الفهرس 
Chronic total occlusionOnly 14 pages are availabe for public view
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Abstract
The aim of this study was to assess the short -term clinical outcome of percutaneous coronary intervention in patients with chronic total occlusion LAD coronary artery in Ain shams university hospital& Gamal abd elnaser health insurance hospital.
The study was carried out on 27 patients with chronic total occlusions of duration ≥3 months & with evidence of viable myocardium. Percutaneous coronary intervention was done for all patients.
All patients were subjected to detailed history taking, full clinical evaluation before, & 90 days after PCI assessing the CCS angina class &, Dobutamine echocardiograms before, & 90 days after PCI assessing changes in the ejection fraction & wall motion score index.
Patients were divided into 2 groups; success & failure groups according to procedure outcome. Technical success was defined as restoration of TIMI flow grade II or III & MBG 2 or 3 with a residual stenosis of ≤20%. Procedural success was defined as technical success without in-hospital major adverse cardiac events (MACE). MACE were defined as death, Q-wave & non Q-wave MI, urgent CABG or urgent PCI.
Patients were submitted to follow up to evaluate the effect of PCI to CTO on short-term clinical outcome changes in patients symptoms (CCS angina class) & changes in left ventricular function (Ejection fraction & WMSI). Dobutamine Echocardiograms were done 90 days after the procedure.
The results of this study showed:
Technical success was obtained in 74% of lesions. Procedural success was obtained in 74% of patients. Success group was 20 patients & failure group was 7 patients. The in-hospital MACE rate was 11.11% in the whole group (0% in the success group versus 42.85% in the failure group).
There was no significant difference between both groups as regards age, sex, risk factors or other baseline clinical variables.
In this study, the lesion characteristics that had a significant relationship with technical outcome were the degree of calcification & stump morphology.
Severe calcification & blunt or absent stump were associated with technical failure of the procedure.
Reasons of procedural failure were inability to cross the lesion with a guidewire, inability to cross with a balloon & inability to dilate the lesion .
The antegrade approach was the strategy applied to open CTO in all cases. In few cases Parallel wires technique was applied. HyDROPhilic wires were used in most of cases. Contra-lateral injection, Buddy wire & Anchor balloon techniques were applied by the operators in some cases with good benefit. In the success group, after balloon pre-dilatation, all implanted stents were bare metal stents.
During follow-up, As regards the patients symptoms, CCS angina class status improved significantly in the success group 3 months after successful PCI. However, in the failure group, they didn’t improve within 3 months after the failed procedure. In addition, while there were no differences between both groups as regards patients symptoms before PCI, 3 months after the procedure, symptoms were significantly better in the success group than the failure group.
We assessed the impact of revascularization of CTO on left ventricular function by assessing the ejection fraction & wall motion score index 3 months post PCI in both groups.
In the success group, opening of CTO had significant impact on the LVF. Mean WMSI & mean EF improved significantly after 3 months. In the failure group, there was no improvement in LVF as regards EF or WMSI 3 months after the failed procedure. In addition, comparison of LVF of both groups revealed no significant difference between both groups before PCI, however LVF were significantly better in the success group than the failed group 3 months after the procedure as regards the EF & WMSI.