Lesion Characteristics of Chronic Totally Occluded Coronary Arteries on Computed Tomography Angiography in Patients with and without Prior Coronary Artery Bypass Graft
DOI:
https://doi.org/10.51253/pafmj.v74iSUPPL-1.10801Keywords:
Chronic Total Occlusion, Computed Tomography Angiography, Coronary Artery Bypass GraftAbstract
Objective: To study the differences in characteristics of Chronic Totally Occluded coronary artery lesions on computed tomography angiography in patients with and without prior Coronary Artery Bypass Graft.
Study Design: Comparative Cross-sectional Study.
Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Feb to Jul 2023.
Methodology: The study included ninety six patients, with 48 patients in each group (prior CABG and non-CABG). Patients presenting with chest pain and having Chronic Totally Occluded lesions on Computed Tomography Angiography were selected using non-probability consecutive sampling. Data was analyzed using SPSS-23:00. Chi-square test was applied to find the association of lesion characteristics in study groups and level of significance was taken ˂0.05.
Results: This study analyzed the characteristics of lesions in different target vessels among n= 96 patients, with 74(77.1%) being males and 22(22.9%) females. The mean age was 61.98±8.04 years. No statistically significant distinctions in the distribution of target vessels were observed when comparing the two groups. (p=0.48). However, osteal lesions had higher prevalence in the CABG group 20(41.7%) (p=0.04). The presence of blunt stump [21(43.8) vs 18(37.5); p=0.67] and calcification [(20(41.7%) vs 21(43.8%), p=1.00)] had no significant divergence between CABG and non-CABG groups. Bending was more common in the CABG group 17(35.4%) (p=0.002). In the CABG group, a higher occurrence of a side branch at the proximal cap 22(45.8%) (p=0.01) as well as a distal cap at the bifurcation 20(41.7%) (p<0.001), was noted.
Conclusion: Chronic Totally Occluded lesions were more intricate ..
Downloads
References
. Koelbl CO, Nedeljkovic ZS, Jacobs AK. Coronary chronic total occlusion (CTO): A review. Rev Cardiovasc Med 2018; 19(1): 33–9. Available from:. https://doi.org/10.31083/j.rcm.2018.01.896
Guo L, Wu J, Zhong L, Ding H, Xu J, Zhou X, et al. Two-year clinical outcomes of medical therapy vs. revascularization for patients with coronary chronic total occlusion. Hellenic J Cardiol . 2020; 61(4): 264–71. https://doi.org/10.1016/j.hjc.2019.03.006
Werner GS, Glaser P, Coenen A, Moehlis H, Tischer K-H, Koch M, et al. Reduction of radiation exposure during complex interventions for chronic total coronary occlusions: Implementing low dose radiation protocols without affecting procedural success rates. Catheter Cardiovasc Interv . 2017; 89(6): 1005–12. https://doi.org/10.1002/ccd.26886
Pereg D, Fefer P, Samuel M, Wolff R, Czarnecki A, Deb S, et al. Native coronary artery patency after coronary artery bypass surgery. JACC Cardiovasc Interv. 2014;7(7):761–7.
https://doi.org/10.1016/j.jcin.2014.01.164
Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Osherov AB, Yalonetsky S, et al. Current perspectives on coronary chronic
total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol. 2012; 59(11): 991–7.
https://doi.org/10.1016/j.jacc.2011.12.007
Kusu-Orkar TE, Masharani K, Harky A, Muir AD. Redo Coronary Artery Bypass Grafting in the era of Advanced PCI. Braz J Cardiovasc Surg. 2022 Aug 16; 37(4): 546-553.
https://doi.org/10.21470/1678-9741-2019-0206.
Brilakis ES, O’Donnell CI, Penny W, Armstrong EJ, Tsai T, Maddox TM, et al. Percutaneous coronary intervention in native coronary arteries versus bypass grafts in patients with prior coronary artery bypass graft surgery: Insights from the Veterans Affairs clinical assessment, reporting, and tracking program. JACC Cardiovasc Interv. 2016; 9(9): 884–93.
https://doi.org/10.1016/j.jcin.2016.01.034
Brilakis ES, Rao SV, Banerjee S, Goldman S, Shunk KA, Holmes DR Jr, et al. Percutaneous coronary intervention in native arteries versus bypass grafts in prior coronary artery bypass grafting patients: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv 2011; 4(8): 844–50.
https://doi.org/10.1016/j.jcin.2011.03.018
Maeremans J, Spratt JC, Knaapen P, Walsh S, Agostoni P, Wilson W, et al. Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score: The RECHARGE score for CTO-PCI. Catheter Cardiovasc Interv 2018; 91(2): 192–202.
https://doi.org/10.1002/ccd.27092
Tajti P, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, et al. The hybrid approach to chronic total occlusion percutaneous coronary intervention. JACC Cardiovasc Interv. 2018;11(14):1325–35. https://doi.org/10.1016/j.jcin.2018.02.036
van Veelen A, the PCI, Claessen BEPM, Houterman S, Hoebers LPC, Elias J, et al. Registration Committee of the Netherlands Heart Registration. Incidence and outcomes of chronic total occlusion percutaneous coronary intervention in the Netherlands: data from a nationwide registry. Neth Heart J . 2021;29(1):4–13. Available from:
https://doi.org/10.1007/s12471-020-01521-y
Shi Y, He S, Luo J, Jian W, Shen X, Liu J. Lesion characteristics and procedural complications of chronic total occlusion percutaneous coronary intervention in patients with prior bypass surgery: A meta‐analysis. Clinical Cardiology. 2022 Jan; 45(1): 18-30.
Eertmans W, Kayaert P, Bennett J, Ungureanu C, Bataille Y, Saad G, et al. The evolution of the CTO-PCI landscape in Belgium and Luxembourg: a four-year appraisal. Acta Cardiologica. 2021; 76(10): 1043–51
https://doi.org/10.1080/00015385.2020.1801197
Lee S-W, Lee PH, Ahn J-M, Park D-W, Yun S-C, Han S, et al. Randomized trial evaluating percutaneous coronary intervention for the treatment of chronic total occlusion: The DECISION-CTO trial. Circulation. 2019; 139(14): 1674–83
https://doi.org/10.1161/circulationaha.118.031313
Rigueira J, Aguiar-Ricardo I, Nobre Menezes M, Santos R, Rodrigues T, Cunha N, et al. The CTo-aBCDE score: A new predictor of success in chronic total occlusions. Rev Port Cardiol . 2020;39(10):575–82. https://doi.org/10.1016/j.repc.2020.05.007
Muraca I, Carrabba N, Virgili G, Bruscoli F, Migliorini A, Pennesi M, et al. Chronic total occlusion revascularization: A complex piece to “complete” the puzzle. World J Cardiol . 2022;14(1):13–28. https://doi.org/10.4330/wjc.v14.i1.13
Potter BJ, Matteau A, Noiseux N, Mansour S. High stakes: CTO-PCI in the post-CABG patient. Can J Cardiol. 2018;34(3):238–40. Available from: https://doi.org/10.1016/j.cjca.2017.12.022
Guo L, Lv H, Yin X. Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Graft: Current Evidence and Future Perspectives. Front Cardiovasc Med. 2022 Apr 11;9:753250.
https://doi.org/10.3389/fcvm.2022.753250.
Hernandez-Suarez DF, Azzalini L, Moroni F, Tinoco de Paula JE, Lamelas P, Campos CM, et al. Outcomes of chronic total occlusion percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Insights from the LATAM CTO registry. Catheter Cardiovasc Interv 2022;99(2):245–53. https://doi.org/10.1002/ccd.30041
Budassi S, Zivelonghi C, Dens J, Bagnall AJ, Knaapen P, Avran A, et al. Impact of prior coronary artery bypass grafting in patients undergoing chronic total occlusion‐percutaneous coronary intervention: procedural and clinical outcomes from the REgistry of Crossboss and Hybrid procedures in FrAnce, the NetheRlands, BelGium, and UnitEd Kingdom (RECHARGE). Catheterization and Cardiovascular Interventions. 2021 Jan 1;97(1):E51-60. https://doi.org/10.1002/ccd.28954
Sakakura K, Nakano M, Otsuka F, Yahagi K, Kutys R, Ladich E, et al. Comparison of pathology of chronic total occlusion with and without coronary artery bypass graft. Eur Heart J. 2014;35(25):1683–93. https://doi.org/10.1093/eurheartj/eht422
Downloads
Published
Issue
Section
How to Cite
