patients having 36-65% LV function were observed having successful and failed PCI, respectively. Conclusions: The success rate of guidewire crossing through CTO in patients having a J-CTO Score =2 (difficult lesion) is acceptable so J-CTO score can be considered for difficulty grading of the lesion before intervention to prevent complications and success rate of PCI.

Comparison of Mean Fluoroscopic Time and Mean Contrast Volume Used in Patients Undergoing Coronary Angiography by the Transfemoral Versus Transradial Route.

Introduction The prolonged fluoroscopic time during coronary angiography results in a higher radiation dose delivered to patients. Similarly, a higher contrast volume used is associated with higher rates of contrast-induced nephropathy. This study was designed to identify the better technique in terms of lesser fluoroscopic time and volume of contrast used during the procedure. Objective To compare mean fluoroscopic time and mean contrast volume used in patients undergoing coronary angiography through the transfemoral versus transradial route. Methods A randomized controlled trial (RCT) was conducted at the department of cardiology, Pakistan Institute of Medical Sciences (PIMS) Islamabad between June 2017 and December 2017. Ninety (n=90) patients planned for coronary angiography between 30 and 70 years of age were enrolled. Patients were randomly allocated to Group A (transfemoral route group) and Group B (transradial route group). Fluoroscopic time (minutes) and contrast volume (milliliters) used were measured in each patient. Results The mean contrast volume used in Group A was 70.4 ml (SD=8.7) and in Group B, it was 90.1 ml (SD=9.8) (P<0.001). The mean fluoroscopic time in Group A was 5.1 min (SD=1.2), and in group B, it was 8.6 min (SD=1.2) (P<0.001). Similar trends were noted when data were stratified with respect to age and gender. Conclusion The mean fluoroscopic time and the mean contrast volume were significantly less in patients where coronary angiography was performed through the transfemoral route than through the transradial route in this study.