Subadventitial stenting around occluded stents: A bailout technique to recanalize in-stent chronic total occlusions.

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.

• Authors: Lorenzo Azzalini, Aris Karatasakis, James C Spratt, Péter Tajti, Robert F Riley, Luiz F Ybarra, Stefan P Schumacher, Susanna Benincasa, Barbara Bellini, Luciano Candilio, Satoru Mitomo, Peter Henriksen, Francisco Hidalgo, Leo Timmers, Adriaan O Kraaijeveld, Pierfrancesco Agostoni, James Roy, David R Ramsay, James C Weaver, Paul Knaapen, Alexander Nap, Boris Starcevic, Soledad Ojeda, Manuel Pan, Khaldoon Alaswad, William L Lombardi, Mauro Carlino, Emmanouil S Brilakis, Antonio Colombo, Stéphane Rinfret, Kambis Mashayekhi
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 92 Issue 3 Pg. 466-476 (09 01 2018) ISSN: 1522-726X [Electronic] United States
• PMID: 29314563 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2018 Wiley Periodicals, Inc.

Topics

• Aged
• Australia
• Canada
• Chronic Disease
• Computed Tomography Angiography
• Coronary Angiography (methods)
• Coronary Occlusion (diagnostic imaging, etiology, mortality, therapy)
• Coronary Restenosis (diagnostic imaging, etiology, mortality, therapy)
• Drug-Eluting Stents
• Europe
• Female
• Humans
• Male
• Middle Aged
• Multidetector Computed Tomography
• Percutaneous Coronary Intervention (adverse effects, instrumentation, methods, mortality)
• Prosthesis Design
• Registries
• Retreatment
• Retrospective Studies
• Time Factors
• Tomography, Optical Coherence
• Treatment Outcome
• Ultrasonography, Interventional
• United States
• Vascular Patency