TY - JOUR
T1 - Subadventitial stenting around occluded stents
T2 - A bailout technique to recanalize in-stent chronic total occlusions
AU - Azzalini, Lorenzo
AU - Karatasakis, Aris
AU - Spratt, James C
AU - Tajti, Péter
AU - Riley, Robert F
AU - Ybarra, Luiz F
AU - Schumacher, Stefan P
AU - Benincasa, Susanna
AU - Bellini, Barbara
AU - Candilio, Luciano
AU - Mitomo, Satoru
AU - Henriksen, Peter
AU - Hidalgo, Francisco
AU - Timmers, Leo
AU - Kraaijeveld, Adriaan O
AU - Agostoni, Pierfrancesco
AU - Roy, James
AU - Ramsay, David R
AU - Weaver, James C
AU - Knaapen, Paul
AU - Nap, Alexander
AU - Starcevic, Boris
AU - Ojeda, Soledad
AU - Pan, Manuel
AU - Alaswad, Khaldoon
AU - Lombardi, William L
AU - Carlino, Mauro
AU - Brilakis, Emmanouil S
AU - Colombo, Antonio
AU - Rinfret, Stéphane
AU - Mashayekhi, Kambis
PY - 2018/9/1
Y1 - 2018/9/1
N2 - OBJECTIVES: To evaluate the outcomes of subadventitial stenting (SS) around occluded stents for recanalizing in-stent chronic total occlusions (IS-CTOs).BACKGROUND: There is little evidence on the outcomes of SS for IS-CTO.METHODS: We examined the outcomes of SS for IS-CTO PCI at 14 centers between July 2011 and June 2017, and compared them to historical controls recanalized using within-stent stenting (WSS). Target-vessel failure (TVF) on follow-up was the endpoint of this study, and was defined as a composite of cardiac death, target-vessel myocardial infarction, and target-vessel revascularization.RESULTS: During study period, 422 IS-CTO PCIs were performed, of which 32 (7.6%) were recanalized with SS, usually when conventional approaches failed. The most frequent CTO vessel was the right coronary artery (72%). Mean J-CTO score was 3.1 ± 0.9. SS was antegrade in 53%, and retrograde in 47%. Part of the occluded stent was crushed in 37%, while the whole stent was crushed in 63%. Intravascular imaging was used in 59%. One patient (3.1%) suffered tamponade. Angiographic follow-up was performed in 10/32 patients: stents were patent in six cases, one had mild neointimal hyperplasia, and three had severe restenosis at the SS site. Clinical follow-up was available for 29/32 patients for a mean of 388 ± 303 days. The 24-month incidence of TVF was 13.8%, which was similar to historical controls treated with WSS (19.5%, P = 0.49).CONCLUSIONS: SS is rarely performed, usually as last resort, to recanalize complex IS-CTOs. It is associated with favorable acute and mid-term outcomes, but given the small sample size of our study additional research is warranted.
AB - OBJECTIVES: To evaluate the outcomes of subadventitial stenting (SS) around occluded stents for recanalizing in-stent chronic total occlusions (IS-CTOs).BACKGROUND: There is little evidence on the outcomes of SS for IS-CTO.METHODS: We examined the outcomes of SS for IS-CTO PCI at 14 centers between July 2011 and June 2017, and compared them to historical controls recanalized using within-stent stenting (WSS). Target-vessel failure (TVF) on follow-up was the endpoint of this study, and was defined as a composite of cardiac death, target-vessel myocardial infarction, and target-vessel revascularization.RESULTS: During study period, 422 IS-CTO PCIs were performed, of which 32 (7.6%) were recanalized with SS, usually when conventional approaches failed. The most frequent CTO vessel was the right coronary artery (72%). Mean J-CTO score was 3.1 ± 0.9. SS was antegrade in 53%, and retrograde in 47%. Part of the occluded stent was crushed in 37%, while the whole stent was crushed in 63%. Intravascular imaging was used in 59%. One patient (3.1%) suffered tamponade. Angiographic follow-up was performed in 10/32 patients: stents were patent in six cases, one had mild neointimal hyperplasia, and three had severe restenosis at the SS site. Clinical follow-up was available for 29/32 patients for a mean of 388 ± 303 days. The 24-month incidence of TVF was 13.8%, which was similar to historical controls treated with WSS (19.5%, P = 0.49).CONCLUSIONS: SS is rarely performed, usually as last resort, to recanalize complex IS-CTOs. It is associated with favorable acute and mid-term outcomes, but given the small sample size of our study additional research is warranted.
U2 - https://doi.org/10.1002/ccd.27472
DO - https://doi.org/10.1002/ccd.27472
M3 - Article
C2 - 29314563
SN - 1522-1946
VL - 92
SP - 466
EP - 476
JO - Catheterization and cardiovascular interventions
JF - Catheterization and cardiovascular interventions
IS - 3
ER -