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ABS20191020_0001
| Physiologic Lesion Assessment | |
| Post Procedural Physiological Assessment of CTO Lesion | |
| Nao Yasuda1, Takuma Tsuda1 | |
| Nagoya Ekisaikai Hospital, Japan1 | |
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Background:
Success rate of CTO-PCI have dramatically improved during decades due to development of both device and technical aspects. However physiological aspect of CTO remains unclear. This study was to assess the relationship between wire position and physiological improvement during CTO-PCI.
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Methods:
Among 2018 April to 2019 September, a total of 24 CTO cases were enrolled in this study. Resting index, FFR and pCFR were assessed after recanalizing CTO, which was compared to pre-procedural values. Moreover, we divided them into two groups regarding wire position inside CTO; All true lumen tracking was divided as true Intra-plaque group (IP group: n=20) and the other was divided as sub-intimal group (SI group: n=4) (Table1).
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Results:
Post-procedural resting index (0.42 ¡¾ 0.17 vs. 0.86 ¡¾ 0.15, p<0.01), FFR(0.42 ¡¾ 0.11 vs. 0.82 ¡¾ 0.17, p<0.01) and pCFR(1.10 ¡¾ 0.12 vs. 1.61 ¡¾ 0.78, p<0.01) were significantly improved respectively (Fig.1). Although SI group had significantly high number of stents (2.1 ¡¾ 0.9 vs. 3.3 ¡¾ 1.5, p=0.05) and high number in total stent length (64.4 ¡¾ 32.7 mm vs. 107.3 ¡¾ 52.3 mm, p=0.04), post procedural resting index (0.84¡¾0.15 vs. 1.00¡¾0.00, p=0.18), FFR(0.82¡¾0.16 vs. 0.81¡¾0.28, p=0.95) and pCFR(1.66¡¾0.82 vs. 1.28¡¾0.40, p=0.44) weren¡¯t statistically significant compared to T group (Talbe2, Fig.2).
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Conclusion:
Although sub-intimal tracking during CTO-PCI associated with high number of stents and stent length, sub-intimal stenting is a feasible strategy regarding to post-procedural physiological improvement compared to intra-luminal stenting,
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Nao Yasuda (nagoya ekisaikai) Aug 09, 2020
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| Thank you for your good comments. We are sorry, but still don't have the physiological assessment during follow-up period yet. We already have co-relation between ¥Äresting index and pre-Rentrop classification, ¥ÄFFR and lesion length, ¥ÄCFR and CKD, BNP. BNP might suggest that high BNP could damage coronary microcirculation. This is why high BNP have less improvement of ¥ÄCFR after CTO-PCI. Actually, we also assessed each of ¥Äresting index, ¥ÄFFR and ¥ÄCFR during procedure, but we couldn't find any benefit of intra luminal stenting compared to sub-intimal stenting in this small number study. However, ¥ÄCFR have some tendency of more improvement in intra luminal stenting compared to sub-intimal stenting. |
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Takuma Tsuda (Nagoya Ekisaikai Hospital) Aug 07, 2020
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| Do you have any data of physiological improvement during follow up period in this study ? | |
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Takuma Tsuda (Nagoya Ekisaikai Hospital) Aug 07, 2020
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| What is the significant predictor of ¥Äresting index, ¥ÄFFR and ¥ÄCFR after recanalysing CTO-PCI ? | |
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Takuma Tsuda (Nagoya Ekisaikai Hospital) Aug 07, 2020
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| How do you think the point of benefit regarding to intra luminal stenting compared to sub-intimal stenting in physiological aspect? | |