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Drive-By Radial Artery Re-Entry: Extending Chronic Total Occlusion Techniques to the Peripheral Arteries.

ABSTRACT: Despite the success of the hybrid coronary chronic total occlusion percutaneous coronary intervention techniques, there has been little translation of these techniques into peripheral interventions. We describe a case of recanalization of an occluded radial artery that was dissected and re-entered using chronic total occlusion techniques before moving on to revascularize the coronary artery. (Level of Difficulty: Advanced.).

SUBMITTER: Mcquillan C

PROVIDER: S-EPMC8304570 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Drive-By Radial Artery Re-Entry: Extending Chronic Total Occlusion Techniques to the Peripheral Arteries.

Mcquillan Conor C Egred Mohaned M

JACC. Case reports 20201111 15

Despite the success of the hybrid coronary chronic total occlusion percutaneous coronary intervention techniques, there has been little translation of these techniques into peripheral interventions. We describe a case of recanalization of an occluded radial artery that was dissected and re-entered using chronic total occlusion techniques before moving on to revascularize the coronary artery. (<b>Level of Difficulty: Advanced.</b>). ...[more]

PMID: 34317181

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Side branch preservation using tip detection-antegrade dissection re-entry after failed subintimal tracking and re-entry in chronic total occlusion: a case report.

Project description:BackgroundTechniques for treating difficult chronic total occlusions (CTOs) have evolved with the discovery of the tip detection-antegrade dissection re-entry (TDADR) guided by intravascular ultrasound (IVUS). This case demonstrates TDADR as a viable bailout in failed subintimal tracking and re-entry (STAR) technique.Case summaryA 78-year-old man with stable angina on optimal medical therapy had exertional angina pectoris secondary to a residual CTO lesion of the left circumflex coronary (LCX) artery. Percutaneous coronary intervention was performed for a mid-LCX CTO with a blunt proximal stump where the dissection plane expanded along the main vessel and side branch 2. Due to lack of promising collaterals for the retrograde approach, STAR successfully recanalized side branch 1. As main vessel failed to be recanalized, we proceeded with an AnteOwl IVUS-guided TDADR, intending guidewire penetration into the true lumen from the middle of the dissection plane at the main vessel, proximal to side branch 2 origin. Accurate wiring was achieved, and a guidewire was placed on side branch 2 for protection. After stent placement in the main vessel and kissing inflation, cutting balloon dilatation was performed to create re-entries for the STAR-induced extended main vessel haematoma. The procedure resulted in complete revascularization of main vessel and side branches. At 12-month follow-up, no further angina was reported, and coronary computed tomography showed patent side branches with no significant in-stent restenosis.DiscussionImaging-based TDADR method was effective in our present case despite failed STAR technique. Limited IVUS and operator availability may become a barrier in implementing TDADR.

| S-EPMC11536087 | biostudies-literature

Clinical Experience of a Novel Optical Coherence Tomography-Guided Coronary Chronic Total Occlusion Re-Entry Device.

Project description:We demonstrated a first-in-human case of successful antegrade dissection and re-entry using an image-guided re-entry catheter that enables real-time high-resolution visualization with graphical augmentation, and precision steering and advancement of a guidewire. The total time from over-the-wire deployment in the proximity of the distal cap to successful re-entry was <20 minutes. (Level of Difficulty: Advanced.).

| S-EPMC10715934 | biostudies-literature

Total Occlusion of Pulmonary Arteries by Embolization of Myxoma.

Project description: Not available

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Preliminary Study on Retrograde Recanalization of Radial Artery Occlusion Through Distal Radial Artery Access: a Single-Center Experience.

Project description:PurposeRadial artery occlusion (RAO) is an unresolved complication after transradial artery (TRA) puncture. The aim of this observational study was to assess the feasibility and safety of retrograde recanalization of RAO through distal transradial access (dTRA).MethodsFrom June 2021 to March 2022, 28 consecutive patients with successful puncture and intubation through the dTRA in the anatomical snuffbox and RAO confirmed by angiography were enrolled.ResultsAmong the 28 patients, 27 (96.4%) patients with RAO were successfully retrogradely recanalized through the dTRA and successfully underwent coronary angiography or coronary intervention. After the procedure, only 1 (3.7%) patient developed a forearm hematoma, and there were no other bleeding complications or nerve disorders.ConclusionsDTRA is a safe and feasible approach for retrograded recanalization of RAO, with a high procedure success rate and few complications.

| S-EPMC11680607 | biostudies-literature

Use of antegrade dissection re-entry in coronary chronic total occlusion percutaneous coronary intervention in a contemporary multicenter registry.

Project description:BackgroundWe assessed efficacy and safety of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using antegrade dissection re-entry (ADR).MethodsWe examined outcomes of ADR among 1313 CTO PCIs performed at 11 US centers between 2012-2015.Results84.1% of patients were men. Prevalence of prior coronary artery bypass graft surgery was 34.3%. Overall technical and procedural success were 90.1% and 88.7%, respectively. In-hospital major adverse cardiovascular events (MACE) occurred in 31 patients (2.4%). ADR was used in 458 cases (34.9%), and was the first strategy in 169 cases (12.9%). ADR cases were angiographically more complex than non-ADR cases (mean J-CTO score: 2.8±1.2 vs. 2.4±1.2, p<0.001). ADR was performed using the CrossBoss catheter in 246 of 458 (53.7%) and the Stingray system in 251 ADR cases (54.8%). Compared with non-ADR cases, ADR cases had lower technical (86.9% vs. 91.8%, p=0.005) and procedural success (85.0% vs. 90.7%, p=0.002), but similar risk for MACE (2.9% vs. 2.2%, p=0.42). ADR was associated with longer procedure and fluoroscopy time, and higher patient air kerma dose and contrast volume (all p<0.001). After excluding retrograde cases, ADR and antegrade wire escalation (AWE) had similar technical success (92.7% vs. 94.2%, p=0.43), procedural success (91.8% vs. 94.1%, p=0.23), and MACE (2.1% vs. 0.6%, p=0.12).ConclusionsADR is used relatively frequently in contemporary CTO PCI, especially for challenging lesions and after failure of other strategies. ADR is associated with similar success rates and risk for complications as compared with AWE, and is important for achieving high procedural success.

| S-EPMC4862911 | biostudies-literature

The impact of dissection and re-entry versus wire escalation techniques on long-term clinical outcomes in patients with chronic total occlusion lesions following percutaneous coronary intervention: An updated meta-analysis.

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| S-EPMC8169187 | biostudies-literature

Influence of Puncture Site on Radial Artery Occlusion After Transradial Coronary Intervention.

Project description:BackgroundThe risk of radial artery occlusion (RAO) needs particular attention in transradial intervention (TRI). Therefore, reducing vascular occlusion has an important clinical significance. The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI.MethodsWe prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI. Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention. Risk factors for RAO were evaluated using a multivariate model analysis.ResultsOf the 606 patients, the RAO occurred in 56 patients. Compared with TRI at 2-5 cm away from the radius styloid process, the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P = 0.033) and 8.90 (P = 0.040), respectively. The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 (OR = 2.45, P = 0.004).ConclusionDistal puncture sites (0-1 cm away from the radius styloid process) can lead to a higher rate of RAO.Trial registrationClinicalTrials.gov, NCT01979627; https://clinicaltrials.gov/ct2/show/NCT01979627?term = NCT01979627 and rank = 1.

| S-EPMC4831522 | biostudies-literature

Distal Re-Entry to Treat Lower Limb Chronic Total Occlusions Using a Novel Electrically Guided Re-Entry Catheter.

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Project description:BACKGROUND The primary aim of this study was to evaluate the level of autophagy and apoptosis enzymes in patients with coronary artery disease (CAD). Furthermore, we investigated the role of autophagy and apoptosis in the progression of coronary collateral and coronary total occlusion (TO). MATERIAL AND METHODS We enrolled 115 patients in this prospective, observational, controlled study, who were categorized into 3 groups as follows: group 1, patients with chronic TO (n=49); group 2, patients with acute TO such as myocardial infarction (n=36); and group 3, healthy control patients (n=30). We used the enzyme-linked immunosorbent assay (ELISA) kit for autophagy-related protein 5 (ATG5) and apoptosis (M30) in the plasma for these 3 groups. RESULTS Autophagy levels significantly varied among the groups (13.7±5.3 ng/mL, 11.7±3.4 ng/mL, and 7.5±3, respectively; P<0.001). In addition, apoptosis levels significantly varied among the groups (78.6±33.4 ng/mL, 64.9±30.6 ng/mL, and 47.6±18.2, respectively; P<0.001). The subgroup analysis revealed significant positive correlations between the autophagy level and the Rentrop score in contrast to apoptosis in group 1 (r=0.463; P<0.001). CONCLUSIONS This study determined that autophagy and apoptosis levels were higher in patients with CAD than in healthy controls. In contrast to the serum apoptosis level, serum autophagy levels demonstrated a significant positive correlation with the Rentrop score. Hence, an elevated autophagy level might be a potential activator and marker of the process by which the body protects itself in CAD.

| S-EPMC6180916 | biostudies-other

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