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Changes in Distal Vessels after CTO Recanalization;
Relation with Myocardial Viability
Javier GoicoleaHospital Universitario Puerta de Hierro
CTO
STEMI
Changes in Distal Vessels after CTO Recanalization; QCA (n=91 les)
J. Gomez-Lara et al Eurointervention 2014
IVUS post/FU in 58 pts
ΔLD=0.21 ΔEEMD=0.21
ΔEEMA=0.85ΔLA=0.87
J A C C Cardiovascular Interventions, , 2 0 1 2
J. Gomez-Lara et al Eurointervention 2014
Changes in Distal Vessels after CTO Recanalization; IVUS (n= 43 les)
Post F-U0
0.5
1
1.5
2
2.5
3
22.25
RVD
(J Am Coll Cardiol 2012;59:711–8)
Vasomotion Changes at F-U
• Intense and resistant vasoconstriction
• Vessel remodeling (structural)
– Plaque volume decrease
– EEM volume enlargement
• Combination of both
Changes in Distal Vessels after CTO Recanalization
Clinical Implications
• “True” distal vessel size may be difficult to determine accurately immediately after CTO recanalization (even with IVUS).
• Complete functional vessel recovery may even take longer ¿endothelial friendly stents?
• Relationship between myocardial and vascular viability …..
What About Myocardial Viability?
74 patients with CTO, screened from March 2010 to December 2011, were
included in a prospective protocol
47 patients underwent PCI of CTO
24 patients were included in the statistical analysis.
27 patients treated with medical therapy
8 patients refused cardiac MRI/MIBI
7 patients without successful PCI
8 patients without angiographic follow-up
What About Myocardial Viability?
Demographics
n=24
Age 60±6Female gender 2 (8.3%)HBP 13 (54.2%)Dyslipidemia 19 (79.2%)Q MI 2 (8.3%)
Lesion Characteristicsn=24
1 Vessels 7 29%
2 Vessels 10 42%
3 Vessels 7 29%
CTO duration (months) 35.9 23.9-155.6
Vessel
LAD 3 12.5%
LCx 5 20.8%
RCA 16 66.7%
CC
1 6 25%
2 18 75%
Procedure
Stent
Paclitaxel 1
Sirolimus 1
Everolimus 14
Zotarolimus 1
Biolimus 7
Procedure time ‘ 131.7±54.6
Fluoro time ‘ 52.5±30.4
Contrast ml 243±99
QCA Results
Post FU p
MLD intra Stent 2.14±0.4 1.95±0.5 0.010
MLD post Stent 1.15±0.06 1.39±0.6 0.005
Mean D post Stent 1.67±0.6 1.83±0.7 0.038
Changes in QCA
+ Viability -Viability pΔMLD 0.29±0.4 0.03±0.4 0.17
Δ mean Diam 0.25±0.3 -0.19±0.2 0.010Δ mean Area 0.62±1 -0.19±0.4 0.034
Univariate Analysis
OR CI P
Viability 2.67 1.09-6.52 <0.001
Creatinine <0.8 2 1.02-3.92 0.06
Age, gender, dislipidemia, cc, MLD intra and post stent.
Conclusion
• Despite the small number of patients included, underlying myocardial viability seems to predict both functional recovery and of the vascular architecture, after CTO recanalization.
• This lends support to the hypothesis linking vascular and myocardial viability and should be taken in consideration when choosing a particular stent size.