Subadventitial stenting around occluded stents: A bailout technique to recanalize in-stent chronic total occlusions
Corresponding Author
Lorenzo Azzalini MD PhD MSc
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Correspondence Lorenzo Azzalini, MD, PhD, MSc, Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy. Email: [email protected]Search for more papers by this authorAris Karatasakis MD
Interventional Cardiology Unit, North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
Search for more papers by this authorJames C. Spratt BSc MD
Department of Cardiology, New Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
Search for more papers by this authorPéter Tajti MD
Minneapolis Heart Institute, Minneapolis, Minnesota
Search for more papers by this authorRobert F. Riley MD
The Christ Hospital Heart & Vascular Center and the Lindner Center for Research and Education, Cincinnati, Ohio
Search for more papers by this authorLuiz F. Ybarra MD
Interventional Cardiology, McGill University Health Centre, Montreal, Quebec
Search for more papers by this authorStefan P. Schumacher MD
Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorSusanna Benincasa MD
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorBarbara Bellini MD
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorLuciano Candilio MD (Res)
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorSatoru Mitomo MD
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorPeter Henriksen BSc, MB, ChB, PhD
Department of Cardiology, New Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
Search for more papers by this authorFrancisco Hidalgo MD
Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
Search for more papers by this authorLeo Timmers MD, PhD
Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
Search for more papers by this authorAdriaan O. Kraaijeveld MD, PhD
Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
Search for more papers by this authorPierfrancesco Agostoni MD, PhD
Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
Search for more papers by this authorJames Roy MB, BCh
Department of Cardiology, St. George Hospital, Sydney, Australia
Search for more papers by this authorDavid R. Ramsay MBBS
Department of Cardiology, St. George Hospital, Sydney, Australia
Search for more papers by this authorJames C. Weaver MBBS, PhD
Department of Cardiology, St. George Hospital, Sydney, Australia
Search for more papers by this authorPaul Knaapen MD, PhD
Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorAlexander Nap MD, PhD
Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorBoris Starcevic MD, PhD
Department of Cardiology, Clinical Hospital Dubrava, Zagreb, Croatia
Search for more papers by this authorSoledad Ojeda MD, PhD
Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
Search for more papers by this authorManuel Pan MD, PhD
Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
Search for more papers by this authorKhaldoon Alaswad MD
Interventional Cardiology Unit, Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan
Search for more papers by this authorWilliam L. Lombardi MD
Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington
Search for more papers by this authorMauro Carlino MD
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorEmmanouil S. Brilakis MD, PhD
Interventional Cardiology Unit, North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
Minneapolis Heart Institute, Minneapolis, Minnesota
Search for more papers by this authorAntonio Colombo MD
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorStéphane Rinfret MD, SM
Interventional Cardiology, McGill University Health Centre, Montreal, Quebec
Search for more papers by this authorKambis Mashayekhi MD
Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany
Search for more papers by this authorCorresponding Author
Lorenzo Azzalini MD PhD MSc
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Correspondence Lorenzo Azzalini, MD, PhD, MSc, Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy. Email: [email protected]Search for more papers by this authorAris Karatasakis MD
Interventional Cardiology Unit, North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
Search for more papers by this authorJames C. Spratt BSc MD
Department of Cardiology, New Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
Search for more papers by this authorPéter Tajti MD
Minneapolis Heart Institute, Minneapolis, Minnesota
Search for more papers by this authorRobert F. Riley MD
The Christ Hospital Heart & Vascular Center and the Lindner Center for Research and Education, Cincinnati, Ohio
Search for more papers by this authorLuiz F. Ybarra MD
Interventional Cardiology, McGill University Health Centre, Montreal, Quebec
Search for more papers by this authorStefan P. Schumacher MD
Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorSusanna Benincasa MD
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorBarbara Bellini MD
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorLuciano Candilio MD (Res)
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorSatoru Mitomo MD
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorPeter Henriksen BSc, MB, ChB, PhD
Department of Cardiology, New Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
Search for more papers by this authorFrancisco Hidalgo MD
Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
Search for more papers by this authorLeo Timmers MD, PhD
Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
Search for more papers by this authorAdriaan O. Kraaijeveld MD, PhD
Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
Search for more papers by this authorPierfrancesco Agostoni MD, PhD
Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
Search for more papers by this authorJames Roy MB, BCh
Department of Cardiology, St. George Hospital, Sydney, Australia
Search for more papers by this authorDavid R. Ramsay MBBS
Department of Cardiology, St. George Hospital, Sydney, Australia
Search for more papers by this authorJames C. Weaver MBBS, PhD
Department of Cardiology, St. George Hospital, Sydney, Australia
Search for more papers by this authorPaul Knaapen MD, PhD
Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorAlexander Nap MD, PhD
Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorBoris Starcevic MD, PhD
Department of Cardiology, Clinical Hospital Dubrava, Zagreb, Croatia
Search for more papers by this authorSoledad Ojeda MD, PhD
Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
Search for more papers by this authorManuel Pan MD, PhD
Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
Search for more papers by this authorKhaldoon Alaswad MD
Interventional Cardiology Unit, Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan
Search for more papers by this authorWilliam L. Lombardi MD
Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington
Search for more papers by this authorMauro Carlino MD
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorEmmanouil S. Brilakis MD, PhD
Interventional Cardiology Unit, North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
Minneapolis Heart Institute, Minneapolis, Minnesota
Search for more papers by this authorAntonio Colombo MD
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorStéphane Rinfret MD, SM
Interventional Cardiology, McGill University Health Centre, Montreal, Quebec
Search for more papers by this authorKambis Mashayekhi MD
Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany
Search for more papers by this authorFunding information: None.
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, 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.
CONFLICT OF INTEREST
Dr. Azzalini received honoraria from Guerbet and research support from ACIST Medical Systems. Dr. Riley received honoraria from Spectranetics. Dr. Agostoni received honoraria from Aquilant, Meril, Neovasc, Genae, and Angiodynamics. Dr. Brilakis received consulting/speaker honoraria from Abbott Vascular, Amgen, Asahi, Cardinal Health, Elsevier, GE Healthcare, and Medicure; research support from Osprey and Boston Scientific; spouse is employee of Medtronic. Dr. Rinfret received consulting fees from Boston Scientific. Dr. Mashayekhi has received consulting fees from Asahi Intecc; and has received honoraria from Vascular Solutions. The other authors have no disclosures.
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