Subadventitial stenting around occluded stents: A bailout technique to recanalize in-stent chronic total occlusions
Azzalini, Lorenzo; Karatasakis, Aris; Spratt, James C; Tajti, Péter; Riley, Robert F; Ybarra, Luiz F; Schumacher, Stefan P; Benincasa, Susanna; Bellini, Barbara; Candilio, Luciano; Mitomo, Satoru; Henriksen, Peter; Hidalgo, Francisco; Timmers, Leo; Kraaijeveld, Adriaan O; Agostoni, Pierfrancesco; Roy, James; Ramsay, David R; Weaver, James C; Knaapen, Paul; Nap, Alexander; Starcevic, Boris; Ojeda, Soledad; Pan, Manuel; Alaswad, Khaldoon; Lombardi, William L; Carlino, Mauro; Brilakis, Emmanouil S; Colombo, Antonio; Rinfret, Stéphane; Mashayekhi, Kambis
(2018) Catheterization and Cardiovascular Interventions, volume 92, issue 3, pp. 466 - 476
(Article)
Abstract
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,
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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.
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Keywords: chronic total occlusion, crushing, in-stent restenosis, percutaneous coronary intervention, subadventitial, subintimal, Journal Article
ISSN: 1522-1946
Publisher: Wiley-Liss Inc.
Note: Publisher Copyright: © 2018 Wiley Periodicals, Inc.
(Peer reviewed)