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Diabetes AND Chronic Total Occlusion

Yoshihisa Shimada, Naoto Kino, Daisuke Tonomura, Yuki Yamanaka, Satoshi Nishiura, Kentaro Yano, Kazato Ito, Masataka Yoshida, Takao Tsuchida, Hitoshi Fukumoto
BACKGROUND: Chronic total occlusion (CTO) of femoropopliteal artery (FP) continues to be a lesion subset where maintaining long-term patency after endovascular treatment is challenging. We evaluated the efficacy of cutting balloon angioplasty (CBA) for de novo FP-CTOs in patients with symptomatic lower limb ischemia. METHODS: Seventy-three limbs of 67 symptomatic patients with de novo FP-CTOs successfully recanalized using CBA alone were enrolled in this study. Primary patency was defined as the absence of recurrent symptoms and no deterioration of the ankle-brachial index (ABI) >0...
February 12, 2019: Annals of Vascular Surgery
Yutaka Tadano, Jun-Ichi Kotani, Yoshifumi Kashima, Daisuke Hachinohe, Tomohiko Watanabe, Takuro Sugie, Umihiko Kaneko, Ken Kobayashi, Daitaro Kanno, Tsutomu Fujita
BACKGROUND: Although bioresorbable polymer sirolimus-eluting Ultimaster stents (BP-SESs) are likely useful for percutaneous coronary interventions (PCIs), the clinical data from real-world cases are insufficient. Furthermore, the predictors of adverse clinical outcomes after BP-SES implantation have not been fully investigated. OBJECTIVES: This study evaluated the 1-year clinical outcomes after BP-SES implantation in real-world PCI cases and identified the predictors of adverse outcomes...
January 13, 2019: Catheterization and Cardiovascular Interventions
Gabriele Testi, Tanja Ceccacci, Mauro Cevolani, Silvia Acquati, Fabio Tarantino, Giorgio Ubaldo Turicchia
Purpose: To report the endovascular treatment of a full metal jacket (FMJ) femoropopliteal chronic total occlusion (CTO) using a new ancillary retrograde technique. Case report: An 80 year old woman with type 2 diabetes presented to the Diabetic Foot Clinic with critical limb ischaemia with tissue loss in the right leg. Her comorbidities included coronary artery disease, morbid obesity, hypertension, dyslipidaemia, and active smoking habit. The patient had been treated at another hospital by femoropopliteal FMJ stenting six years before this presentation...
2018: EJVES Short Reports
Grigoris V Karamasis, Andreas S Kalogeropoulos, Shah R Mohdnazri, Firas Al-Janabi, Richard Jones, Rohan Jagathesan, Rajesh K Aggarwal, Gerald J Clesham, Kare H Tang, Paul A Kelly, John R Davies, Gerald S Werner, Thomas R Keeble
Background The aim of this study was to evaluate the functional result of chronic total occlusion percutaneous coronary intervention (PCI) measured by fractional flow reserve (FFR) immediately post the index procedure and at short-term follow-up. Methods and Results This was a prospective single-center observational study. Consecutive patients with right coronary artery chronic total occlusion scheduled for elective PCI were included. FFR measurements were performed immediately after successful PCI and at 4 months follow-up...
November 2018: Circulation. Cardiovascular Interventions
Sho Torii, Jihad A Mustapha, Jagat Narula, Hiroyoshi Mori, Fadi Saab, Hiroyuki Jinnouchi, Kazuyuki Yahagi, Atsushi Sakamoto, Maria E Romero, Navneet Narula, Frank D Kolodgie, Renu Virmani, Aloke V Finn
OBJECTIVES: The aim of this study was to comprehensively evaluate the pathology of the lower extremity arteries across their entire length in subjects dying with abundant risk factors and to evaluate the clinical and imaging implications of the pathological characteristics. BACKGROUND: Lower extremity peripheral arterial disease is a major cause of cardiovascular morbidity, but a systematic characterization of the pathology has never been undertaken. METHODS: Twelve legs were obtained from 8 cadavers with histories of coronary risk factors (median age 82 years, 6 men); 8 of 12 legs were evaluated using computed tomography before the major peripheral arteries were dissected along their entire length...
December 6, 2018: JACC. Cardiovascular Imaging
X F Tang, Y L Ma, Y Song, J J Xu, H H Wang, L Jiang, P Jiang, R Liu, X Y Zhao, Z Gao, L J Gao, Y Zhang, L Song, J Chen, S B Qiao, Y J Yang, R L Gao, B Xu, J Q Yuan
Objective: To investigate the long-term prognosis of Second generation drug-eluting stents(G2-DES) in diabetic mellitus(DM) and non-DM patients. Methods: Patients with coronary heart disease(CHD) in Fuwai Hospital from January 2013 to December 2013 who had exclusively G2-DES implantation, were consecutively included the follow-up period was 2 years. Results: A total of 6 094 patients with CHD were implanted with G2-DES, of which 1 862 patients with DM, and 4 232 patients without DM.The proportion of DM patients receiving G2-DES implantation with the following characteristics: advanced age, female, hypertension, hyperlipidemia, history of previous stroke, history of peripheral artery disease, previous history of PCI, and with triple vessel, high preoperative Syntax score, high number of target lesions, B2 or C type lesions, severe calcification lesions, and chronic occlusive disease were significantly higher than those of non-DM patients( P <0...
November 20, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Kimihiko Kichikawa, Shigeo Ichihashi, Hiroyoshi Yokoi, Takao Ohki, Masato Nakamura, Kimihiro Komori, Shinsuke Nanto, Erin E O'Leary, Aaron E Lottes, Scott A Snyder, Michael D Dake
PURPOSE: A prospective, multicenter post-market surveillance study in Japan evaluated the 2-year safety and effectiveness of the DES in real-world patients with complex femoropopliteal artery lesions. METHODS: There were no exclusion criteria, and consecutive symptomatic patients with femoropopliteal lesions treated with the DES were enrolled in the study. Clinically driven target lesion revascularization (TLR) was defined as reintervention performed for > 50% diameter stenosis after recurrent clinical symptoms of peripheral arterial disease...
November 8, 2018: Cardiovascular and Interventional Radiology
Vikrant Deshmukh, Mukund Vasantrao Phutane, Kalyan Munde, Narendra Bansal
Background: A chronic total occlusion (CTO) is defined as an angiographically documented or clinically suspected complete interruption of antegrade coronary flow (Thrombolysis in Myocardial Infarction (TIMI)-0 flow) of greater than 3 months standing. Coronary CTOs represent the most technically challenging lesion subset that interventional cardiologists face. CTOs are identified in up to one third of patients referred for coronary angiography and remain seriously undertreated with percutaneous techniques...
October 2018: Cardiology Research
David E Kandzari, J Aaron Grantham, Dimitrios Karmpaliotis, William Lombardi, Jeffrey W Moses, William Nicholson, Stephen Cook, Ashish Pershad, Jeffrey J Popma
BACKGROUND: Limited study has detailed the procedural outcomes and utilization of contemporary coronary guidewires and microcatheters designed for chronic total occlusion (CTO) percutaneous revascularization and with application of modern techniques. PATIENTS AND METHODS: A prospective, multicenter, single-arm trial was conducted to evaluate procedural and in-hospital outcomes among 163 patients undergoing attempted CTO revascularization with specialized guidewires and microcatheters...
December 2018: Coronary Artery Disease
Leszek Bryniarski, Łukasz Klima, Sławomir Surowiec, Krzysztof L Bryniarski, Michał Terlecki, Dariusz Dudek
Introduction: In past studies, it has been questioned whether success of recanalization of chronic total occlusion (CTO) depends on the location of the occlusion - the circumflex artery (Cx) was considered as the most difficult to open. Aim: To determine whether the effectiveness of recanalization of CTO depends on the location of the obstruction. Material and methods: From January 2011 to January 2016, a single operator dedicated to chronic total occlusions performed in our center 357 procedures on 337 patients...
2018: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
Ozan M Demir, Francesca Lombardo, Enrico Poletti, Alessandra Laricchia, Alessandro Beneduce, Davide Maccagni, Massimo Slavich, Francesco Giannini, Mauro Carlino, Alberto Margonato, Alberto Cappelletti, Antonio Colombo, Lorenzo Azzalini
Contrast volume is associated with the incidence of contrast-induced nephropathy (CIN), and CIN risk could be particularly high in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Our aim was to evaluate the incidence of CIN in patients who underwent CTO versus non-CTO PCI. All PCIs performed at our institution from January 2012 to December 2016 were included in this study. CIN was defined as an increase of ≥0.3 mg/dl or ≥50% from baseline within 72 hours. Multivariable logistic regression analysis was performed to identify independent predictors of CIN...
December 1, 2018: American Journal of Cardiology
Peter Tajti, Aris Karatasakis, Barbara A Danek, Khaldoon Alaswad, Dimitri Karmpaliotis, Farouc A Jaffer, James W Choi, Robert W Yeh, Mitul Patel, Ehtisham Mahmud, M Nicholas Burke, Oleg Krestyaninov, Dmitrii Khelimskii, Catalin Toma, Anthony H Doing, Barry Uretsky, Michalis Koutouzis, Ioannis Tsiafoutis, R Michael Wyman, Santiago Garcia, Elizabeth Holper, Iosif Xenogiannis, Bavana V Rangan, Subhash Banerjee, Imre Ungi, Emmanouil S Brilakis
OBJECTIVES: The effect of chronic kidney disease (CKD) on in-hospital outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. METHODS: We evaluated the prevalence of CKD and its impact on CTO-PCI outcomes in 1979 patients who underwent 2040 procedures between 2012 and 2017 at 18 centers. CKD was defined as preprocedural estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m². RESULTS: Compared with patients without CKD (n = 1444; 73%), patients with CKD (n = 535; 27%) had more comorbidities (hypertension, diabetes mellitus, heart failure, peripheral arterial disease, prior myocardial infarction, PCI, coronary artery bypass graft surgery, and stroke), and more severe calcification and proximal vessel tortuosity...
November 2018: Journal of Invasive Cardiology
Keon-Joo Lee, Ji Sung Lee, Keun-Hwa Jung
BACKGROUND: Diabetes mellitus is a well-established risk factor for ischemic stroke and is known to increase stroke risk by 2-6 fold. Numerous studies have reported the relationship between parameters for glycemic status and stroke-related outcomes; however, studies focusing on the interaction between acute and chronic glycemic status indexes with stroke phenotype are lacking. METHODS: Acute ischemic stroke patients who were admitted to a tertiary hospital stroke center from 2002 to 2015 were consecutively enrolled in this study...
August 3, 2018: BMC Neurology
Michele Piazza, Marco Zavatta, Margherita Lamaina, Jacopo Taglialavoro, Francesco Squizzato, Franco Grego, Michele Antonello
OBJECTIVE/BACKGROUND: The aim was to evaluate early outcomes of carotid endarterectomy (CEA) in asymptomatic patients using a standardised technique based on routine shunting after rapid plaque removal ("delayed"). METHODS: A retrospective review of all asymptomatic patients who underwent CEA during a 10 year single centre experience (January 2007-December 2016) was performed. The technique was based on rapid endarterectomy with distal intimal edge visualisation, followed by routine shunt insertion; subsequent time spent on the manoeuvre and closure were completed under shunting...
September 2018: European Journal of Vascular and Endovascular Surgery
Daniel A Jones, Krishnaraj S Rathod, Antonis N Pavlidis, Sean M Gallagher, Zoe Astroulakis, Pitt Lim, Alexander Sirker, Charles J Knight, Miles C Dalby, Iqbal S Malik, Anthony Mathur, Roby Rakhit, Simon Redwood, Philip A MacCarthy, Chris Baker, Ranil Desilva, Carlo Di Mario, Roshan Weerackody, Jonathan Hill, Andrew Wragg, Elliot J Smith
BACKGROUND: Chronic total occlusions (CTO) are commonly encountered in patients undergoing coronary angiography; however, percutaneous coronary intervention (PCI) is infrequently performed owing to technical difficulty, the perceived risk of complications and a lack of randomized data. The aim of this study was to analyse the frequency and outcomes of CTO-PCI procedures in a large contemporary cohort of successive patients. PATIENTS AND METHODS: We undertook an observational cohort study of 48 234 patients with stable angina of which 5496 (11...
November 2018: Coronary Artery Disease
Jung Woo Chang, Woong Heo, Matthew Seung Suk Choi, Jang Hyun Lee
BACKGROUND: Diabetic foot management is a challenge for reconstructive surgeons because it combines dramatically decreased circulation and chronic infection. The goal of managing this condition is to maximize viable tissue; however, unsatisfactory results, such as extremity amputation, are unavoidable in some cases. For appropriate management, thorough understanding of diabetic foot and the phased approach to its management is needed. The purpose of this study is to introduce an optimal algorithm for diabetic foot management by analyzing cases >12 years...
July 2018: Medicine (Baltimore)
Ying Shen, Zhen Kun Yang, Jian Hu, Xiao Qun Wang, Yang Dai, Su Zhang, Rui Yan Zhang, Lin Lu, Feng Hua Ding, Wei Feng Shen
BACKGROUND: We investigated whether and to what extent stenosis of predominant collateral donor artery (PCDA) affects coronary collateral flow in relation to blood pressure (BP) in type 2 diabetic patients with chronic total occlusion (CTO). METHODS: Collateral flow index (CFI) as derived from intracoronary pressure distal to occluded segment and mean aortic pressure in 220 type 2 diabetic patients and 220 propensity score matched non-diabetic controls undergoing percutaneous coronary intervention for CTO...
June 1, 2018: Cardiovascular Diabetology
Masahiro Natsuaki, Takeshi Morimoto, Kyohei Yamaji, Hirotoshi Watanabe, Yusuke Yoshikawa, Hiroki Shiomi, Yoshihisa Nakagawa, Yutaka Furukawa, Kazushige Kadota, Kenji Ando, Takashi Akasaka, Keiichi Igarashi Hanaoka, Ken Kozuma, Kengo Tanabe, Yoshihiro Morino, Toshiya Muramatsu, Takeshi Kimura
BACKGROUND: Prediction of thrombotic and bleeding risk is important to optimize antithrombotic therapy after percutaneous coronary intervention. METHODS AND RESULTS: We developed the prediction rules for thrombotic and bleeding events separately in Japanese patients. Derivation and validation cohorts consisted of 4778 patients from CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) registry cohort 2 and 4669 patients from RESET (Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial) and NEXT (Nobori Biolimus-Eluting Versus Xience/Promus Everolimus-Eluting Stent Trial)...
May 22, 2018: Journal of the American Heart Association
Peter Tajti, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A Jaffer, Robert W Yeh, Mitul Patel, Ehtisham Mahmud, James W Choi, M Nicholas Burke, Anthony H Doing, Phil Dattilo, Catalin Toma, A J Conrad Smith, Barry Uretsky, Elizabeth Holper, R Michael Wyman, David E Kandzari, Santiago Garcia, Oleg Krestyaninov, Dmitrii Khelimskii, Michalis Koutouzis, Ioannis Tsiafoutis, Jeffrey W Moses, Nicholas J Lembo, Manish Parikh, Ajay J Kirtane, Ziad A Ali, Darshan Doshi, Bavana V Rangan, Imre Ungi, Subhash Banerjee, Emmanouil S Brilakis
OBJECTIVES: The aim of this study was to determine the techniques and outcomes of hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a diverse group of patients and operators on 2 continents. BACKGROUND: CTO PCI has been evolving with constant improvement of equipment and techniques. METHODS: Contemporary outcomes of CTO PCI were examined by analyzing the clinical, angiographic, and procedural characteristics of 3,122 CTO interventions performed in 3,055 patients at 20 centers in the United States, Europe, and Russia...
July 23, 2018: JACC. Cardiovascular Interventions
Asaad A Khan, George D Dangas
Several chronic total occlusions (CTOs) may be undilatable despite successful wire passage; several techniques can be used for lesion preparation, such as high-pressure balloon inflations, rotational atherectomy laser, cutting balloon, and scoring balloons. Presence of moderate to severe calcification and lesion length over 40 mm in association with comorbidities, such as diabetes mellitus and reduced ejection fraction, may contribute to making a CTO lesion undilatable. Still, appropriate therapy selection for a patient with CTO should be individualized and procedure safety attended to...
March 1, 2018: Catheterization and Cardiovascular Interventions
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