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    Coronary collateral development and arterial stiffness in patients with chronic coronary total occlusions
    (Taylor & Francis Ltd, 2015) Baykan, Ahmet Oytun; Gur, Mustafa; Acele, Armagan; Seker, Taner; Quisi, Alaa; Yildirim, Arafat; Cayli, Murat
    Objective. Coronary collateral circulation (CCC) mainly develops through arteriogenesis in response to shear forces. Increased arterial stiffness (AS) causes decreased coronary perfusion, which may reduce shear stress, arteriogenesis, and thus collateral formation. The aim of this study was to assess the relationship between CCC and AS in patients with chronic coronary total occlusion (CTO). Design. We prospectively enrolled 163 patients with CTO. Patients were divided into two groups according to their Rentrop scores: (a) poorly developed (PD) CCC group (Rentrop 0-1) and (b) well-developed (WD) CCC group (Rentrop 2-3). AS measurements were carried out using a Mobil-O-Graph arteriography system. Results. Fasting glucose, creatinine, uric acid, neutrophil count, and neutrophil-to-lymphocyte ratio were found to be higher in patients with PD-CCC. Moreover, patients with PD-CCC had significantly higher augmentation index (AIx) and pulse wave velocity (PWV) compared with WD-CCC group (27.3 +/- 8.9 vs. 18.7 +/- 7.4, p < 0.001 and 11.7 +/- 2.6 vs. 8.5 +/- 1.4, p < 0.001, respectively). In multivariate logistic regression analysis, PWV, AIx, and serum uric acid were found to be independently associated with the development of CCC. Conclusion. AS parameters, such as AIx and PWV, as well as serum uric acid are independently associated with the development of CCC in stable coronary artery disease with CTO.
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    Predictors of successful percutaneous coronary intervention in chronic total coronary occlusions
    (Termedia Publishing House Ltd, 2016) Baykan, Ahmet Oytun; Gur, Mustafa; Acele, Armagan; Seker, Taner; Quisi, Alaa; Kivrak, Ali; Yildirim, Arafat
    Introduction: Percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) is one of the most challenging procedures of interventional cardiology and is associated with increased risk of significant complications. However, debate continues in regard to which factors adversely influence the success rate of PCI and whether the benefits of revascularization of CTO outweigh the risks and challenges. Aim: To analyze the relationship between lesion characteristics and overall success rates as well as in-hospital outcomes after PCI for CTO. Material and methods: We retrospectively examined the procedural outcomes of 173 consecutive native coronary artery CTO PCIs performed from February 2012 to March 2013 (78% men; mean age: 60.3 +/- 12.1 years). Results: The CTO target vessel was the right coronary artery (53.8%), circumflex (10.4%) and left anterior descending artery (35.8%), respectively. The retrograde approach was used in 13.9% of all procedures. Successful revascularization was achieved in 83.2% of patients. Major complications occurred in 13.3% of patients. In multivariate analysis, bridge collaterals, severe calcification and tortuosity as well as tandem occlusions were independent predictors of procedural failure, whereas existence of micro-channels was the only predictor of procedural success. Conclusions: Revascularization of coronary CTOs may be performed with high success and low major complication rates. Bridge collaterals, severe calcification and tortuosity, tandem/multiple occlusions and micro-channels were independent predictors of successful CTO revascularization.