Wang Geng

ASSA14-12-16 Comparative analysis of left trans-radial approach and trans-femoral approach in coronary bypass graft vessel angiography

Objective To investigate the feasibility of coronary graft vessel angiography by the left radial approach. Methods The 45 patients with coronary artery bypass grafting (CABG) history were enrolled from January, 2012 to June, 2014. All the patients were divided to two groups according to the angiography approach. Coronary bypass graft angiographies in one group of 13 another group of 32 patients were done by the femoral approach. Success rate of angiography, time of vein graft angiography, time of left internal mammary artery (LIMA) angiography, numbers of conduct, volume of contrast were observed. The complications at the puncture point including haemorrhage, hematoma, false aneurysm, arteriovenous fistula were noticed. Results There were no difference in success rate of angiography, time of vein graft angiography, numbers of conduct, volume of contrast between the two groups. The time of LIMA angiography was shorter in the left radial approach group than it in the femoral approach group (4.7 ± 4.4 min vs 9.6 ± 6.3 min, p = 0.023). There was no difference in complication after procedure between the two groups. Conclusion It is feasible that the coronary bypass graft vessel angiography is done by the left radial approach, especially for the LIMA angiography because of less time and simple manipulate. The bypass graft vessel angiography done by the left radial approach should be the first choice for the experienced manipulator.

ASSA14-12-12 The analyses of incidence of failure and relate factors in patients with retrograde wire for the treatment of chronic coronary artery occlusion

Background To evaluate the incidence of failure and related factors in patients with regrograde wire technique for the treatment of chronic coronary artery occlusion. Methods The data of 170 CTO patients undergoing retrograde PCI for a CTO from August 2004 to October 2013.170 cases with chronic coronary artery occlusion underwent transcutaneous coronary artery intervention (PCI) therapy by retrograde wire technique were enrolled in this study (male: 97, mean age: 60.6 ± 11.3 years). Failure is defined as wire is unable to pass through the occlusion of the target – artery or retrograde wire is unable to find the collateral circulation of miraclechannel. And the procedure is failed in stent implantation. We assessed the plasticity and determinants of retrograde wire technique of PCI Results The data of 170 CTO patients undergoing retrograde PCI for a CTO from August 2004 to October 2013 were analysed. The average occlusion time lasts more than 3.3 years, including 70 LAD CTO and 88 RCA CTO. Retrograde wire technique was failued to performe in 26 patients with chronic coronary artery occlusion. The average of 26 patients were treated by 4.3 guidewires, 1.2 microcatheters and intravascular contrast media 210 ml. there were no significantly changes about left atrial (LA)diameter and and left ventricular (LV) ejection fraction (p > 0.05) between success group and failue group. There were 26 patients (26/170, 15.2%) with at least one reason, including 17 cases with the wire is unable to pass through the collosion; 2 cases with small right coronary artery; 7 cases with bad collateral miraclechannel. In logistic regression analysis, the occlusion time between 3–12 months and whether the target artery had received antigrade wire technique before were the independent predictors of failure rate. Conclusions According to the data, the success rate of the occlusion time between 3–12 months is the lower than 1–3 years. There is no difference of the success rate between occlusion segment ≥15 mm and <15 mm, which is different from the previous view. Retrograde wire technique significantly increases the success rate of procedure in patients who failed in antegrade wire technique.

GW24-e1830 Interventional treatment in maintenance hemodialysis patients with acute coronary syndrome

Objectives To observe the efficacy of percutaneous coronary intervention (PCI) in maintenance hemodialysis (MHD) patients with acute coronary syndrome (ACS). Methods From January 2008 to October 2011, we completed PCI in the 38 MHD patients with ACS in our hospital hemodialysis Division, including 23 males and 15 females, aged 48-74 (mean 64.2 ± 8.2) years old. Protopathy were diabetic nephropathy in 25 cases, hypertensive renal disease in 11 cases, chronic glomerulonephritis in 2 cases; 33 patients were unstable angina, 4 patients were acute non-ST-segment elevation myocardial infarction, and 1 patients was acute ST-segment elevation myocardial infarction. 1 day before PCI, all patients took aspirin 300 mg and clopidogrel 300 mg, then took clopidogrel 75 mg for 1 year and aspirin 100 mg for lifetime. The results of coronary angiography were observed. All cases received 1-year follow-up about the adverse cardiovascular and cerebrovascular events (MACCE). Results Coronary angiography showed all patients with multi-vessel disease, double-vessel disease in 28 patients (73.7%) and three-vessel disease in 10 patients (26.3%). All patients were deployed with drug-eluting stents (DES). Implanted stents diameter were an average of 3.0 ± 0.3 mm, and length were an average of 37.7 ± 23.9 mm. The angina symptoms disappeared in all patients, while no intraoperative deaths happened. Postoperative angina occurred in 4 cases (10.5%), which relieved after medication adjustment and no one accepted coronary angiography again. NO acute myocardial infarction happened. 1 patients died of acute left ventricular failure, and 1 patients died of cerebral haemorrhage. MACCE occurred in 5.3%. Conclusions Interventional therapy can improve quality of life and survival in MHD patients with ACS.

ASSA14-01-05 Thrombus aspiration followed by direct stenting during primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

Objectives Previous studies have reported that low final thrombolysis in myocardial infarction (TIMI) flow and/or myocardial blush grade (MBG) are independent predictors of mortality in patients with ST-elevation myocardial infarction (STEMI). Several studies with thrombus aspiration (TA) showed different results, mainly due to use of TA as an additional device not instead of balloon predilatation (BP). The aim of the present study was to assess impact of TA followed by direct stenting during primary percutaneous coronary intervention (PPCI). Methods Between Dec 2008 and Jun 2011, a total of 429 patients (107 patients in TA group and 322 patients in BP group) who were eligible for the observation criteria, admitted with STEMI (within 9 h from symptoms onset) and candidates for PPCI were enrolled. Exclusion criteria were a previous PCI on infarct-related artery, infarct-related artery < 2.5 mm in diameter, previous coronary artery bypass graft, cardiogenic shock, 3-vessel disease, left main disease, infarct-related lesion treated with balloon predilatation and TA simultaneously, and calcium or tortuous infarct-related lesion. The main indexes of this study were the TIMI flow grade, MBG, and the rate of 60-min ST-segment resolution > 50% after PCI and in-hospital major adverse cardiac events (MACE). Secondary indexes included distal embolizations of infarct-related artery, peak CK-MB release, and MACE after one year. Results Baseline clinical and angiographic characteristics, initial TIMI flow and initial MBG did not differ between the two groups. Procedural success was obtained in all patients. Stent length, number of stents per patient, and stent/vessel ratio were similar between both groups. The rate of 60-min ST-segment resolution > 50% was significantly more frequent in TA group than in BP group (69.2% vs 48.5%, P < 0.01). The TIMI flow grade after PCI was significantly higher among patients in TA group compared with BP group (2.65 ± 0.49 vs 2.44 ± 0.61, P < 0.01). Also the MBG was significantly higher among patients in TA group compared with BP group (2.86 ± 0.34 vs 2.41 ± 0.56, P < 0.01). There were 23 patients with evident distal embolizations in the group without TA and two patients in the group with TA (1.9% vs 7.1%, P < 0.05). The peak CK-MB release was significantly lower in TA group compared with the BP group (660 ± 144 U/L vs 711 ± 165 U/L, P < 0.01). There was no difference in between the groups in in-hospital MACE (0.9% vs 2.8%, P > 0.05), in 12-month cardiac mortality (1.2% vs 2.2%, P > 0.05), reinfarction rate (0.9% vs 3.1%,P > 0.05) and target vessel revascularisation (2.8 vs 6.5%, P > 0.05). But Total MACE was significantly higher in BP group compared with the TA group (6.5% vs 14.5%, P < 0.05). Conclusions Compared with conventional PCI, TA and direct stenting before primary PCI improved final myocardial reperfusion and the long-term outcome for STEMI patients.

ASSA14-03-29 Angiographic features of patients with atherosclerosis in the segments proximal to the myocardial bridge

Objectives By studying the clinical and imaging features of myocardial bridge and severe atherosclerosis lesions in the segments proximal to the myocardial bridge, compared with that of pure myocardial bridge retrospectively, to analyze the clinical and imaging characteristics of these patients. Methods The study population consisted of 2 groups (192 patients). The CHD Group included 92 patients with severe atherosclerosis lesion of luminal narrowing of ≥ 70% in the segments proximal to the myocardial bridge. The bridge group included 100 patients with symptomatic myocardial bridge lesion of systolic luminal narrow. All lesions were successfully treated with stent by standard interventional techniques. Quantitative coronary angiography was performed before and immediately after stent deployment. Results The mean age and systolic pressure in the CHD patients were more than that in the pure bridge group (58 ± 11 vs 42 ± 10 ys and 157.8 ± 9.8 vs 146.1 ± 10.2 mmHg, respectively), P < 0.05. No significant difference was found between two groups such as gender, DM, smoking, hyperlipidemia, old myocardial infarction percentage. There was a significant difference in the extent of diameter stenosis during systolic stage between CHD and bridge groups (95 ± 5% vs 90 ± 7%). But the average length from the proximal end of myocardial bridge to the ostium of LAD and the average length of myocardial bridge had not difference between two groups. Conclusions The patients with severe atherosclerosis lesion in the segments proximal to the myocardial bridge has more risk factors of CHD, the extent of diameter stenosis during systolic stage has some promotive effect on CHD.

ASSA13-15-10 Analysis of 135 Cases of Retrograde Wire For the Treatment of Chronic Coronary Artery Occlusion

Objective To investigate the feasibility and safety of wire technique for the treatment of chronic coronary artery occlusion. Methods 135 patients with chronic coronary artery occlusion who received coronary artery inner bracket operations by retrograde wire technique following failure of routine transcutaneous antegrade wire technique, or estimating difficulty in the antegrade operation, were followed up last 8 years by angiography or on telephone. The data of 135 CTO patients undergoing PCI for a CTO from August 2004 were analysed. Retrograde wire technique was performed successfully in 128 patients with chronic coronary artery occlusion. The average occlusion lasts more than 3.3 years. PCI was successfully performed in 110 CTO patients with 2–3 coronary collateral blood flow circulationby author (JING) independently, including 64 LAD CTO and 76 RCA CTO. The average of 128 patients were treated by using 3.6 drug-eluting stents, 4.6 guidewires, 1.7 microcatheters and intravascular contrast media 320ML. The successful rate of guided catheter placement by right radial and right femoral approach was very high (96.4%). The successful rate of antegrade wire into regtrograde microcatheter in catheter 39.4% was higher (P < 0.05) than anterior of CTO lesion33.3% and in CTO lesion 27.3%. All the patients took the statins and antiplatelet drugs regularly once a day, were followed up 6–12 months by angiography or on telephone. The improvement rate of heart function and angina pectoris was 87.4% and 76.1%. Operative failures occurred in 7 patients owing to failure to pass through the occlusion. The locations were femoral artery pseudoaneurysm in 2 cases. Only 1 patients had reoperations due to coronary stent occlusion No major events such as death, myocardial infarction, and emergency CABG occurred. This new technique, can be used as an alternative method in establishing the antegrade guidewire channel in CTO retrograde intervention. Results and Conclusions Conclusion method is feasibility and safety for patients. Careful evaluation on CTO lesion is a key to obtain a relatively high success rate of PCI. Retrograde wire technique significantly increases the success rate of procedure in patients who failed in antegrade wire technique. Exquisite operating and select equipment are important too. It confirmed its good effect for patients with coronary artery inner bracket operation.

ASSA13-15-29 Long-Term Follow-Up Study of Patients with Covered Stent Implantation After Coronary Perforation

Objective To evaluate the long-term efficacy of covered stent implantation to the patients with coronary perforation occurred in percutaneous coronary intervention (PCI). Methods From June 2004 to March 2011, a total of 8 cases received 8 covered stents implantation because of coronary perforation in our centre. Ellis grade III coronary perforation occurred in 7 patients, and Ellis grade I in 1 patient. The patients took clopidogrel 75 mg/d for 2 years, and 100 mg/d for lifetime. The major adverse cardiac events (MACE) were observed in the 8 patients through long-term follow-up. Results There were 5 males and 3 females in the 8 patients who aged 63–76 (mean 69.3 ± 4.7) years. Six patients had multi-vessel disease. The target vessels were left anterior descending artery (LAD) in 7 patients. Calcified lesions emerged in 3 patients and total occlusion lesions in 3 patients. In addition to 2 patients with balloon dilating after guidewire into the false lumen, the coronary artery perforation of the remaining six patients were associated with too high pressure of stent expansion or balloon dilating. Pericardial tamponade happened in 7 patients, and pericardial effusion of 100–470 ml was drained by pericardiocentesis. Implanted covered stents average diameter was 3.3 ± 0.3mm, and average length was 21.3 ± 4.1mm. All perforation of the patients were successfully closed, while no patients died in PCI. During follow-up of 0.6–67 months (mean 35.3 ± 25.1 months), 2 patients died. Nineteen days after PCI, one patient died of multiple organ failure due to lung infection. Thirteen months after PCI, another patient died of cardiac sudden death. One patient was hospitalised with angina pectoris after 53 months, and the symptoms was relieved. The imaging was not reviewed. After 6 months one patient received multi-slice CT examination, and no restenosis was found. He was currently asymptomatic. The remaining four patients were reviewed coronary angiography after 15–67 months. Only one patient showed LAD stent restenosis and received target vessel revascularization. The remaining 3 patients had no restenosis within the stent. During the entire follow-up, restenosis rate was 20% (1/5), mortality rate was 25% (2/8) and MACE rate was 50% (4/8). If follow-up after PCI was 12 months, MACE rate decreased to 25% (2/8). Conclusions Treatment of covered stent to coronary perforation can achieve good long-term efficacy. A two-year dual antiplatelet drugs can be effective in preventing covered stent thrombosis.

ASSA14-03-30 Long-term Efficacy of PCI vs CABG for Patients with Multiple Coronary Chronic Total Occlusions

Backgroud Data on the efficacy of percutaneous coronary intervention (PCI) for treatment of multiple coronary chronic total occlusion (CTO) lesions are scanty. The optimal revascularisation strategy for multiple coronary CTO disease in the era of drug-eluting stents (DES) has become more controversial between coronary artery bypass grafting (CABG) and PCI. The aim of the present study is to compare the long-term outcomes of DES implantation for multiple coronary CTO lesions compared with CABG. Methods We analysed 261 patients who underwent coronary angiography for at least two de novo CTO lesions in our centre from November 2000 to November 2006. Among them, 118 patients (45.2%) received DES implantation after recanalisation for CTO lesions and 143 patients (54.8%) received CABG. Major adverse cardiac and cerebrovascular events (MACCE: death, acute myocardial infarction, stroke and repeat revascularisation) and hospitalisation costs were compared. Long-term survival rates were estimated with the Kaplan-Meier method. Results Patients in the CABG group were likely to have hyperlipidemia, diabetes mellitus, multivessel disease and higher euroSCORE. The mean follow-up was 4.2 ± 0.7 years in the CABG group and 4.3 ± 0.5 years in the DES group. Total hospitalisation costs were lower (p = 0.017) in the CABG group (median: 107 thousand Yuan) than in the DES group (median: 156 thousand Yuan). Rates of MACCE at 12 months were higher in the PCI group (16.9% vs 11.2% for CABG; P = 0.179), but not statistically significant, in large part because of an increased rate of repeat revascularisation (15.3% vs 7.0%, p = 0.016). The overall survival rate (CABG: 73.4% and DES: 76.2% at 5 years, p = 0.599) and the TVR-free survival rate did not differ between the groups. Conclusions This study demonstrates the long-term (up to 5 years) efficacy and safety of DES for treatment of multiple coronary CTO lesions. The long-term survival rate of PCI with DES was comparable to that of CABG for the treatment of multiple coronary CTO. PCI with DES was more costly than CABG. PCI using DES might be an alternative to CABG in selected patients with multiple coronary CTO disease.