Angioplastie coronaire des occlusions totales chroniques : Une expérience monocentrique de 5 ans
DOI :
https://doi.org/10.62438/tunismed.v104i02.6457Mots-clés :
Occlusion chronique totale, Intervention coronaire percutanée, Pronostic, Succès technique.Résumé
Introduction : Les occlusions totales chroniques (CTO) sont fréquentes (15-30%) mais leur désocclusion ne présente que 10% des interventions coronaires percutanées (ICP). Les données tunisiennes sont rares. Cette étude vise à combler cette lacune en analysant les résultats à court et long terme.
Méthodes :Étuderétroprospective monocentrique, entre 2018 et 2023. Le critère principal de jugement était le succès technique, les complications et les échecs de la lésion cible à 12 mois. Le critère secondaire était d'identifier les facteurs associés à l'échec technique.
Résultats : 115 patients, 122 lésions CTO, 133 procédures. Age moyen 62±14,4 ans. Genre-Ratio=6. Le J-CTO score était 1,47±1,12. L’injection controlatérale (43,6%) et l’utilisation de microcathéters (50,4%) étaient sous-utilisées. Le nombre du guide était de 2,35±1,1 par procédure. L'approche antérograde, rétrograde et hybride étaient de 85%, 9,0% et 6,0%, respectivement. Le taux de succès technique était de 69,2% (133 procédures) et procédural de 73,0% (115 patients). Le taux de complications majeures était à 3%. À 12 mois, la mortalité cardiovasculaire était de 7,0% non influencée par le résultat procédural. L'échec de la lésion cible était de 9,4%. Les facteurs associés à l'échec technique étaient l'implication de bifurcations (OR=5,83 [1,69–20,10]; p=0,005), l'utilisation de plus de 4 guides (OR=6,83 [1,63–28,65]; p=0,009), les CTO de-novo (OR=8,43 [1,94–36,55]; p=0,004), les tentatives précédentes (OR=8,87 [1,82–43,62]; p=0,007), et la non-utilisation de microcathéter (OR=11,39 [3,53–36,77]; p=0,001).
Conclusion : Ce registre confirme des résultats immédiats satisfaisants de l’ICP de CTO. La survie à 12 mois était indépendante du résultat procédural.
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Références
FeferP,KnudtsonML,CheemaAN,GalbraithPD,OsherovAB,YalonetskyS,etal.
Current perspectives on coronary chronic total occlusions:the Canadian multicenter chronic
total occlusions registry.JAmCollCardiol.2012Mar;59(11):991-7.
AzzaliniL,JolicoeurEM,PighiM,MillánX,PicardF,TadrosVX,etal.²Epidemiology,
management strategies,and out comes of patients with chronic tota lcoronary occlusion.AmJ
Cardiol.2016Oct;118(8):1128-35.
TsaiTT,StanislawskiMA,ShunkKA,Armstrong EJ,GrunwaldGK,SchobAH,etal.
Contemporary incidence,management,andlong-term out comes of percutaneous coronary
interventions for chronic coronary artery total occlusions.JACCCardiovascInterv.2017
May;10(9):866-75.
AbbottJD,KipKE,VlachosHA,SawhneyN,SrinivasVS,JacobsAK,etal.Recent
trends in the percutaneous treatment of chronic total coronary occlusions.AmJCardiol.2006
Jun;97(12):1691-6.
RinfretS.Percutaneous intervention for coronary chronic total occlusion:the hybrid
approach.Cham:Springer;2016.
DehmerGJ,MirzaMA.The cost of percutaneous coronary intervention for chronic total
occlusions in our current cost-conscious environment.JACCCardiovascInterv.2019
Feb;12(4):332-4.
SalisburyAC,KarmpaliotisD,GranthamJA,SapontisJ,MengQ,MagnusonEA,et al.
In-hospital costs and costs of complications of chronic total occlusion angioplasty:insights
fromtheOPEN-CTOregistry.JACCCardiovascInterv.2019Feb;12(4):323-31.
LawtonJS,TamisHollandJE,BangaloreS,BatesER,BeckieT,BischoffJM,etal.
ACC/AHA/SCAIguidelineforcoronaryarteryrevascularization:areportoftheAmerican
collegeofcardiology/American heart association joint committee on clinical practice
guidelines.Circulation.2022 Jan;145(3):18-114.
NeumannFJ,SousaUvaM,AhlssonA,AlfonsoF,BanningAP,BenedettoU,etal.
ESC/EACTSguidelines on myocardial revascularization .EurHeartJ.2019Jan;40(2):87-165.
WernerGS,MartinYusteV,HildickSmithD,BoudouN,SianosG,GelevV,etal.A
randomized multicentretrial to comparere vascularization with optimal medical therapy for the
treatment of chronic total coronary occlusions. Eur Heart J.2018 Jul;39(26):2484-93.
CardonaM,MartínV,PratGonzalezS,OrtizJT,PereaRJ,DeCaraltTM,etal.Benefits
of chronic total coronary occlusion percutaneous intervention in patients with heart failure and
reduced ejection fraction:insights from a cardiovascular magnetic resonance study.J
CardiovascMagnReson. 2016Nov;18(1):78.
IwamaM,TokoroF,TanakaS,MatsuokaR,KojimaT,YagasakiH,etal.Improvement
of left ventricular function after successful chronic total occlusion recanalization in patients
with evidence of ischemia by stress myocardial perfusion imaging.EurHeartJ.2013Aug;34
Suppl 1:5335.
SamyM,ElAwadyWS,AlDaydamonyMM,AbdElSameiMM,ShokryKA.
Echocardiographic assessment of left ventricular function recovery post percutaneous coronary
intervention of chronic total occlusions in patients with lowand mid-range left ventricular
ejection fractions.Echocardiography.2020Feb;37(2):239-46.
Toma A,GickM,MinnersJ,FerencM,ValinaC,LöffelhardtN,etal.Survivalafter
percutaneous coronary intervention for chronic total occlusion.ClinResCardiol.2016
Nov;105(11):921-9.
AndreottiF,VrintsC,KoskinasKC,RosselloX,etal.2024ESCGuidelinesforthe
diagnosis and management of chronic coronary syndromes .EurHeartJ.2024;45:3415–3537.
doi:10.1093/eurheartj/ehae177.
GalassiAR,VadalàG,WernerGS,CosynsB,SianosG,HillJ,etal.Evaluationand
management of patients with coronary chronic total occlusions considered for revascularisation.
A clinical consensus statement of the European Association of Percutaneous Cardiovascular
Interventions(EAPCI)oftheESC,the European Association of Cardiovascular Imaging
(EACVI)of the ESC,and the ESC Working Group on Cardiovascular Surgery.
Euro Intervention.févr2024;20(3):e174‑84.
YbarraLF,RinfretS,BrilakisES,KarmpaliotisD,AzzaliniL,GranthamJA,etal.
Definitions and clinical trialde sign principles for coronary artery chronic total occlusion
therapies:CTO-ARCconsensus recommendations.circulation.2021Feb;143(5):479-500.
WernerG.Chronic total occlusions [Enligne].Mar2022[Consultéle29jan2024].
Consultableàl’URL:https://www.pcronline.com/PCR-Publications/Textbooks/PCR-EAPCI-
textbook/The-PCR-EAPCI-textbook-chapter-on-chronic-total-occlusions.
IvanhoeRJ,WeintraubWS,DouglasJS,LemboNJ,FurmanM,GershonyG,etal.
Percutaneous transluminal coronaryangioplasty of chronic total occlusions.primary success,
restenosis,andlong-term clinical follow-up.Circulation.1992Jan;85(1):106-15.
HafeezY,VargheseV.Chronic total occlusion of the coronary artery.StatPearls.[Enligne].
Juil 2023 [Consulté le 29 jan 2024]. Consultable à l’URL:
http://www.ncbi.nlm.nih.gov/books/NBK560507/
Mario CD,Mashayekhi K,GarboR, Pyxaras S, Ciardetti N,WernerG.Recanalisation of
coronary chronic total occlusions.Euro Intervention.2022Sep;18(7):535-61.
WuEB,BrilakisES,MashayekhiK,TsuchikaneE,AlaswadK,ArayaM,etal.Global
chronic total occlusion crossing algorithm.JAmColl Cardiol. 2021Aug;78(8):840-5.
BrilakisES,GranthamJA,RinfretS,WymanRM,BurkeMN,KarmpaliotisD,etal.A
percutaneous treatment algorithm for crossing coronary chronic total occlusions.JACC
CardiovascInterv.2012Apr;5(4):367-79.
VranckxP,CutlipDE,MehranR,LeonMB,SerruysPW.Consensus on definitions of
clinical endpoints:percutaneous coronary and valvular intervention trials[Enligne]. Mai2021
[Consultéle29jan2024].Consultableàl’URL:https://textbooks.pcronline.com/the-pcr-eapci-
textbook/consensus-on-definitions-of-clinical-endpoints-percutaneous-coronary-and-valvular-
intervention-trials
KonstantinidisNV, WernerGS,DeftereosS,Di Mario C,GalassiAR,BuettnerJH, etal.
Temporal trends in chronic total occlusion interventions in Europe.Circ CardiovascInterv.
Oct;11(10):e006229.
BenRomdhaneH,BenAliS,SkhiriH,TraissacP,BougatefS,MaireB,etal.Hypertension
amongTunisian adults:results of theTAHINA project.HypertensRes.2012Mar;35(3):341-7.
SapontisJ,SalisburyAC,YehRW,CohenDJ,HiraiT,LombardiW,etal.Early procedural
and health status out comes after chronic total occlusion angioplasty: are port from theOPEN-
CTO registry(outcomes,patient health status,and efficiency in chronic total occlusion hybrid
procedures).JACCCardiovascInterv.2017Aug;10(15):1523-34.
LeeSW,LeePH,AhnJM,ParkDW,YunSC,HanS,etal.Randomizedtrialevaluating
percutaneous coronary intervention for the treatment of chronic total occlusion.Circulation.
Apr;139(14):1674-83.
AllanaSS,KostantinisS,SimsekB,KaracsonyiJ,AlaswadK,RempakosA,etal.
Contemporary outcomes of chronic total occlusion interventions:update from the progress-cto
(prospective global registry for the study of chronic total occlusion intervention) international
registry.JAmCollCardiol.2023Mar;81Suppl 8:1040.
HenriquesJS,HoebersLP,RåmunddalT,LaanmetsP,EriksenE,BaxM,etal.
Percutaneous intervention for concurrent chronic total occlusions in patients with STEMI: the
EXPLOREtrial.JAmCollCardiol.2016Oct;68(15):1622-32.
KonstantinidisNV,WernerGS,DeftereosS,DiMarioC,GalassiAR,BuettnerJH,etal.
Temporal trends in chronic total occlusion interventions in Europe.CircCardiovascInterv.
Oct;11(10):e006229.
MashayekhiK,NührenbergTG,TomaA,GickM,FerencM,HochholzerW,etal.A
randomized trial to assess regional left ventricular function after stent implantation in chronic
total occlusion:the REVASCTrial.JAmCollCardiolIntv.2018Oct;11(19):1982-91.
GhazzalZ,SawayaF.In-stentCTOPCI:anexpanding horizon.JACCCardiovascInterv.
Jun;14(12):1320-2.
ChristopoulosG,KarmpaliotisD,AlaswadK,LombardiWL,GranthamJA,RanganBV,
etal.Theefficacyof“hybrid”percutaneous coronary intervention in chronic total occlusions
caused by in-stent restenosis: Insights from a US multicenterregistry.CatheterCardiovasc
Interv.2014Oct;84(4):646-51.
LefèvreT,PanM,StankovicG,OjedaS,BoudouN,BrilakisES,etal.CTOandbifurcation
lesions.JACCCardiovascInterv.2023Sep;16(17):2065-82.
QuintanaB,IbrahimA.Roleofintravascularultrasoundinguidingcomplexpercutaneous
coronaryinterventions.USCardiol.2020 Jun;14:e07.
MorinoY,AbeM,MorimotoT,KimuraT,HayashiY,MuramatsuT,etal.Predicting
successful guide wire crossing through chronic total occlusion of native coronary lesions with in
minutes.JACCCardiovascInterv.2011Feb;4(2):213-21.
GalassiAR,SianosG,WernerGS,EscanedJ,TomaselloSD,BoukhrisM,etal.Retrograde
recanalization of chronic total occlusions in Europe:procedural,in-hospital,andlong-term
outcomesfromthemulticenterERCTOregistry.JAmCollCardiol.2015Jun;65(22):2388-400.
KalogeropoulosA,AlsanjariO,KeebleTR,TangKH,KonstantinouK,KatsikisA,etal.
CASTLEscoreversusJ-CTO score for the prediction of technical success in chronic total
occlusion percutaneous revascularisation.EuroIntervention.2020Apr;15(18):1615-23.
BrilakisES,MashayekhiK,TsuchikaneE,RafehNA,AlaswadK,ArayaM,etal.Guiding
principles for chronic total occlusion percutaneous coronary intervention.Circulation.2019
Jul;140(5):420-33.
TsuchikaneE,KatohO,KimuraM,NasuK,KinoshitaY,SuzukiT.The first clinical
experience with an ovel catheter for collateral channel tracking in retrograde approach for
chronic coronary total occlusions.JAmCollCardiolIntv.2010Feb;3(2):165-71.
KostantinisS,SimsekB,KaracsonyiJ,AlaswadK,JafferFA,KhatriJJ,etal.Equipment
utilization in chronic total occlusion percutaneous coronary interventions:insights from the
progress-ctoregistry.JAmCollCardiol.2023Mar;81Suppl8:780.
AlexandrouM,RempakosA,MutluD,OgailiAA,ChoiJW,PoommipanitP,etal.
Comparative analysis of polymerversusnon-polymerjacketedwires in chronic total occlusion
percutaneous coronary intervention.AmJCardiol.2024 Mar;215:10-8.
IannacconeG,ScarparoP,WilschutJ,DaemenJ,DekkerWD,JaegerePD,etal.Current
approaches for treatment of coronary chronic occlusions.Expert RevMedDevices.2019
Nov;16(11):941-54.
RempakosA,KostantinisS,SimsekB,KaracsonyiJ,ChoiJW,PoommipanitP,etal.
Outcomes of chronic total occlusion percutaneous coronary intervention after a previous failed
attempt.AmJ Cardiol.2023Apr;193:61-9.
RileyRF,HenryTD.CTOPCI:whenatfirstyoudon’tsucceed…CatheterCardiovasc
Interv.2019Oct;94(4):525-6.
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