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| Six-month Angiographic and Clinical Outcomes of Chronic Total Occlusion Intervention with Drug-eluting Stent |
| Cardiovascular Center, Korea University Guro Hospital¹ , Korea University Ansan hsopital² , Korea University Anam Hospital³ |
| Seung-Woon Rha¹, Soon Yong Suh¹ , Uk Yeol Chwe¹ , Jin Won Kim¹ , Jeong Cheon Ahn² , Woo Hyuk Song² , Chang Gyu Park¹ , Hong Seog Seo¹ , Dong Joo Oh¹ , Young Moo Ro³ |
Background: Chronic total occlusion (CTO) intervention is still challenging because of the limited procedural success rate and higher target lesion failure. The aim of this study was to evaluate the clinical and angiographic outcomes of DES implantation in CTO lesions up to 6 months.
Methods: A total 21 patients (pts) with typical CTO lesion (The duration of occlusion (TIMI 0 or 1) was ≥ 3 months) were enrolled for the study. Successfully recanalized CTO lesion in a major coronary branch received either Sirolimus-eluting stent (SES, CypherTM) or Paclitaxel-eluting stent (PAS; TaxusTM). Pts underwent an angiography at 6 months and were followed clinically for 6 months.
Results: A total 21 pts (Male 13, mean age 56.6 ± 8.4 years) underwent CTO intervention. Mean ejection fraction was 54.1%. Procedural success rate was 90.5% (19/21). Target lesions were LAD (35%), LCX (25%) and RCA (40%). ISR lesion was 15%. Most commonly used guidewire were Miracle 3 (47.4%) and Conquest (26.3%). Microcatheter was used in 31.6%. Two pts (2/19, 10.5%) were treated by POBA only. A total 37 DESs [16-Cypher (43.2%), 21-Taxus (56.8%)] were utilized to cover 22 target lesions (1.85 DES/pt). Pts received 3 or more DESs were in 31.6% (6/19). Mean DES diameter was 2.91 mm, length 25.5 mm and inflation pressure 13.8 atm. Additional balloon was used in 36.8% (7/19, mean 15.7 atm). Two pts had periprocedural complications (Side branch dissection-1, minimal perforation-1). CK-MB elevation was noted in 19.3% (5/19). At 6 months, angiographic binary restenosis was 15.8% (3/19). Two focal ISR (type Ic) were successfully treated by cutting balloon and one diffuse ISR (type II) by implantation of different DES. There were 3 TLR & TVR and 1 non-cardiac death. Six-month TVR-major adverse cardiac events (MACE) was 15.8% (3/19).
Conclusion: Despite the expected higher risk of procedural failure and recurrence, DES implantation in CTO lesions with careful CTO wire manipulation and device selection was associated with higher procedural success rate, lower angiographic restenosis and favorable clinical outcomes up to 6 months.
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