Cardiac and Extracardiac Complications During CTO Interventions
Cardiac and Extracardiac Complications During CTO Interventions
The knowledge of type, rate and natural history of complications that may occur during chronic total occlusion (CTO) intervention is an essential step of the decision-making process for evaluating the risk:benefit ratio of treating a CTO and the need to stop the procedure. Despite the traditional conviction that percutaneous coronary intervention (PCI) of CTO is a low-risk procedure, even in high volume and experienced centers, death may occur in up to 1% of patients, and in-hospital myocardial infarction (MI) may occur in up to 5% of cases. In a series of 2007, PCIs for CTO performed over a 25-year period in a large volume center, the causes of death and MI were coronary perforation, acute ischemia owing to proximal damage of donor artery and aortic dissection. However, as with other lesion subsets, in-hospital major adverse cardiac events associated with PCI of CTO have decreased over time. A great improvement in terms of reduction of urgent coronary artery bypass graft (CABG) and re-PCI has been observed after the introduction of stents in the 1990s. Similarly, there has been a progressive decrease in periprocedural MI and rate of death reflecting the evolution and amelioration of PCI techniques, the development of dedicated devices and the utilization of adjunctive pharmacological therapy. For didactic purpose, we divided CTO-related complications into cardiac and extracardiac complications. The in-hospital complications reported in the main studies of CTO intervention are shown in Table 1.
Background
The knowledge of type, rate and natural history of complications that may occur during chronic total occlusion (CTO) intervention is an essential step of the decision-making process for evaluating the risk:benefit ratio of treating a CTO and the need to stop the procedure. Despite the traditional conviction that percutaneous coronary intervention (PCI) of CTO is a low-risk procedure, even in high volume and experienced centers, death may occur in up to 1% of patients, and in-hospital myocardial infarction (MI) may occur in up to 5% of cases. In a series of 2007, PCIs for CTO performed over a 25-year period in a large volume center, the causes of death and MI were coronary perforation, acute ischemia owing to proximal damage of donor artery and aortic dissection. However, as with other lesion subsets, in-hospital major adverse cardiac events associated with PCI of CTO have decreased over time. A great improvement in terms of reduction of urgent coronary artery bypass graft (CABG) and re-PCI has been observed after the introduction of stents in the 1990s. Similarly, there has been a progressive decrease in periprocedural MI and rate of death reflecting the evolution and amelioration of PCI techniques, the development of dedicated devices and the utilization of adjunctive pharmacological therapy. For didactic purpose, we divided CTO-related complications into cardiac and extracardiac complications. The in-hospital complications reported in the main studies of CTO intervention are shown in Table 1.
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