open access

Vol 67, No 8 (2009)
Other
Published online: 2009-09-09
Submitted: 2012-12-28
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Original article
Intracoronary ultrasound-guided angioplasty for coronary chronic total occlusion

Leszek Bryniarski, Jacek Dragan, Michał Zabojszcz, Artur Klecha, Piotr Jankowski, Tadeusz Królikowski, Marek Rajzer, Dariusz Dudek, Kalina Kawecka-Jaszcz
Kardiol Pol 2009;67(8):992-1003.

open access

Vol 67, No 8 (2009)
Other
Published online: 2009-09-09
Submitted: 2012-12-28

Abstract

Background: Recanalisation for coronary chronic total occlusion (CTO) is associated with high rates of restenosis and reocclusion. The use of intracoronary ultrasound (ICUS) may improve immediate and long-term outcomes following recanalisation. To our knowledge, no study has examined the use of ICUS-guided balloon angioplasty in CTO.
Aim: To compare the results of ICUS-guided balloon angioplasty and ICUS-guided angioplasty with stent implantation in patients with CTO.
Methods: 6.0 mm2 and a residual plaque burden (RPB) of < 65%. Of the 51 patients, the ICUS criteria defining optimal balloon angioplasty were achieved in 23 patients and 7 patients did not undergo stent implantation due to calcification and/or small vessel diameters (group A &#8211; 30 patients). In 21 patients, the failure to achieve optimal ICUS parameters resulted in stent implantation with the goal of achieving in stent MLCSA > 9 mm2 55% of average total cross-sectional area of the vessel according to distal and proximal reference segments (group B). The two groups were similar in terms of clinical and angiographic characteristics.
Results: Balloon angioplasty which was regarded as optimal by QCA, was shown to be non-optimal by ICUS in 41 patients (80.4 %). The MLCSA was smaller in group A than group B (6.5 &#177; 1.5 vs. 8.9 &#177; 2.0 mm2; p < 0.001). Restenosis was found in 8 (26.6%) group A patients and 4 group B patients (19%) (p > 0.05). The restenosis rate in 23 group A patients with optimal ICUS parameters was 8.6% (2 patients). Consecutive ICUS measurements showed a gradual increase in the total vessel area during the PCI procedure and at the 6-month follow-up (p < 0.05).
Conclusions: 1. Achieving an optimal balloon angioplasty result in CTO patients requires confirmation using ICUS. 2. In some patients immediate and long-term outcomes following ICUS-guided optimised balloon angioplasty are comparable to those of ICUS-guided stent implantation. 3. Direct measurement of a chronically occluded coronary artery at pre-intervention, during the intervention and at long-term follow-up may argue in favour of using ICUS in recanalisation of CTO. 4. ICUS-guided balloon angioplasty for CTO could be a method of choice in patients in whom long-term dual antiplatelet therapy is associated with a high probability of bleeding complications.

Abstract

Background: Recanalisation for coronary chronic total occlusion (CTO) is associated with high rates of restenosis and reocclusion. The use of intracoronary ultrasound (ICUS) may improve immediate and long-term outcomes following recanalisation. To our knowledge, no study has examined the use of ICUS-guided balloon angioplasty in CTO.
Aim: To compare the results of ICUS-guided balloon angioplasty and ICUS-guided angioplasty with stent implantation in patients with CTO.
Methods: 6.0 mm2 and a residual plaque burden (RPB) of < 65%. Of the 51 patients, the ICUS criteria defining optimal balloon angioplasty were achieved in 23 patients and 7 patients did not undergo stent implantation due to calcification and/or small vessel diameters (group A &#8211; 30 patients). In 21 patients, the failure to achieve optimal ICUS parameters resulted in stent implantation with the goal of achieving in stent MLCSA > 9 mm2 55% of average total cross-sectional area of the vessel according to distal and proximal reference segments (group B). The two groups were similar in terms of clinical and angiographic characteristics.
Results: Balloon angioplasty which was regarded as optimal by QCA, was shown to be non-optimal by ICUS in 41 patients (80.4 %). The MLCSA was smaller in group A than group B (6.5 &#177; 1.5 vs. 8.9 &#177; 2.0 mm2; p < 0.001). Restenosis was found in 8 (26.6%) group A patients and 4 group B patients (19%) (p > 0.05). The restenosis rate in 23 group A patients with optimal ICUS parameters was 8.6% (2 patients). Consecutive ICUS measurements showed a gradual increase in the total vessel area during the PCI procedure and at the 6-month follow-up (p < 0.05).
Conclusions: 1. Achieving an optimal balloon angioplasty result in CTO patients requires confirmation using ICUS. 2. In some patients immediate and long-term outcomes following ICUS-guided optimised balloon angioplasty are comparable to those of ICUS-guided stent implantation. 3. Direct measurement of a chronically occluded coronary artery at pre-intervention, during the intervention and at long-term follow-up may argue in favour of using ICUS in recanalisation of CTO. 4. ICUS-guided balloon angioplasty for CTO could be a method of choice in patients in whom long-term dual antiplatelet therapy is associated with a high probability of bleeding complications.
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Keywords

chronic total occlusion; coronary angioplasty; intracoronary ultrasound

About this article
Title

Original article
Intracoronary ultrasound-guided angioplasty for coronary chronic total occlusion

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 67, No 8 (2009)

Pages

992-1003

Published online

2009-09-09

Bibliographic record

Kardiol Pol 2009;67(8):992-1003.

Keywords

chronic total occlusion
coronary angioplasty
intracoronary ultrasound

Authors

Leszek Bryniarski
Jacek Dragan
Michał Zabojszcz
Artur Klecha
Piotr Jankowski
Tadeusz Królikowski
Marek Rajzer
Dariusz Dudek
Kalina Kawecka-Jaszcz

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