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|Title: ||Percutaneous Coronary Intervention of Chronic Total Occlusions: Exploring the Final Frontier|
|Authors: ||Maeremans, Joren|
|Advisors: ||Dens, Joseph|
|Issue Date: ||2018|
|Abstract: ||Coronary chronic total occlusions are frequently encountered atherosclerotic lesions in patients with coronary artery disease. Although the efficiency of CTO-PCI in improving clinical outcomes is supported by trials, only 10% of these patients are treated via PCI. The low rate of invasive treatment mainly stems from the greater technical complexity and perceived higher risk of complications, which makes that CTOs are referred to as “the final frontier” of PCI. During recent years, more advanced (CTO-dedicated) devices, techniques, and algorithms have been developed to overcome these technical challenges. Yet, both the short- and long-term benefits of these developments on CTO-PCI outcomes remain to be validated in larger communities.
In part I of this doctoral thesis, we demonstrated the improved procedural efficiency, safety, and applicability of the hybrid algorithm and the different contemporary wiring and dissection and re-entry techniques for a broader community. Moreover, we re-evaluated current CTO complexity scores and developed a novel scoring tool that copes with the current evolutions in CTO-PCI. In addition, we provided the first appraisal of the evolutions in the field of CTO-PCI in the BeLux landscape. In part II, we proved the efficiency of certain specific new and improved CTO-dedicated materials to address common failure modes in CTO-PCI. Besides this, we demonstrated the long-term satisfactory performance and safety of BRS in the setting of CTO-PCI. We also added novel insights regarding patient’ and staff’ radiation exposure during CTO-PCI and determined the benefits of radioprotective drapes in CTO-PCI. In the final part, we evaluated the long-term outcomes of current percutaneous CTO intervention, and found that the advent of the hybrid algorithm results in favorable one-year outcomes. Moreover, event rates were comparable between wiring and DR techniques, indicative of the improved safety and efficiency of these contemporary techniques in the hybrid setting. Finally, measured hs-TnT levels indicated that one-year MACCE rates were significantly greater in patients with significant troponin elevation. In turn, troponin elevation was more frequently associated with more complex techniques.
The work performed in this doctoral thesis has generated significant insights in the field of CTO-PCI and provided the much-needed evidence to support the continued use of the various, contemporary techniques, materials, and algorithms by a broad community of operators. Ultimately, this might result in treatments being targeted specifically to the individual patient’s needs.|
|Type: ||Theses and Dissertations|
|Appears in Collections: ||PhD theses|
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|Published version - Doctoral Thesis Joren Maeremans||4.52 MB||Adobe PDF|
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