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TCTAP A-055 Absorb Bioresorbable Vascular Scaffolds in the Treatment of Chronic Total Occlusion of Coronary Arteries: Utility and Outcomes
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
major adverse clinical event was reported during the entire follow up period. Conventional coronary angiography and OCT demonstrated patent scaffolds in one patient at 20 months follow up. Investigations performed until 36 months of follow up such as stress echocardiography, stress myocardial perfusion imaging study and CT coronary angiography demonstrated patent scaffolds. CONCLUSION Stenting of diffuse coronary lesions with Absorb BVS is possible giving excellent outcomes during the procedure and at longterm follow up. TCTAP A-055 Absorb Bioresorbable Vascular Scaffolds in the Treatment of Chronic Total Occlusion of Coronary Arteries: Utility and Outcomes Babu Ezhumalai,1 Ashok Seth1 Fortis Escorts Heart Institute, India
1
BACKGROUND The feasibility, safety and efficacy of using Absorb BVS (bioresorbable vascular scaffold) in treating chronic total occlusion (CTO) of coronary arteries has not been well established. Our objective is to study the utility of Absorb BVS in treating CTO lesions of coronary arteries and its follow up. METHODS Patients who underwent stenting of coronary CTO lesions with Absorb BVS over a period of 30 months were included in this study. Contralateral coronary artery injection was performed wherever appropriate. J-CTO (Japanese CTO) score was used to predict the success of the procedure. Lesion was crossed with CTO guidewire and predilated adequately. Absorb BVS was deployed After the procedure, patients were followed up for 30 months with stress testing and CT coronary angiography. RESULTS 23 patients with 24 CTO lesions were included in this study. Out of 24 lesions, 9 lesions were found in LAD, 12 lesions in RCA and 3 lesions in LCX. The mean J-CTO score was 1.30.7. All CTO lesions were crossed through antegrade approach. The most common guidewire used for crossing CTO lesion was Cross IT 100XT and microcatheter was used in 18 lesions. Totally 38 Absorb BVS scaffolds were used in these 24 lesions and the mean number of Absorb BVS used per lesion was 1.70.9. The mean diameter and length of individual Absorb BVS scaffold used were 2.90.4 mm and 25.14.6 mm respectively. The median duration of follow up was 20 months (range: 8 to 30 months) in this study. Two patients were lost to follow up. No stent thrombosis was reported. Two patients with positive stress echocardiography at 9 months and 22 months after the index procedure demonstrated target lesion restenosis necessitating re-intervention. The remaining 19 patients were asymptomatic without any major adverse clinical event during the entire follow up period. Stress echocardiography, stress myocardial perfusion imaging study and CT coronary angiography demonstrated patent scaffolds in these patients. CONCLUSION Treatment of coronary CTO lesions is possible with Absorb BVS giving excellent outcomes at short-term and long-term follow up. CARDIAC SURGERY/HYBRID REVASCULARIZATION (TCTAP A-056) TCTAP A-056 Outcomes in Patients with Triple Vessel Disease Undergoing Coronary Artery Bypass Graft Gopal Murugesan,1 Ashwin Lysander1 1 Mahatma Gandhi Medical College, India BACKGROUND Coronary artery bypass grafting (CABG) which was introduced in 1960s has now become a commonly performed procedure for patients with multivessel coronary artery disease. Although there has been an explosion in the field of interventional cardiology with various new techniques and hardware, coronary artery bypass grafting remains the mainstay of treatment for diabetic patients with triple vessel disease, left main disease and ostioproximal LAD and circumflex disease. CABG is performed for patients with coronary artery disease and above mentioned findings and left ventricular dysfunction. CABG greatly improves the quality of life and reduces cardiac-related mortality. In many cases other concomitant cardiac surgeries are performed along with CABG such as mitral valve repair, Dorr procedure, mitral and aortic valve repair or replacement. Elderly patients have a shorter life expectancy CABG may not necessarily prolong survival. Also these patients are also more likely to experience perioperative complications after CABG and so CABG is less
commonly performed in this group of patients. Either veins or arteries or both may be used for CABG. The great and small saphenous veins are the most commonly used vein grafts, whereas the internal thoracic artery is the most commonly used artery. The disadvantage of saphenous vein grafts is their declining patency with time. 10-20% are occluded 1 year after surgery because of technical errors, thrombosis, and intimal hyperplasia. Internal thoracic artery grafts have better patency rates and at 10 years, more than 90% of internal thoracic artery grafts are patent. The left internal thoracic artery is preferably used for bypass of the left anterior descending coronary artery. METHODS This is a prospective study conducted in a tertiary care center in rural southern India. We analyzed 76 cases who underwent coronary artery bypass surgery. We analyzed the clinical and angiographic profile of these patients who underwent coronary artery bypass graft surgery. The risk factors, mode of presentation, demographics, angiographic findings, type of surgery, type of grafts, number of grafts, complications and outcomes were analyzed. RESULTS Total number of patients was 76. There were 52 males and 24 females. The youngest patient was a 38 year old male who presented late with anterior wall myocardial infarction and the oldest patient was a 85 year old male who also presented with myocardial infarction. 88% of the patients had diabetes, 59% were hypertensive, 62% were smokers and 72% had dyslipidemia. 61% of these patients presented with ST elevation myocardial infarction, 17% presented with unstable angina, 4% presented with non ST elevation myocardial infarction and the rest presented with chronic stable angina. 42% of these patients had left main disease. 59% of patients had triple vessel disease 23% had double vessel disease 8% had left main with double vessel disease and the rest had left main with triple vessel disease. 1 patient had isolated left main disease. Left internal thoracic artery graft was used for LAD and diagonals. Saphenous vein graft was used for LCX, obtuse marginal and PDA. 85% of the procedure was done on pump and the remaining were done off pump. There was one mortality due to left ventricular failure, 3 cases of left pleural effusion, 6 cases of pericardial effusion and 11 cases of graft site infection. All patients were followed up for a period of one year and showed no additional complications. CONCLUSION Coronary artery bypass grafting for multi vessel coronary artery disease is a safe procedure offering significant mortality benefit for these groups of patients. The complications are minimal with off pump surgery. In our study there was no difference between the off pump and on pump groups in terms of mortality or morbidity. This is also the procedure of choice for diabetic patients with multi vessel involvement and for patients with calcific or long diffuse lesions. All our patients showed improvement in the ejection fraction which was sustained in the one year follow up period. There was no additional mortality or morbidity in the one year follow up period. CAROTID & NEUROVASCULAR INTERVENTION (TCTAP A-057) TCTAP A-057 Endovascular Thrombectomy for Acute Ischemic Stroke: A Single-Center Experience in Taiwan Hai Jui Chu,1 Chung-Wei Lee,1 Sung-Chun Tang,1 Jiann-Shing Jeng1 1 National Taiwan University Hospital, Taiwan BACKGROUND It has become a standard treatment option for acute ischemic stroke (AIS) by endovascular thrombectomy after 6 positive trials published in 2015. This study aimed to evaluate the efficacy and safety of the endovascular thrombectomy for AIS with large artery occlusion in Taiwan. METHODS Patients who experienced AIS and received endovascular thrombectomy during September 2014 and October 2015 at National Taiwan University Hospital were retrospectively reviewed. A favorable outcome was defined as modified Rankin scale 0–2 at 3 months after stroke. Successful revascularization was assessed as restoration of flow to more than 50% of the involved brain territory at the end of the thrombectomy procedure (a score of 2b or 3 on the modified Treatment in Cerebral Ischemia [mTICI] scale). RESULTS During the study period, 23 patients (mean age 71.3 12.3 years; 8 females) received endovascular thrombectomy. The sites of vessel occlusion included internal carotid artery in 2, middle cerebral artery in 18 and basilar artery in 3. The mean NIHSS on admission was 19.05.8 in 20 patients with anterior circulation stroke and 16.717.6 in 3 patients with posterior circulation stroke. Fifteen (65.2%) patients received intravenous alteplase prior to the procedure. The mean time from stroke onset to groin puncture and puncture to recanalization time were 176.361.6 and 36.418.7 minutes, respectively. Successful
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
major adverse clinical event was reported during the entire follow up period. Conventional coronary angiography and OCT demonstrated patent scaffolds in one patient at 20 months follow up. Investigations performed until 36 months of follow up such as stress echocardiography, stress myocardial perfusion imaging study and CT coronary angiography demonstrated patent scaffolds. CONCLUSION Stenting of diffuse coronary lesions with Absorb BVS is possible giving excellent outcomes during the procedure and at longterm follow up. TCTAP A-055 Absorb Bioresorbable Vascular Scaffolds in the Treatment of Chronic Total Occlusion of Coronary Arteries: Utility and Outcomes Babu Ezhumalai,1 Ashok Seth1 Fortis Escorts Heart Institute, India
1
BACKGROUND The feasibility, safety and efficacy of using Absorb BVS (bioresorbable vascular scaffold) in treating chronic total occlusion (CTO) of coronary arteries has not been well established. Our objective is to study the utility of Absorb BVS in treating CTO lesions of coronary arteries and its follow up. METHODS Patients who underwent stenting of coronary CTO lesions with Absorb BVS over a period of 30 months were included in this study. Contralateral coronary artery injection was performed wherever appropriate. J-CTO (Japanese CTO) score was used to predict the success of the procedure. Lesion was crossed with CTO guidewire and predilated adequately. Absorb BVS was deployed After the procedure, patients were followed up for 30 months with stress testing and CT coronary angiography. RESULTS 23 patients with 24 CTO lesions were included in this study. Out of 24 lesions, 9 lesions were found in LAD, 12 lesions in RCA and 3 lesions in LCX. The mean J-CTO score was 1.30.7. All CTO lesions were crossed through antegrade approach. The most common guidewire used for crossing CTO lesion was Cross IT 100XT and microcatheter was used in 18 lesions. Totally 38 Absorb BVS scaffolds were used in these 24 lesions and the mean number of Absorb BVS used per lesion was 1.70.9. The mean diameter and length of individual Absorb BVS scaffold used were 2.90.4 mm and 25.14.6 mm respectively. The median duration of follow up was 20 months (range: 8 to 30 months) in this study. Two patients were lost to follow up. No stent thrombosis was reported. Two patients with positive stress echocardiography at 9 months and 22 months after the index procedure demonstrated target lesion restenosis necessitating re-intervention. The remaining 19 patients were asymptomatic without any major adverse clinical event during the entire follow up period. Stress echocardiography, stress myocardial perfusion imaging study and CT coronary angiography demonstrated patent scaffolds in these patients. CONCLUSION Treatment of coronary CTO lesions is possible with Absorb BVS giving excellent outcomes at short-term and long-term follow up. CARDIAC SURGERY/HYBRID REVASCULARIZATION (TCTAP A-056) TCTAP A-056 Outcomes in Patients with Triple Vessel Disease Undergoing Coronary Artery Bypass Graft Gopal Murugesan,1 Ashwin Lysander1 1 Mahatma Gandhi Medical College, India BACKGROUND Coronary artery bypass grafting (CABG) which was introduced in 1960s has now become a commonly performed procedure for patients with multivessel coronary artery disease. Although there has been an explosion in the field of interventional cardiology with various new techniques and hardware, coronary artery bypass grafting remains the mainstay of treatment for diabetic patients with triple vessel disease, left main disease and ostioproximal LAD and circumflex disease. CABG is performed for patients with coronary artery disease and above mentioned findings and left ventricular dysfunction. CABG greatly improves the quality of life and reduces cardiac-related mortality. In many cases other concomitant cardiac surgeries are performed along with CABG such as mitral valve repair, Dorr procedure, mitral and aortic valve repair or replacement. Elderly patients have a shorter life expectancy CABG may not necessarily prolong survival. Also these patients are also more likely to experience perioperative complications after CABG and so CABG is less
commonly performed in this group of patients. Either veins or arteries or both may be used for CABG. The great and small saphenous veins are the most commonly used vein grafts, whereas the internal thoracic artery is the most commonly used artery. The disadvantage of saphenous vein grafts is their declining patency with time. 10-20% are occluded 1 year after surgery because of technical errors, thrombosis, and intimal hyperplasia. Internal thoracic artery grafts have better patency rates and at 10 years, more than 90% of internal thoracic artery grafts are patent. The left internal thoracic artery is preferably used for bypass of the left anterior descending coronary artery. METHODS This is a prospective study conducted in a tertiary care center in rural southern India. We analyzed 76 cases who underwent coronary artery bypass surgery. We analyzed the clinical and angiographic profile of these patients who underwent coronary artery bypass graft surgery. The risk factors, mode of presentation, demographics, angiographic findings, type of surgery, type of grafts, number of grafts, complications and outcomes were analyzed. RESULTS Total number of patients was 76. There were 52 males and 24 females. The youngest patient was a 38 year old male who presented late with anterior wall myocardial infarction and the oldest patient was a 85 year old male who also presented with myocardial infarction. 88% of the patients had diabetes, 59% were hypertensive, 62% were smokers and 72% had dyslipidemia. 61% of these patients presented with ST elevation myocardial infarction, 17% presented with unstable angina, 4% presented with non ST elevation myocardial infarction and the rest presented with chronic stable angina. 42% of these patients had left main disease. 59% of patients had triple vessel disease 23% had double vessel disease 8% had left main with double vessel disease and the rest had left main with triple vessel disease. 1 patient had isolated left main disease. Left internal thoracic artery graft was used for LAD and diagonals. Saphenous vein graft was used for LCX, obtuse marginal and PDA. 85% of the procedure was done on pump and the remaining were done off pump. There was one mortality due to left ventricular failure, 3 cases of left pleural effusion, 6 cases of pericardial effusion and 11 cases of graft site infection. All patients were followed up for a period of one year and showed no additional complications. CONCLUSION Coronary artery bypass grafting for multi vessel coronary artery disease is a safe procedure offering significant mortality benefit for these groups of patients. The complications are minimal with off pump surgery. In our study there was no difference between the off pump and on pump groups in terms of mortality or morbidity. This is also the procedure of choice for diabetic patients with multi vessel involvement and for patients with calcific or long diffuse lesions. All our patients showed improvement in the ejection fraction which was sustained in the one year follow up period. There was no additional mortality or morbidity in the one year follow up period. CAROTID & NEUROVASCULAR INTERVENTION (TCTAP A-057) TCTAP A-057 Endovascular Thrombectomy for Acute Ischemic Stroke: A Single-Center Experience in Taiwan Hai Jui Chu,1 Chung-Wei Lee,1 Sung-Chun Tang,1 Jiann-Shing Jeng1 1 National Taiwan University Hospital, Taiwan BACKGROUND It has become a standard treatment option for acute ischemic stroke (AIS) by endovascular thrombectomy after 6 positive trials published in 2015. This study aimed to evaluate the efficacy and safety of the endovascular thrombectomy for AIS with large artery occlusion in Taiwan. METHODS Patients who experienced AIS and received endovascular thrombectomy during September 2014 and October 2015 at National Taiwan University Hospital were retrospectively reviewed. A favorable outcome was defined as modified Rankin scale 0–2 at 3 months after stroke. Successful revascularization was assessed as restoration of flow to more than 50% of the involved brain territory at the end of the thrombectomy procedure (a score of 2b or 3 on the modified Treatment in Cerebral Ischemia [mTICI] scale). RESULTS During the study period, 23 patients (mean age 71.3 12.3 years; 8 females) received endovascular thrombectomy. The sites of vessel occlusion included internal carotid artery in 2, middle cerebral artery in 18 and basilar artery in 3. The mean NIHSS on admission was 19.05.8 in 20 patients with anterior circulation stroke and 16.717.6 in 3 patients with posterior circulation stroke. Fifteen (65.2%) patients received intravenous alteplase prior to the procedure. The mean time from stroke onset to groin puncture and puncture to recanalization time were 176.361.6 and 36.418.7 minutes, respectively. Successful