Dataset Information

Prompt and consistent improvement of coronary flow velocity reserve following successful recanalization of the coronary chronic total occlusion in patients with viable myocardium.

ABSTRACT: BACKGROUND:Coronary chronic total occlusion (CTO) is characterized by the presence of collateral blood vessels which can provide additional blood supply to CTO-artery dependent myocardium. Successful CTO recanalization is followed by significant decrease in collateral donor artery blood flow and collateral derecruitment, but data on coronary hemodynamic changes in relation to myocardial function are limited. We assessed changes in coronary flow velocity reserve (CFVR) by echocardiography in collateral donor and recanalized artery following successful opening of coronary CTO. METHODS:Our study enrolled 31 patients (60?±?9?years; 22 male) with CTO and viable myocardium by SPECT scheduled for percutaneous coronary intervention (PCI). Non-invasive CFVR was measured in collateral donor artery before PCI, 24?h and 6?months post-PCI, and 24?h and 6?months in recanalized artery following successful PCI of CTO. RESULTS:Collateral donor artery showed significant increase in CFVR 24?h after CTO recanalization compared to pre-PCI values (2.30?±?0.49 vs. 2.71?±?0.45, p?=?0.005), which remained unchanged after 6-months (2.68?±?0.24). Baseline blood flow velocity of the collateral donor artery significantly decreased 24?h post-PCI compared to pre-PCI (0.28?±?0.06 vs. 0.24?±?0.04?m/s), and remained similar after 6?months, with no significant difference in maximum hyperemic blood flow velocity pre-PCI, 24?h and 6?months post-PCI. CFVR of the recanalized coronary artery 24?h post-PCI was 2.55?±?0.35, and remained similar 6?months later (2.62?±?0.26, p?=?NS). CONCLUSIONS:In patients with viable myocardium, prompt and significant CFVR increase in both recanalized and collateral donor artery, was observed within 24?h after successful recanalization of CTO artery, which maintained constant during the 6?months. TRIAL REGISTRATION:ClinicalTrials.gov (Number NCT04060615 ).

SUBMITTER: Dobric M

PROVIDER: S-EPMC7374915 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Prompt and consistent improvement of coronary flow velocity reserve following successful recanalization of the coronary chronic total occlusion in patients with viable myocardium.

Dobric Milan M Beleslin Branko B Tesic Milorad M Djordjevic Dikic Ana A Stojkovic Sinisa S Giga Vojislav V Tomasevic Miloje M Jovanovic Ivana I Petrovic Olga O Rakocevic Jelena J Boskovic Nikola N Sobic Saranovic Dragana D Stankovic Goran G Vukcevic Vladan V Orlic Dejan D Simic Dragan D Nedeljkovic Milan A MA Aleksandric Srdjan S Juricic Stefan S Ostojic Miodrag M

Cardiovascular ultrasound 20200721 1

<h4>Background</h4>Coronary chronic total occlusion (CTO) is characterized by the presence of collateral blood vessels which can provide additional blood supply to CTO-artery dependent myocardium. Successful CTO recanalization is followed by significant decrease in collateral donor artery blood flow and collateral derecruitment, but data on coronary hemodynamic changes in relation to myocardial function are limited. We assessed changes in coronary flow velocity reserve (CFVR) by echocardiography ...[more]

PMID: 32693812

Similar Datasets

Project description:Background and aimsBasilar artery occlusion is a most devastating form of stroke, and the current practice is to reverse it with revascularization therapies. Pharmacological thrombolysis, intravenous or intraarterial, has been adjuncted or replaced with invasive, endovascular thrombectomy procedures. The preferred approach remains unknown and many recanalizations are futile with no clinical benefit. We sought to determine reasons for futility and weigh the existing reports to find whether endovascular mechanical interventions provide superior outcomes over pharmacological thrombolysis alone.MethodsAfter analyzing systematically the reports of outcomes produced by variable basilar artery occlusion recanalization protocols, information was retrieved and reconciled from 15 reports published from year 2005 comprising 803 patients in 17 cohorts. In the largest single-center cohort (162, Helsinki), predictors of futile recanalization (three-month modified Rankin Scale score 4 to 6) were determined.ResultsGood outcome was reported by mechanical approaches either alone or on demand more frequently than by pharmacological, intravenous or intraarterial thrombolysis protocols (35.5% versus 24.4%, p < 0.001), accompanied by higher recanalization rates (84.1% versus 70.9%, p < 0.001). Along with superior recanalization rate at 91%, good outcome was reached by primary thrombectomy in 36% at the cost of substantial futile recanalization rate at 60%, which was lower when using modern stentrievers only (52.8%). In the Helsinki cohort, the single most significant predictor was extensive baseline ischemia, increasing the odds of futility 20-fold (95%CI 4.39-92.29, p < 0.001). Other attributes of futility were ventilation support and history of atrial fibrillation or previous stroke.ConclusionsEndovascular mechanical approaches have been reported to provide superior outcomes over pharmacological thrombolysis in basilar artery occlusion. Stricter patient selection, most notably to exclude victims of already extended ischemia, would assist in translating excellent recanalization rates into improved clinical outcomes and more acceptable futility rates.

Dataset Information

Prompt and consistent improvement of coronary flow velocity reserve following successful recanalization of the coronary chronic total occlusion in patients with viable myocardium.

Publications

Prompt and consistent improvement of coronary flow velocity reserve following successful recanalization of the coronary chronic total occlusion in patients with viable myocardium.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets