The Influence of Radiographic Equipment, Setup, and Operator Experience on Radiation Exposure in Chronic Total Occlusion Interventions.

Background: High radiation exposure is a significant risk with recanalizations for chronic total coronary occlusions (CTO).

Aims: To analyze the influence of radiographic equipment, radiation protocols, and operator experience on radiation exposure.

Methods: We analyzed 17,769 procedures by 27 operators from a multicenter European Registry between 2015 and 2023.

Retrograde Stenting of the Left Main Coronary Artery After Double Chimney Stenting in Previously Double Implanted Self-Expandable Transcatheter Heart Valves in a Degenerated Stentless Surgical Bioprosthetic Aortic Valve.

We report an interesting complex percutaneous coronary intervention (PCI) case in an 84-year-old male, with typical angina pectoris after previous coronary artery bypass graft (CABG) surgery and coronary double chimney stenting during a transcatheter aortic valve replacement (TAVR)-in-TAVR procedure with double self-expanding transcatheter heart valve (THV) in his degenerated stentless aortic surgical valve bioprosthesis.

Prevalence and Prognostic Impact of Coronary Chronic Total Occlusions in Patients With Cardiogenic Shock.

Background: Mortality in patients with cardiogenic shock (CS) remains high despite advanced treatment strategies in CS patients, underlining the need for the identification of predictors of prognosis in CS patients. Therefore, the present study investigates the prognostic impact of coronary chronic total occlusions (CTO) in patients with CS.

Methods: All consecutive patients being acutely admitted with CS to an intensive care unit (ICU) and undergoing invasive coronary angiography (ICA) from 2019 to 2021 were included, irrespective of the etiology of CS.

Coronary Chronic Total Occlusions Affect Long-Term Prognosis in Heart Failure With Mildly Reduced Ejection Fraction.

Background: This study investigates the prevalence and prognostic impact of coronary chronic total occlusions (CTO) in patients with heart failure with mildly reduced ejection fraction (HFmrEF). Although coronary artery disease (CAD) represents the leading HF etiology in HFmrEF, data about CTO in this population are rare.

Methods: All consecutive patients with HFmrEF (ie, left ventricular ejection fraction 41%-49% with signs and/or symptoms of heart failure) undergoing invasive coronary angiography from 2016 to 2022 were included retrospectively.

Spontaneous Recanalized Thrombus in the Left Internal Mammary Artery.

Background: We report a conspicuous lesion in the proximal to ostial segment of the left internal mammary artery (LIMA) occurring 28 years post-intervention in an 87-year-old man.

Case Summary: The patient reported dyspnea on exertion. Intracoronary imaging revealed a spontaneous recanalized thrombus, which is a rare and mostly underdiagnosed entity.

Procedural Impact of Advanced Calcific Plaque Modification Devices Within Percutaneous Revascularization of Chronic Total Occlusions.

Background: Significant calcifications within a coronary chronic total occlusion (CTO) increase procedural complexity and the risk for complications. Expert consensus documents recommend the use of advanced calcific plaque modification devices (ACPMDs) for calcified CTO percutaneous coronary intervention (PCI), whereas data on their procedural impact are limited.

Objectives: The aim of this study was to describe trends, settings, and outcomes of PCI of severely calcified CTO performed with and without ACPMDs.

Predictors and prognosis of progression of aortic valve stenosis in patients hospitalized with heart failure with mildly reduced ejection fraction.

Background: Although aortic valve stenosis (AS) is a recognized predictor of outcomes in heart failure (HF), limited data is available concerning predictors for and the prognostic value of progressive AS in patients with HF with mildly reduced ejection fraction (HFmrEF).

Methods: From 2016 to 2022, consecutive patients hospitalized with HFmrEF at one institution were retrospectively included. AS progression was assessed during follow-up echocardiography and patients with and without progression were compared regarding the primary endpoint long-term all-cause mortality at 30 months (median follow-up) using Kaplan-Meier and Cox regression analyses.

Partial arterial carbon dioxide and oxygen pressure in patients with cardiogenic shock.

In patients with acute cardiovascular diseases, hypocapnia, hypoxia and hyperoxia are known to be associated with increased mortality. This monocentric prospective registry study included 238 consecutive patients with cardiogenic shock (CS). The study aimed to assess the prognostic impact of partial arterial carbon dioxide (PaCO) and oxygen pressure (PaO) on 30-day all-cause mortality.

Chronic Total Occlusion Percutaneous Coronary Intervention: Present and Future.

Chronic total occlusion percutaneous coronary intervention has evolved into a subspecialty of interventional cardiology. Using a variety of antegrade and retrograde techniques, experienced operators currently achieve success rates of 85% to 90%, with an incidence of major periprocedural complications of ≈2% to 3%. Several developments in equipment (new microcatheters and guidewires, novel reentry devices), imaging (computed tomography angiography guidance, intravascular imaging for reentry), techniques (intraocclusion contrast injection, advanced subintimal tracking and reentry), and artificial intelligence (automated computed tomography image analysis and prediction of the likelihood of crossing success with various techniques) could further improve outcomes.

Impact of Chronic Total Occlusion PCI in Non-LAD Coronary Arteries on Patients With Cardiomyopathy.

To evaluate the impact of left circumflex artery (LCX) or right coronary artery (RCA) chronic total occlusion percutaneous coronary intervention (CTO PCI) on left ventricular ejection fraction (LVEF) in heart failure patients with reduced ejection fraction (HFrEF). The effect of RCA or LCX CTO PCI on HFrEF patients remains understudied. We conducted a retrospective analysis of patients with HFrEF (EF <40%) who underwent LCX or dominant RCA CTO PCI at a high-volume center.

Obesity is associated with impaired long-term prognosis in patients undergoing coronary angiography: Results from a large-scaled single centre registry.

Background: The study investigates the prognostic value of body mass index (BMI) in a large cohort of unselected patients undergoing invasive coronary angiography (CA). More than one third of the world population is overweight or obese with increasing prevalence. Obesity is an established risk factor for the development of coronary artery disease (CAD), but its impact on outcomes in patients undergoing CA remains controversial.

Machine Learning-Based Algorithm to Predict Procedural Success in a Large European Cohort of Hybrid Chronic Total Occlusion Percutaneous Coronary Interventions.

CTOs are frequently encountered in patients undergoing invasive coronary angiography. Even though technical progress in CTO-PCI and enhanced skills of dedicated operators have led to substantial procedural improvement, the success of the intervention is still lower than in non-CTO PCI. Moreover, the scores developed to appraise lesion complexity and predict procedural outcomes have shown suboptimal discriminatory performance when applied to unselected cohorts.

Improvement of Radiation Management in Percutaneous Interventions of Chronic Total Occlusions in a Multicenter Registry.

Background: Excess radiation exposure is a limiting factor in percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO).

Objectives: The aim of this study was to analyze changes in radiation dose for CTO PCI with increasing risk awareness during the past decade and the determinants of these changes.

Methods: A total of 16,439 procedures performed by 14 operators continuously participating in the European Registry of CTO-PCI from 2012 to 2023 were analyzed.

Prior hospitalizations as a predictor of prognosis in heart failure with mildly reduced ejection fraction.

Objective: This study aims to investigate the prognostic impact of the presence and type of prior hospitalizations in patients with heart failure with mildly reduced ejection fraction (HFmrEF).

Background: Data investigating the prognostic impact of the present and type of previous all-cause hospitalizations in HFmrEF is limited.

Methods: Consecutive patients hospitalized with HFmrEF at a single medical center were retrospectively included from 2016 to 2022.

Long-term outcomes of unselected patients undergoing coronary angiography according to the presence or absence of type II diabetes mellitus.

Objective: The study investigates long-term outcomes of unselected inpatients undergoing invasive coronary angiography (CA) with and without diabetes mellitus type II (T2DM).

Background: Due to continual shifts in demographics and advancements in treating cardiovascular disease, there has been a notable evolution in the types of patients undergoing CA over the past decades. Comprehensive data on the extended outcomes of CA patients, both with and without concurrent T2DM, remains scarce.

Comprehensive Overview of Retrograde-Antegrade Connection Techniques Without Externalization in Chronic Total Occlusion PCI: The Portal Techniques.

Background: Advancing the retrograde microcatheter (MC) into the antegrade guide catheter during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be challenging or impossible, preventing guidewire externalization.

Objectives: To detail and evaluate all the techniques focused on wiring to achieve intubation of the distal tip of a microcatheter, balloon, or stent with an antegrade or retrograde guidewire, aiming to reduce complications by minimizing tension on fragile collaterals during externalization and enabling rapid antegrade conversion in various clinical scenarios.

Methods: We describe the two main techniques, tip-in and rendezvous, and their derivatives such a facilitated tip-in, manual MC-tip modification, tip-in the balloon, tip-in the stent, deep dive rendezvous, catch-it and antegrade microcatheter probing.

Parallel Wire Approach for Recanalisation of Chronic Total Coronary Occlusions in a Large Contemporary Multi-Center Registry.

Background: The parallel wire technique (PW) is a classic part of the antegrade strategy to open chronic total coronary occlusions (CTO).

Aims: With modern wires and dual-lumen catheters (DLC) the approach has evolved, but this progress had not been evaluated in a contemporary registry of CTO interventions.

Method: This analysis is based on 26,589 CTO procedures performed by 36 operators with > 50 procedures annually between 2015 and 2022.

Prognostic Influence of Lung Compliance in Patients with Cardiogenic Shock and Invasive Mechanical Ventilation.

Background: There is limited data regarding the influence of lung compliance on the outcome of patients with cardiogenic shock (CS). Thus, a registry study was conducted to assess the prognostic influence of lung compliance in invasively ventilated patients with CS.

Methods: Hospital records for consecutive invasively ventilated CS-patients from June 2019 to May 2021 were collected into a prospective registry.

Knuckle Guidewires to Create Dissections in Chronic Total Occlusion Percutaneous Coronary Intervention: Position Statement.

Dissection and re-entry techniques are essential to achieve safe and effective chronic total occlusion recanalization. Several studies have demonstrated similar outcomes following extraplaque stenting compared with intraplaque stenting. Dissection techniques most often involve the use of knuckled wires to progress within and beyond the chronic total occlusion segment.

Left ventricular diastolic dysfunction in patients with heart failure with mildly reduced ejection fraction.

Objective: This study investigates the prevalence and prognostic impact of diastolic dysfunction (DD) in patients hospitalized with heart failure (HF) with mildly reduced ejection fraction (HFmrEF) in sinus rhythm.

Background: Data regarding the prognostic impact of DD in patients with HFmrEF is limited.

Methods: From 2016 to 2022, all patients hospitalized with HFmrEF (i.