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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 6, November/December 2016

346

AFRICA

Methods

Forty-one consecutive patients who underwent CTO

revascularisation with one or two BVSs between January 2013

and December 2014 were analysed in the present study. A total

of 52 BVSs were implanted. All patients were over 18 years old

and had a diagnosis of stable angina pectoris. Lesions with a

reference vessel diameter (RVD) of between 2.5 and 4 mm were

included. Patients who had suffered from a myocardial infarction

(MI) within one month of the procedure and patients who had

left main coronary artery (LMCA) lesions or bifurcation lesions

consisting of a side branch of over 2.5 mm were excluded. An

informed consent for the procedure was obtained from each

patient.

All CTO lesions were recanalised with dedicated CTO guide

wires. After a mandatory pre-dilatation with an appropriate

balloon, one or two BVS were implanted in the lesion. We did

not use a strategy of hybrid stenting and no metallic stent was

implanted in the lesions. Post-dilatation was performed with a

compliant or non-compliant balloon after BVS implantation at

the physician’s discretion if it was necessary.

Procedural features [target vessel, Japanese CTO score

(J-CTO score), BVS diameter, BVS length, post-dilatation rate,

type of post-dilatation balloon, procedure time, fluoroscopy

time, contrast volume, post-procedure reference vessel diameter

(RVD), post-procedure minimal lesion diameter (MLD),

CTO technique and rate of microcatheter use] were analysed.

Quantitative coronary angiography (QCA) measurements were

used to assess RVD and MLD.

One-, three- and six-month, and one-year follow-up visits

were made after each intervention. During routine visits,

cardiovascular stress tests (treadmill exercise test or myocardial

perfusion imaging test) were performed to diagnose the ischaemic

situation associated with the intervention. Re-intervention and

revascularisation were performed as needed. Rates of death,

myocardial infarction (MI), angina, coronary artery bypass graft

(CABG), target lesion revascularisation (TLR) and target-vessel

revascularisation (TVR) were analysed.

Statistical analysis

Measurement data were described as mean and standard

deviation. Descriptive and frequency statistics were used for

statistical analysis. The level of statistical significance accepted

was 0.05. Data were analysed with the use of SPSS 17.0 software

(SPSS, IBM, Chicago, USA).

Results

Baseline patient characteristics and therapy at discharge are

shown in Table 1. Thirty patients were treated by single BVS, and

11 patients were treated with two BVSs. Mean age was 61.9

±

9.7

years, and 85.4% of the patients were male. Among our patient

group, 51.2% had diabetes mellitus, 80.5% had hypertension and

46.3% had hyperlipidaemia. Renal function was within normal

limits in all patients, 65.9% had prior MI, 56.1% had prior

percutaneous coronary intervention (PCI) and 17.1% had prior

CABG surgery; 24.3% of the procedures were performed by the

radial route.

Nearly half of the BVSs were implanted in the right coronary

artery (RCA). Fourteen patients had lesions on the left anterior

descending (LAD) artery and seven had lesions on the circumflex

(CX) artery. Six patients had easy lesion complexity, 23 had

intermediate complexity, eight had difficult, and four had very

difficult complexity, according to the J-CTO score. Procedural

success rate was 100%. Case examples are shown in Fig. 1.

All patients were treated with acetylsalicylic acid after

the intervention. Additionally, 35 patients were treated with

clopidogrel, three with ticagrelor and three with prasugrel. The

rate of statin use was 97.5% among our patient group and beta-

blocker use was 85.3%.

Mean BVS diameter and BVS length were 2.8

±

0.29

and 25.6

±

4.2 mm, respectively. Our post-dilatation rate was

97.5%, mainly by non-compliant balloon (NCB) (92.6%). Post-

procedure RVD was 2.8

±

0.25 mm and post-procedure MLD

was 2.5

±

0.25 mm. We performed CTO procedures mainly by

the antegrade approach (87.8%). We used a microcatheter in 13

patients (31.7%).

Six patients had side branch occlusion and four had side

branch narrowing. All of these patients were treated successfully

by provisional stenting and final kissing balloon dilatation. Our

procedure time was 92

±

35.6 min, fluoro time was 20.2

±

4.8

min and the mean value of contrast volume was 146.6

±

26.7 ml

(Table 2).

At the end of one year, no death was observed. One patient

had lesion-related MI and needed revascularisation because of

early cessation of dual anti-platelet therapy. Eleven patients had

angina and five of them needed TVR. Our TLR rate was 2.4%

and TVR rate was 12.2% (Table 3).

Table 1. Patient characteristics and therapy at discharge

Patient characteristics

n

= 41 patients (%)

Age (years)

61.9

±

9.7

Male gender

35 (85.4)

Diabetes

21 (51.2)

Hypertension

33 (80.5)

Hyperlipidaemia

19 (46.3)

Smoking

14 (34.1)

Chronic renal failure

Prior MI

27 (65.9)

Prior PCI

23 (56.1)

Prior CABG

7 (17.1)

Radial intervention

10 (24.3)

Lesion complexity (J-CTO score)

Easy (J -CTO score of 0)

6 (14.6)

Intermediate (J-CTO score of 1)

23 (56)

Difficult ( J-CTO score of 2)

8 (19.5)

Very difficult (J-CTO score of ≥ 3)

4 (9.7)

Target vessel

LAD

14 (34.1)

CX

7 (17)

RCA

20 (48.7)

Procedural success

41 (100)

Therapy at discharge

ASA

41 (100)

Clopidogrel

35 (85.3)

Prasugrel

3 (7.3)

Ticagrelor

3 (7.3)

Statin

40 (97.5)

Beta-blocker

35 (85.3)

CABG: coronary artery bypass graft, CX: circumflex artery, J-CTO: Japanese

CTO, LAD: left anterior descending artery, MI: myocardial infarction, PCI:

percutaneous coronary intervention, RCA: right coronary artery.