الفهرس 
INTRODUCTION TO chrONICOnly 14 pages are availabe for public view
 |  | from | 117 |  |  |
| | | from | 117 | | |
Abstract
C
hronic total occlusions (CTO) are found in approximately one-third of patients with significant coronary disease who undergo angiography. Despite the introduction of novel technologies, newer guidewires, and a tremendous advancement of technical skills, percutaneous coronary intervention (PCI) for CTO remains a challenge. Even with stenting, there remains a significant rate of both restenosis (32% to 55%) and reocclusion (8% to 12%).
In a retrospective study design, we included all patients who underwent percutaneous coronary intervention (PCI) for chronic total occlusion of at least one coronary artery during the period from 1 January 2007 to 31 December 2007 in the cath labs of Ain Shams University Hospitals. We revised the database of the cath labs of Ain Shams University Hospitals for risk factors, symptom level, previous MI or unstable angina, previous PCI or coronary artery bypass grafting (CABG), current medications, procedural data including pretreatment with antiplatelets, intra-procedural anticoagulation, stent type (drug-eluting versus bare metal), size, and final result, and in-hospital post-procedural complications including mortality, MI, stroke, heart failure, cardiogenic shock, contrast induced nephropathy, allergy, stent thrombosis (acute/ subacute), coronary dissection, no reflow, urgent target vessel revascularization.
from a total of 320 patients with chronic total occlusion who underwent diagnostic coronary angiography during the period from1 January 2007 to 31 December 2007 in the cath labs of Ain Shams University Hospitals, an attempt at PCI was made only in 91 patients. Among these 91 patients, adequate data was available for only 86 patients.
In these 86 procedures, 73 (84.8 percent) procedures succeeded according to the definition mentioned before (successful crossing of CTO with a wire, stent deployment, residual stenosis < 30%, TIMI flow > 1). Meanwhile, 13 (15.2 percent) procedures failed. Procedural failure was due to failure of crossing CTO with the wire in 9 (10.5 percent) patients [including those patients with TIMI flow < 2], and was due to residual stenosis > 30% in 4 (4.7 percent) patients.
No significant difference was found between patients with failed procedures and patients with successful procedures regarding any of baseline and angiographic characteristics except serum creatinine. Renal function was more impaired in patients with failed procedure as compared to patients with procedural success. Respectively, serum creatinine was 1.2 ± 0.3 versus 1.1 ± 0.2, p value = 0.013. No death occur in the whole study series.
There were four complications in successful PCI procedures (namely; coronary dissection, myocardial infarction, distal embolization and no re-flow), while no complications in failed PCI procedures.