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

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

doi:10.1002/ccd.27472

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

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 KnaapenAlexander Nap, Boris Starcevic, Soledad Ojeda, Manuel Pan, Khaldoon Alaswad, William L Lombardi, Mauro Carlino, Emmanouil S Brilakis, Antonio Colombo, Stéphane Rinfret, Kambis Mashayekhi

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	466-476
Number of pages	11
Journal	Catheterization and Cardiovascular Interventions
Volume	92
Issue number	3
Early online date	4 Jan 2018
DOIs	https://doi.org/10.1002/ccd.27472
Publication status	Published - 1 Sep 2018

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Azzalini, L., Karatasakis, A., Spratt, J. C., Tajti, P., Riley, R. F., Ybarra, L. F., Schumacher, S. P., Benincasa, S., Bellini, B., Candilio, L., Mitomo, S., Henriksen, P., Hidalgo, F., Timmers, L., Kraaijeveld, A. O., Agostoni, P., Roy, J., Ramsay, D. R., Weaver, J. C., ... Mashayekhi, K. (2018). Subadventitial stenting around occluded stents: A bailout technique to recanalize in-stent chronic total occlusions. Catheterization and Cardiovascular Interventions, 92(3), 466-476. https://doi.org/10.1002/ccd.27472

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title = "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.",

author = "Lorenzo Azzalini and Aris Karatasakis and Spratt, {James C} and P{\'e}ter Tajti and Riley, {Robert F} and Ybarra, {Luiz F} and Schumacher, {Stefan P} and Susanna Benincasa and Barbara Bellini and Luciano Candilio and Satoru Mitomo and Peter Henriksen and Francisco Hidalgo and Leo Timmers and Kraaijeveld, {Adriaan O} and Pierfrancesco Agostoni and James Roy and Ramsay, {David R} and Weaver, {James C} and Paul Knaapen and Alexander Nap and Boris Starcevic and Soledad Ojeda and Manuel Pan and Khaldoon Alaswad and Lombardi, {William L} and Mauro Carlino and Brilakis, {Emmanouil S} and Antonio Colombo and St{\'e}phane Rinfret and Kambis Mashayekhi",

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language = "English",

volume = "92",

pages = "466--476",

journal = "Catheterization and Cardiovascular Interventions",

issn = "1522-1946",

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Azzalini, L, Karatasakis, A, Spratt, JC, Tajti, P, Riley, RF, Ybarra, LF, Schumacher, SP, Benincasa, S, Bellini, B, Candilio, L, Mitomo, S, Henriksen, P, Hidalgo, F, Timmers, L, Kraaijeveld, AO, Agostoni, P, Roy, J, Ramsay, DR, Weaver, JC, Knaapen, P , Nap, A, Starcevic, B, Ojeda, S, Pan, M, Alaswad, K, Lombardi, WL, Carlino, M, Brilakis, ES, Colombo, A, Rinfret, S & Mashayekhi, K 2018, 'Subadventitial stenting around occluded stents: A bailout technique to recanalize in-stent chronic total occlusions', Catheterization and Cardiovascular Interventions, vol. 92, no. 3, pp. 466-476. https://doi.org/10.1002/ccd.27472

TY - JOUR

T1 - Subadventitial stenting around occluded stents

T2 - A bailout technique to recanalize in-stent chronic total occlusions

AU - Azzalini, Lorenzo

AU - Karatasakis, Aris

AU - Spratt, James C

AU - Tajti, Péter

AU - Riley, Robert F

AU - Ybarra, Luiz F

AU - Schumacher, Stefan P

AU - Benincasa, Susanna

AU - Bellini, Barbara

AU - Candilio, Luciano

AU - Mitomo, Satoru

AU - Henriksen, Peter

AU - Hidalgo, Francisco

AU - Timmers, Leo

AU - Kraaijeveld, Adriaan O

AU - Agostoni, Pierfrancesco

AU - Roy, James

AU - Ramsay, David R

AU - Weaver, James C

AU - Knaapen, Paul

AU - Nap, Alexander

AU - Starcevic, Boris

AU - Ojeda, Soledad

AU - Pan, Manuel

AU - Alaswad, Khaldoon

AU - Lombardi, William L

AU - Carlino, Mauro

AU - Brilakis, Emmanouil S

AU - Colombo, Antonio

AU - Rinfret, Stéphane

AU - Mashayekhi, Kambis

PY - 2018/9/1

Y1 - 2018/9/1

N2 - 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.

AB - 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.

U2 - 10.1002/ccd.27472

DO - 10.1002/ccd.27472

M3 - Article

C2 - 29314563

VL - 92

SP - 466

EP - 476

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 3

ER -