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.