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Valeri Gelev - Ostial CTO Lesions
- 1. Ostial CTO Lesions Valeri Gelev Tokuda Hospital Sofia
- 2. Ostial Lesions Definition Ostial disease is defined as a lesion arising within 3 mm of the vessel origin Classification – Aorto-ostial – involving the ostia of the RCA, LMS, and ACB grafts. – Non-aorto-ostial – involving the ostia of the major coronary arteries not arising directly from the aorta; i.e., the LAD, Cx and RIM. – Branch ostial – involving the ostia of branches of the major coronary vessels; (diagonals, marginals, PL and PD) Percy Eurointerverntion 2009
- 3. Ostial Lesions - Incidence 33% 12% 32% 18% Overall Incidence around 3% Patel CCI 2016
- 4. CTO - Ostial Lesions Incidence Limited data Galassi Coron Artery Dis 2015
- 5. CTO - Ostial Lesions Incidence Limited data Euro CTO Registry 2012-07.2015 Mayer-Gessner EuroCTO meeting 2015 RCA Ostial Other Lesions n 378 (4%) 9030 (96%) lesion length(mm) 43,4 30,7 J CTO score (men) 3,2 2,3 antegrade only (%) 38 73 retrograde only (%) 37 11 antegradea and retrograde (%) 25 16 stent length (mm) 78,4 62,3 procedural time 140,1 106,2 fluoro time 62,5 41,2 Contrast (ml) 317,5 292,2 Success rate (%) 78 87
- 6. CTO - Ostial Lesions Incidence Limited data Chun Luo JACC – Cardiovascula Imaging 2015 Independent predictor of Failure
- 7. CTO - Ostial Lesions Incidence Non Aorto- ostial Lesions Side Branch at Proximal Cap = Increasing the Proximal Cap Ambiguity
- 8. Angiographic Predictors of Unsuccesful CTO CUMC experience Odds Ratio 95% CI p-value CTO length 1.06 per 1mm increase 1.03-1.09 <0.01 Blunt stump 1.35 0.68-2.66 0.39 Side Branches 2.81 1.45-4.96 <0.01 Bridging collaterals 0.60 0.32-1.15 0.12 >1 CTO in vessel 3.22 1.13-9.19 0.03 Vessel calcification 4.54 2.40-8.56 <0.01 Diffuse disease 0.85 0.34-2.12 0.73 Prior CABG 1.03 0.53-2.03 0.93 Obunal K: ACC 2008
- 9. 1 1,5 2 2,5 3 3,5 Proximal v distal vessel Length <15, 16-30, >30 Absent proximal tortuosity Less calcification Unambiguous proximal cap No previous CABG BMI < 30 Adjusted OR for success Predictors of success – UK HYBRID Multivariate analysis: C statistic = 0.72 All p<0.01 Wilson CTO summit 2016
- 10. PROspective Global REgiStry for the Study of CTO interventions Proximal cap ambiguity Brilakis CTO summit 2016
- 11. CTO - Ostial Lesions - Management – Microchannels – Bridging Collaterals – Calcium in the vessel course – Additional imaging modalities • IVUS • CT angio of CTO – Utility of Retrograde Approach Non Ao-ostial Ao - ostial + +/- ++ +/- ++ ++ +++ - +/- +/- ++ +++ Meticulous attention should be paid to prevent retrograde wire going subintimally in the proximal vessel, LM respectively. How to predict the vessel origin in the absence of stump
- 12. CTO - Ostial Lesions Case presentation
- 13. CTO - Ostial Lesions Case presentation
- 14. CTO - Ostial Lesions Case presentation
- 15. CTO - Ostial Lesions Case presentation
- 16. CTO - Ostial Lesions Case presentation
- 17. CTO - Ostial Lesions Case presentation Final Result
- 19. CTO – Ao-Ostial Lesions - Case presentation
- 20. CTO – Ao-Ostial Lesions - Case presentation
- 21. CTO – Ao - Ostial Lesions - Case presentation
- 22. CTO – Ao - Ostial Lesions - Case presentation Final Result
- 23. CTO - Ostial Lesions • Ostial CTO lesions represent an inhomogeneous subset of chronically occluded coronaries. • There is a paucity of data about their incidence, treatment options and longstanding results. • PCIs in Ao-ostila CTOs are complex, procedures, demanding high expertise of the operator and a lot of resources. • Reported success rates are lower compared with the conventional CTO PCI.