ORAL

ABSTRACTS

APRIL 23e26, 2013

Chronic Total Occlusions

Complex PCI III

Wednesday, April 24, 2013

4:00 PM w 5:00 PM

(Abstract nos. AS-040, AS-041,AS-042, AS-043, AS-044)

- AS-040

Comparison Between Coronary Angiography Assisted andComputed Coronary Tomography Angiography AssistedRecanalization of Chronic Total Occlusion. Shuoyang Zhang,Luyue Gai, Qinhua Jin. Chinese PLA General Hospital, Beijing, China.

Background: Computed coronary tomography angiography (CCTA)provides an alternative and complementary way of imaging to coronaryangiography. However, it is unknown if the CT assistance could helpincrease the recanalization rate.

Methods: Two experienced interventionists participated in the study.One was specialized in both CCTA and percutanieous coronary inter-vention (PCI), and another had no knowledge of the results of theCCTA . The patients were continuously selected if CTO was diagnosedby CAG or by CCTA. The image was analyzed on a dedicated workstation. The analysis involved the calculation of the length of theocclusion, the caliber of the artery, the characteristics of the occlusion,the best projection for precision guide wire penetration, the use of sidebranch and calcification for land marking and selection of most suitableguide wires. The patients underwent CAG guided PCI or CCTAassisted PCI. The main end point was the recanalization rate. Thesecondary end points included the time for successful passage of guidewire, fluoroscopy time, contrast, guide wire and stent consumption.

Results: Thirty-six patients went to CAG and 44 pts to CCTA. Theclinical characteristics and laboratory data were similar, p>0.05. Thepatients in CCTA were more complex than in CAG in term of J-CTOScore, p<0.05. Recanalization rate were 75.8% in the CAG and 72.1%in the CCTA. However, no statistical significance was observed,p>0.05. Seven patients had undergone unsuccessful PCI before.Assisted by CCTA 5 of the 7 at the 2nd attempt were successful. Thepatients were divided into failure and success groups. The J-Score wasthe independent predictor for failure, OR 0.290, (0.158-0.533).

Conclusion: CCTA help recanalize failed unfavorable CTO.Favorable CTO does not need CCTA.

- AS-041

Transradial Intervention for Chronic Total Occlusion.Tsutomu Murakami, Naoki Masuda, Sho Torii, Makoto Natsumeda,Takeshi Ijichi, Yohei Ohno, Gaku Nakazawa, Norihiko Shinozaki,Nobuhiko Ogata, Yuji Ikari. Tokai University School of Medicine,Kanagawa, Japan.

Background: Transradial Intervention (TRI) is currently applied tomore complex lesions in percutaneous coronary intervention (PCI).

The American Journal of Cardiology� APRIL 23e26, 2013 AN

However, the efficacy and feasibility of TRI for chronic total occlusion(CTO) is not established.

Methods: PCI for a total of 221 CTO lesions were performed in ourhospital between January 2008 and December 2011. TRI was used in158 lesions (71.5%). We retrospectively evaluated the medical record ofthe TRI cases.

Results: Average age was 65.1�11.6 years old and male was 77.5%.Coronary risk factors were smoking history (50.5%), diabetes mellitus(41.0%), dyslipidemia (68.6%), hypertension (78.1%), family history(12.4%), old myocardial infarction (39.0%) and chronic kidney disease(5.7%). CTO lesions were located in the left anterior descending artery(31.3%), left circumflex artery (23.5%), right coronary artery (43.5%)and left main trunk (1.7%). Antegrade approach was performed in84.2% and antegrade plus retrograde tracking including at least one TRIwas in 15.8% (n¼25 lesions). Size of the guiding catheter in TRI was 6Fr or less in 95%. During undergoing PCI for CTO, The median time offluoroscopy was 51.2�30.5 minutes and contrast medium was251�115 ml. Success rate of the antegrade approach was 88.0% andthat of antegrade plus retrograde approach was 64.0%. Total successrate for CTO was 84.2%. Major complications within 30 days were asfollows; death 0%, myocardial infarction 0% and emergency bypasssurgery 0%. No bleeding complication was observed but 3 coronaryperforations were successfully treated by fat embolisations or negativepressure method.

Conclusion: TRI for CTO lesions with current approach seemed tobe acceptable. Further investigation is necessary.

- AS-042

Comparative Effectiveness of First Generation Drug-eluting StentVersus Second Generation Drug-eluting Stent for Chronic TotalOcclusion. Takahiro Tokuda, Toshiya Muramatsu, Reiko Tsukahara,Yoshiaki Ito, Tsuyoshi Sakai, Hiroshi Ishimori, Keisuke Hirano,Masatsugu Nakano, Masahiro Yamawaki, Motoharu Araki,Tamon Kato, Norihiro Kobayashi, Hideyuki Takimura,Yasunari Sakamoto, Ai Ishii, Takuro Takama. Saiseikai Yokohama CityEastern Hospital, Yokohama, Japan.

Background: Although there are some studies of effectiveness of thesecond generation drug-eluting stent (DES) for chronic total occlusion(CTO), the comparison between first generation DES and secondgeneration DES for CTO is unclear. So, the aim of this study is toevaluate and compare first generation DES and second generation DESfor CTO, retrospectively.

Methods: From April 2007 to February 2012, we had performed PCIfor 519 de novo CTO lesions in the 288 patients. We investigatedclinical and angiographical outcomes of pre, post-PCI and 8 monthsfollow up,TLR, and MACE (death, MI, TLR, and CABG).

Results: Procedural success was obtained in 268 (93%) patients.160 patients (60%) received first generation DES (SES and PES),and 108 patients (40%) received second generation DES (ZES, EES,and BES). Choice of DES was depended on doctor0s decision. Therewere no significant differences between two groups in the age,gender, coronary risk factors, target vessels, and stent size. (NS) Thepatients with second generation DES had longer stent length (41.0vs. 37.5 mm, p < 0.05), and received more stents (2.60 vs. 1.41, p< 0.01). Among patients who underwent stent deployment, treatmentwith second generation DES rather than first generation DES resultedin less target lesion revascularization (19.2% vs. 22.6%, p < 0.01)and MACE was also the same result (28.8% vs. 36.2%, p < 0.01);definite/probable stent thrombosis rates were similar ( 1.4% vs. 2.3%,p ¼ 0.32).

Conclusion: Successful CTO PCI is associated with reduced long-term cardiac mortality and need for coronary artery bypass graftsurgery. Treatment of CTO with second generation DES rather than first

GIOPLASTY SUMMIT ABSTRACTS/Oral 19B