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An introduction to CTO for fellows

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An introduction to CTO for fellows

An introduction to CTO for fellows

Dr Edwina McNaughton, Complex Intervention Fellow

 

Chronic total occlusion (CTO) PCI has become more widely practiced in the last decade. With the advancement of technology, skills and training, the success of CTO PCI has increased in recent years. The ESC in 2018 gave a Class 2A recommendation for CTO PCI.1 Despite this, there has been reluctance to treat CTO’s due to a lack of survival benefit. Of patients with ischaemic heart disease, 25% have a CTO. Only 9% of these are attempted to be recanalized.2 The CONSISTENT CTO trial showed that out of 230 patients, 90% of CTO’s were opened successfully by interventionists with expertise in CTO.3

Although there have been no studies proving survival benefit, some studies suggest that quality of life and angina burden/frequency is reduced as reported by patients. The EURO-CTO trial demonstrated an improvement in quality of life and symptom management following recanalization of CTO at twelve months using Seattle Angina Questionnaire and European Quality of Life–5 Dimensions assessment.4 The IMPACTOR-CTO trial showed the importance of re-canalization of the RCA in improving functional status and quality of life, without impact on clinical outcomes.5 The DECISION-CTO trial did not see any reduction in major adverse cardiac event (MACE) rates at four years for patients treated with PCI versus those managed medically, although 20% crossover was noted into the PCI arm. However, it did highlight low complication rates during CTO angioplasty.6

Interestingly, the Syntax trial 10 year outcomes demonstrated that if patients are left with incomplete revascularization, the risk of all-cause mortality is higher at SYNTAX score >8 (50%) compared to SYNTAX score 0-4 (24%).7

Ultimately patient selection is important. Those who have a significant angina burden or significant impact on quality of life may benefit most. CTO PCI carries a slightly increased risk of adverse outcomes given the procedural complexity. With appropriate training, we should be well equipped to treat these rather than manage medically.

Procedure preparation

Ensuring the team are adequately trained is important to aid the likelihood of success. Ensuring appropriate CTO kit is available in the cardiac catheter lab is essential prior to commencing a procedure.

Access and angiographic assessment

CTO PCI generally should be performed as an elective procedure, with planning prior to the procedure to maximise success and minimise contrast and radiation use. Dual access is important to fully understand the CTO and visualise the strategic options available to attempt CTO PCI. Bi-radial access in the first instance is adequate; most CTO cases can be completed with 7 French guide catheter. A passively supportive guide catheter is important, typically Voda Left, XB or EBU catheters for the left coronary artery, and AL or 3D curves for the right coronary artery. The use of guide extension catheters may also be required to overcome poor support.

The use of road-mapping angiographic views at the start of the procedure is crucial. Views which are useful include:

 

Right Coronary Artery

  • LAO 30 good for assessing lesion length,
  • LAO 20 CRA 20 will enable assessment of distal cap and landing zone
  • RAO CRA body of CTO and septal collateral filling.

 

Left Anterior Descending Artery

  • PA CRA should demonstrate the proximal and distal cap, and CTO length
  • PA caudal/Spider- will give further information on the proximal cap
  • RAO 30/RAO CRA will show the septal collaterals from RCA and ipsilateral collaterals.

 

Left Circumflex Artery

  • PA caudal 30/LAO caudal-will show proximal cap and length of CTO.

 

A donor guide, a guide engaged in the contralateral coronary system to aid visualisation, should have a workhorse wire routinely placed in the donor vessel. This maintains catheter position, allows easy engagement and disengagement and also importantly expedites any treatment of donor vessel injury, which can cause rapid deterioration in the context of a contralateral CTO.

The use of intravascular imaging is important to aid successful outcomes and also to reduce contrast use.

It is important to understand there are many methods to crossing an occlusive lesion. Wire escalation methods can be anterograde or retrograde (AWE/RWE). This entails changing your wire selection based on the characteristics you encounter and need to overcome. Dissection reentry techniques again can be used either anterogradely or retrogradely (ADR/RDR), these involve dissecting sub-intimally into the vessel architecture past the occlusion, with re-entry into the true vessel lumen below the occlusion.

Figure 3: CTO strategies A) Anterograde wire escalation, B) Retrograde wire escalation, C)Anterograde dissection re-entry, D) Retrograde dissection re-entry (Image reproduced from A guide to mastering Anterograde CTO PCI)

 

CTO body, distal cap and landing zone

The length of the CTO lesion as it increases (>20mm) makes intimal wiring less likely and increases procedural time. A heavy burden of calcification and vessel tortuosity are other features which may influence initial strategy away from AWE.

The vessel beyond the distal cap and before the origin of a major side-branch is known as the distal landing zone. If there is a bifurcation near to the landing zone, it may deter operators from an anterograde dissection re-entry approach as this may result in loss of the side-branch patency.

Figure 1: Understanding the varying parts of a chronic total occlusion are important for successful outcomes (Image reproduced from A guide to mastering Anterograde CTO PCI)

Collateral channels facilitate visualisation of the distal target. It is important to understand the origin and course of the collateral vessel and whether it is useful as an ‘interventional’ collateral if considering a retrograde approach. Typically septal collateral channels are preferred as the risks of complications such as tamponade are limited.

J-CTO score

The Japanese CTO score was developed to assess probability of a successful CTO procedure. The five main components are:

  1. Tapered or blunt cap
  2. angle >45 degrees
  3. long occlusion >20mm
  4. presence of calcification
  5. Previously attempted CTO

Scores in the lower range suggest a straightforward CTO, higher scores reflect more complex lesions.

Figure 2: The hybrid algorithm (Image reproduced from A guide to mastering Anterograde CTO PCI)

 

The hybrid algorithm

There are four angiographic anatomical features that influence initial strategy when using the hybrid algorithm:

  1. Proximal cap – the presence of a clear proximal cap means it can be confidently approached as the starting point. Ambiguous proximal cap refers to one with multiple branches/collaterals, a flush occlusion and uncertainty as to the initial vessel course
  2. Lesion length – attempting CTO PCI on lesions >20mm is associated with significantly less likelihood of success with an anterograde wire escalation approach. These lesions can be more predictably treated with a primary ADR or RDR strategy.
  3. Distal cap and vessel characteristics – a relatively disease free, healthy vessel after a distal cap, clear of any major bifurcation would favour an ADR strategy
  4. Interventional collaterals – this refers to the presence of collateral channels suitable for access with a wire and microcatheter that enter the distal vessel remoted from the distal cap and facilitate RWE or RDR. Absence of these collaterals precludes a primary retrograde strategy

 

Wire selection

Wire selection should be based on their properties and the lesion characteristics you need to overcome. The use of a microcatheter is recommended to further enhance the wire’s properties and to aid wire exchange. Trapping balloons are also useful for switching out equipment. Below is a useful table of wires commonly used in CTO intervention8.

Table 1: Commonly used guidewires for CTO intervention8

 

Intravascular imaging

Intravascular imaging is invaluable in CTO procedures. IVUS is preferred due to OCT needing high pressure contrast injection, which can propagate dissection. IVUS can aid in identifying pathology, confirming true lumen position, and planning stent size, length and expansion targets. It can also aid optimisation of apposition of implanted stents for more durable results from CTO PCI.

Ultimately, CTO PCI success is achievable if the operator has selected appropriate patients, assessed the lesion adequately and prepared a strategy prior to intervention. With appropriate training, these lesions can be treated and patient quality of life improved.

References

    1. Neumann, F.-J., Sousa-Uva, M., Ahlsson, A., Alfonso, F., Banning, A. P., Benedetto, U., Byrne, R. A., Collet, J.-P., Falk, V., Head, S. J., Jüni, P., Kastrati, A., Koller, A., Kristensen, 1. D., Niebauer, J., Richter, D. J., Seferović, P. M., Sibbing, D., Stefanini, G. G., … Group, E. S. C. S. D. (2019). 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal, 40(2), 87–165.
    2. Tsai TT, Stanislawski MA, Shunk KA, Armstrong EJ, Grunwald GK, Schob AH, Valle JA, Alfonso CE, Nallamothu BK, Ho PM, Rumsfeld JS, Brilakis ES. Contemporary Incidence, Management, and Long-Term Outcomes of Percutaneous Coronary Interventions for Chronic Coronary Artery Total Occlusions: Insights From the VA CART Program. JACC Cardiovasc Interv. 2017 May 8;10(9):866-875.
    3. Walsh, S. J., Hanratty, C. G., McEntegart, M., Strange, J. W., Rigger, J., Henriksen, P. A., Smith, E. J., Wilson, S. J., Hill, J. M., Mehmedbegovic, Z., Chevalier, B., Morice, M.-C., & Spratt, J. C. (2020). Intravascular Healing Is Not Affected by Approaches in Contemporary CTO PCI: The CONSISTENT CTO Study. JACC: Cardiovascular Interventions, 13(12), 1448–1457.
    4. Werner, G. S., Martin-Yuste, V., Hildick-Smith, D., Boudou, N., Sianos, G., Gelev, V., Rumoroso, J. R., Erglis, A., Christiansen, E. H., Escaned, J., di Mario, C., Hovasse, T., Teruel, L., Bufe, A., Lauer, B., Bogaerts, K., Goicolea, J., Spratt, J. C., Gershlick, A. H., … investigators, E. trial. (2018). A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions. European Heart Journal, 39(26), 2484–2493.
    5. Obedinskiy A, Kretov E, Boukhris M, et al. The IMPACTOR-CTO Trial. J Am Coll Cardiol Intv. 2018 Jul, 11 (13) 1309–1311.
    6. Lee, S.-W., Lee, P. H., Ahn, J.-M., Park, D.-W., Yun, S.-C., Han, S., Kang, H., Kang, S.-J., Kim, Y.-H., Lee, C. W., Park, S.-W., Hur, S. H., Rha, S.-W., Her, S.-H., Choi, S. W., Lee, B.-K., Lee, N.-H., Lee, J.-Y., Cheong, S.-S., … Park, S.-J. (2019). Randomized Trial Evaluating Percutaneous Coronary Intervention for the Treatment of Chronic Total Occlusion. Circulation, 139(14), 1674–1683
    7. Takahashi, K., Serruys, P. W., Gao, C., Ono, M., Wang, R., Thuijs, D. J. F. M., Mack, M. J., Curzen, N., Mohr, F.-W., Davierwala, P., Milojevic, M., Wykrzykowska, J. J., de Winter, R. J., Sharif, F., Onuma, Y., Head, S. J., Kappetein, A. P., Morice, M.-C., Holmes, D. R., & null, null. (2021). Ten-Year All-Cause Death According to Completeness of Revascularization in Patients With Three-Vessel Disease or Left Main Coronary Artery Disease: Insights From the SYNTAX Extended Survival Study. Circulation, 144(2), 96–109.
    8. Creaney C, Walsh SJ. Antegrade Chronic Total Occlusion Strategies: A Technical Focus for 2020. Interv Cardiol. 2020 Jun 29;15:e08.
    9. Brilakis, E. S., Mashayekhi, K., Tsuchikane, E., Abi Rafeh, N., Alaswad, K., Araya, M., Avran, A., Azzalini, L., Babunashvili, A. M., Bayani, B., Bhindi, R., Boudou, N., Boukhris, M., Božinović, N. Ž., Bryniarski, L., Bufe, A., Buller, C. E., Burke, M. N., Büttner, H. J., … Rinfret, S. (2019). Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention. Circulation, 140(5), 420–433.
    10. A guide to mastering Anterograde CTO PCI, Spratt J.C, Hanratty C.G, Walsh S.J, Wilson S.J. Optima Education Limited 2019.

Radiation Survey

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Radiation Survey

14th February 2023

Occupational exposure to ionising radiation is a workplace hazard, we wish to understand how this is viewed and how exposure may have impacted you within your work environment. Please participate by taking 5 minutes to have your answers included in this vital topic.

Thank you for providing your perspective and helping create a safer environment for all to work in.

Prof. James Spratt

Complete the Survey Here

ACI 2023 — Day Three: My Worst Complication and What I Learned

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ACI 2023 — Day Three: My Worst Complication and What I Learned

Thursday 21st April, 16:35 – 16:45 INNOVATIONS IN INTERVENTION
Does Morphology Affect IVL Efficiency? James Spratt
This presentation has been sponsored and organised by Shockwave

 

Day 2 — BCIS ACI Virtual Experience 2021: BCIS Masterclass 3

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Day 2 — BCIS ACI Virtual Experience 2021: BCIS Masterclass 3

Thursday 21st April, 16:35 – 16:45 INNOVATIONS IN INTERVENTION
Does Morphology Affect IVL Efficiency? James Spratt
This presentation has been sponsored and organised by Shockwave

 

BCIS ACI Virtual Experience 2021: On Demand — Chance to Shine

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BCIS ACI Virtual Experience 2021: On Demand — Chance to Shine

Thursday 21st April, 16:35 – 16:45 INNOVATIONS IN INTERVENTION
Does Morphology Affect IVL Efficiency? James Spratt
This presentation has been sponsored and organised by Shockwave

 

BCIS / NICOR PCI PUBLICATION LIST

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BCIS / NICOR PCI PUBLICATION LIST

Below is an up to date list (15th April 2021) of all publications using BCIS / NICOR dataset. The first is PCI publications the second is TAVI publications

A huge thanks to Tim Kinnaird from University Hospital of Wales for preparing this list

PCI PUBLICATIONS

  1. Revascularisation strategies in patients with significant left main coronary disease during the COVID-19 pandemic. Mohamed MO, Curzen N, de Belder M, Goodwin AT, Spratt JC, Balacumaraswami L, Deanfield J, Martin GP, Rashid M, Shoaib A, Gale CP, Kinnaird T, Mamas MA.Catheter Cardiovasc Interv. 2021 Mar 25. doi: 10.1002/ccd.29663. Online ahead of print.
  2. Vascular complications associated with intraaortic balloon pump supported percutaneous coronary intervention (PCI) and clinical outcomes from the British Cardiovascular Intervention Society National PCI Database. Kinnaird T, Anderson R, Gallagher S, Sharp ASP, Farooq V, Ludman P, Copt S, Curzen N, Sirker A, Nolan J, Mamas M.Catheter Cardiovasc Interv. 2021 Feb 8. doi: 10.1002/ccd.29549. Online ahead of print.
  3. Combined use of rotational and excimer lASER coronary atherectomy (RASER) during complex coronary angioplasty-An analysis of cases (2006-2016) from the British Cardiovascular Intervention Society database. Protty MB, Gallagher S, Farooq V, Sharp AS, Egred M, O’Kane P, Kinnaird T.Catheter Cardiovasc Interv. 2020 Nov 17. doi: 10.1002/ccd.29377. Online ahead of print.
  4. Outcomes Following Percutaneous Coronary Intervention in Renal Transplant Recipients: A Binational Collaborative Analysis. Rashid M, Nagaraja V, Shoaib A, Curzen N, Ludman PF, Kapadia SR, Palmer N, Elgendy IY, Kalra A, Vachharajani TJ, Anderson HV, Kwok CS, Mohamed M, Banning AP, Mamas MA.Mayo Clin Proc. 2021 Feb;96(2):363-376. doi: 10.1016/j.mayocp.2020.04.045.
  5. Excimer laser coronary atherectomy during complex PCI: An analysis of 1,471 laser cases from the British Cardiovascular Intervention Society database. Protty MB, Hussain HI, Gallagher S, Al-Raisi S, Aldalati O, Farooq V, Sharp ASP, Egred M, O’Kane P, Ludman P, Anderson RA, Mamas MA, Kinnaird T.Catheter Cardiovasc Interv. 2021 Apr 1;97(5):E653-E660. doi: 10.1002/ccd.29251. Epub 2020 Sep 18.
  6. Impact of the COVID-19 Pandemic on Percutaneous Coronary Intervention in England: Insights From the British Cardiovascular Intervention Society PCI Database Cohort. Kwok CS, Gale CP, Curzen N, de Belder MA, Ludman P, Lüscher TF, Kontopantelis E, Roebuck C, Denwood T, Burton T, Hains J, Deanfield JE, Mamas MA.Circ Cardiovasc Interv. 2020 Nov;13(11):e009654. doi: 10.1161/CIRCINTERVENTIONS.120.009654.
  7. Impact of COVID-19 on cardiac procedure activity in England and associated 30-day mortality. Mohamed MO, Banerjee A, Clarke S, de Belder M, Patwala A, Goodwin AT, Kwok CS, Rashid M, Gale CP, Curzen N, Mamas MA.Eur Heart J Qual Care Clin Outcomes. 2020 Oct 20:qcaa079. doi: 10.1093/ehjqcco/qcaa079.
  8. Rotational atherectomy complicated by coronary perforation is associated with poor outcomes: Analysis of 10,980 cases from the British Cardiovascular Intervention Society database. Protty MB, Hussain HI, Gallagher S, Al-Raisi S, Aldalati O, Farooq V, Sharp ASP, Anderson R, Kinnaird T.Cardiovasc Revasc Med. 2020 Aug 2:S1553-8389(20)30467-X. doi: 10.1016/j.carrev.2020.07.040.
  9. Clinical Characteristics and Outcomes From Percutaneous Coronary Intervention of Last Remaining Coronary Artery: An Analysis From the British Cardiovascular Intervention Society Database. Shoaib A, Rashid M, Kontopantelis E, Sharp A, Fahy EF, Nolan J, Townend J, Ludman P, Ratib K, Azam ZA, Ahmad A, McEntegart M, Mohamed M, Kinnaird T, Mamas MA; British Cardiovascular Intervention Society (BCIS) and the National Institute for Cardiovascular Outcomes Research (NICOR).Circ Cardiovasc Interv. 2020 Sep;13(9):e009049. doi:10.1161/CIRCINTERVENTIONS.120.009049. Epub 2020 Sep 2.
  10. Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction. Kwok CS, Gale CP, Kinnaird T, Curzen N, Ludman P, Kontopantelis E, Wu J, Denwood T, Fazal N, Deanfield J, de Belder MA, Mamas M.Heart. 2020 Dec;106(23):1805-1811. doi: 10.1136/heartjnl-2020-317650.
  11. Rotational atherectomy and same day discharge: Safety and growth from a national perspective. Taxiarchi P, Martin GP, Curzen N, Kinnaird T, Ludman P, Johnson T, Kwok CS, Rashid M, Kontopantelis E, Mamas MA.Catheter Cardiovasc Interv. 2020 Aug 26. doi: 10.1002/ccd.29228.
  12. Clinical Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion in Native Coronary Arteries vs Saphenous Vein Grafts. Shoaib A, Johnson TW, Banning A, Ludman P, Rashid M, Potts J, Kwok CS, Kontopantelis E, Azam ZA, Kinnaird T, Mamas MA.J Invasive Cardiol. 2020 Sep;32(9):350-357.
  13. Adoption of same day discharge following elective left main stem percutaneous coronary intervention. Taxiarchi P, Kontopantelis E, Kinnaird T, Curzen N, Banning A, Ludman P, Shoaib A, Rashid M, Martin GP, Mamas MA.Int J Cardiol. 2020 Dec 15;321:38-47. doi: 10.1016/j.ijcard.2020.07.038.
  14. A National Evaluation of Emergency Cardiac Surgery After Percutaneous Coronary Intervention and Postsurgical Patient Outcomes. Kwok CS, Sirker A, Nolan J, Zaman A, Ludman P, de Belder M, Kinnaird T, Mamas MA.Am J Cardiol. 2020 Sep 1;130:24-29. doi: 10.1016/j.amjcard.2020.05.041.
  15. Evaluation of the DAPT Score in Patients Who Undergo Percutaneous Coronary Intervention in England and Wales. Kwok CS, Kinnaird T, Ludman P, Mohamed M, Borovac JA, Sirker A, Mamas MA.Cardiovasc Revasc Med. 2020 Dec;21(12):1509-1514. doi: 10.1016/j.carrev.2020.05.003
  16. Are Higher Operator Volumes for Unprotected Left Main Stem Percutaneous Coronary Intervention Associated With Improved Patient Outcomes?: A Survival Analysis of 6724 Procedures From the British Cardiovascular Intervention Society National Database. Kinnaird T, Gallagher S, Anderson R, Sharp A, Farooq V, Ludman P, Copt S, Curzen N, Banning A, Mamas M.Circ Cardiovasc Interv. 2020 Jun;13(6):e008782. doi: 10.1161/CIRCINTERVENTIONS.119.008782.PMID: 32482082
  17. The impact of coronary perforation in percutaneous interventions involving the left main stem coronary artery in the United Kingdom 2007-2014: Insights from the British Cardiovascular Intervention Society database. Hussain HI, Protty MB, Gallagher S, Al-Raisi S, Aldalati O, Farooq V, Sharp ASP, Anderson R, Kinnaird T.Catheter Cardiovasc Interv. 2021 Feb 1;97(2):E179-E185. doi: 10.1002/ccd.28933.
  18. Contributors to the Growth of Same Day Discharge After Elective Percutaneous Coronary Intervention. Taxiarchi P, Martin GP, Kinnaird T, Curzen N, Ahmed J, Ludman P, De Belder M, Shoaib A, Rashid M, Kontopantelis E, Mamas MA.Circ Cardiovasc Interv. 2020 Mar;13(3):e008458. doi: 10.1161/CIRCINTERVENTIONS.119.008458.
  19. Intravascular Imaging and 12-Month Mortality After Unprotected Left Main Stem PCI: An Analysis From the British Cardiovascular Intervention Society Database. Kinnaird T, Johnson T, Anderson R, Gallagher S, Sirker A, Ludman P, de Belder M, Copt S, Oldroyd K, Banning A, Mamas M, Curzen N.JACC Cardiovasc Interv. 2020 Feb 10;13(3):346-357. doi: 10.1016/j.jcin.2019.10.007.
  20. Complex high-risk and indicated percutaneous coronary intervention for stable angina: Does operator volume influence patient outcome? Kinnaird T, Gallagher S, Spratt JC, Ludman P, de Belder M, Copt S, Anderson R, Walsh S, Hanratty C, Curzen N, Banning A, Mamas M.Am Heart J. 2020 Apr;222:15-25. doi: 10.1016/j.ahj.2019.12.019.
  21. Outcomes Following Percutaneous Coronary Intervention in Saphenous Vein Grafts With and Without Embolic Protection Devices. Shoaib A, Kinnaird T, Curzen N, Ludman P, Smith D, Khoo CW, Kontopantelis E, Rashid M, Mohamed M, Nolan J, Zaman A, Mamas MA; British Cardiovascular Intervention Society; National Institute for Cardiovascular Outcomes Research.JACC Cardiovasc Interv. 2019 Nov 25;12(22):2286-2295. doi: 10.1016/j.jcin.2019.08.037.
  22. Intravascular Imaging for left main stem PCI and 12-month mortality. Kinnaird T, Johnson T, Gallagher S, Anderson R, Sharp A, Ludman P, Copt S, Oldroyd K, Banning A, Mamas M and Curzen N. Accepted JACC Intervention 2019.
  23. Shoaib A, Kinnaird T, Curzen N, Ludman P, Smith D, Khoo CW, Kontopantelis E, Rashid M, Mohamed M, Nolan J, Zaman A, Mamas M. Outcomes Following Percutaneous Coronary Intervention (PCI) in Saphenous Vein Grafts (SVG) with and without Embolic Protection Device. Accepted JACC Intervention 2019.
  24. In-hospital gastrointestinal bleeding following percutaneous coronary intervention. Kwok CS, Sirker A, Farmer AD, Kontopantelis E, Potts J, Ayyaz Ul Haq M, Ludman P, de Belder M, Townend J, Zaman A, Large A,Kinnaird T, Mamas MA; British Cardiovascular Intervention Society (BCIS) and National Institute of Cardiovascular Outcomes Research (NICOR). Catheter Cardiovasc Interv. 2019 Apr 8. doi: 10.1002/ccd.28222. [Epub ahead of print]
  25. Comparison of Routine Versus Selective Glycoprotein IIb/IIIa Inhibitors Usage in Primary Percutaneous Coronary Intervention (from the British Cardiovascular Interventional Society). Orzalkiewicz M, Hodson J, Kwok CS, Ludman PF, Giblett JP, George S, Doshi SN, Khan SQ, Kinnaird T, Hildick-Smith D, Townend JN, Mamas MA, Calvert PA. Am J Cardiol. 2019 Aug 1;124(3):373-380. doi: 10.1016/j.amjcard.2019.05.010. Epub 2019 May 9.
  26. British Cardiovascular Intervention Society registry framework: a quality improvement initiative on behalf of the National Institute of Cardiovascular Outcomes Research (NICOR). Rashid M, Ludman PF, Mamas MA. Eur Heart J Qual Care Clin Outcomes. 2019 May 3. pii: qcz023. doi: 10.1093/ehjqcco/qcz023. [Epub ahead of print]
  27. Temporal trends in relative survival following percutaneous coronary intervention. Hulme WJ, Sperrin M, Martin GP, Curzen N, Ludman P, Kontopantelis E, Mamas MA; British Cardiovascular Intervention Society and the National Institute of Cardiovascular Outcomes Research. BMJ Open. 2019 Feb 19;9(2):e024627. doi: 10.1136/bmjopen-2018-024627.
  28. Coronary perforation complicating percutaneous coronary intervention in patients presenting with an acute coronary syndrome: An analysis of 1013 perforation cases from the British Cardiovascular Intervention Society database. Kinnaird T, Kwok CS, Davies R, Calvert PA, Anderson R, Gallagher S, Sirker A,Ludman P, deBelder M, Stables R, Johnson TW, Kontopantelis E, Curzen N, Mamas M; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Int J Cardiol. 2019 Jun 14. pii: S0167-5273(18)36651-8. doi: 10.1016/j.ijcard.2019.06.034. [Epub ahead of print]
  29. Same-Day Discharge After Elective Percutaneous Coronary Intervention: Insights From the British Cardiovascular Intervention Society. Taxiarchi P, Kontopantelis E, Martin GP,Kinnaird T, Curzen N, Banning AP, Ludman P, De Belder M, Rashid M, Sperrin M, Mamas MA. JACC Cardiovasc Interv. 2019 Aug 12;12(15):1479-1494. doi: 10.1016/j.jcin.2019.03.030.
  30. Operator volume is not associated with mortality following percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society registry. Hulme W, Sperrin M, Curzen N, Kinnaird T, De Belder MA,Ludman P, Kwok CS, Gale CP, Cockburn J, Kontopantelis E, Mamas MA; British Cardiovascular Intervention Society and the National Institute of Cardiovascular Outcomes Research. Eur Heart J. 2018 May 7;39(18):1623-1634. doi: 10.1093/eurheartj/ehy125.
  31. Changes in Periprocedural Bleeding Complications Following Percutaneous Coronary Intervention in The United Kingdom Between 2006 and 2013 (from the British Cardiovascular Interventional Society). Olier I, Carr M, Curzen N,Ludman P, Baumbach A, Kinnaird T, de Belder MA, Hildick-Smith D, Sirker A, Kwok CS, Rashid M, Nolan J, Kontopantelis E, Mamas MA. Am J Cardiol. 2018 Sep 15;122(6):952-960. doi: 10.1016/j.amjcard.2018.06.016. Epub 2018 Jul 8.
  32. Outcomes Following Percutaneous Coronary Intervention in Non-ST-Segment-Elevation Myocardial Infarction Patients With Coronary Artery Bypass Grafts. Shoaib A,Kinnaird T, Curzen N, Kontopantelis E, Ludman P, de Belder M, Rashid M, Kwok CS, Nolan J, Zaman A, Mamas MA. Circ Cardiovasc Interv. 2018 Nov;11(11):e006824. doi: 10.1161/CIRCINTERVENTIONS.118.006824.
  33. The impact of diabetes on the prognostic value of left ventricular function following percutaneous coronary intervention: Insights from the British Cardiovascular Intervention Society. Jackson M, Austin D, Kwok CS, Rashid M, Kontopantelis E, Ludman P, de Belder M, Mamas MA, Zaman A. Catheter Cardiovasc Interv. 2018 Nov 15;92(6):E393-E402. doi: 10.1002/ccd.27642. Epub 2018 May 4.
  34. Access Site and Outcomes for Unprotected Left Main Stem Percutaneous Coronary Intervention: An Analysis of the British Cardiovascular Intervention Society Database. Kinnaird T, Anderson R, Gallagher S, Sirker A, Ludman P, de Belder M, Copt S, Oldroyd K, Curzen N, Banning A,Mamas M. JACC Cardiovasc Interv. 2018 Dec 24;11(24):2480-2491. doi: 10.1016/j.jcin.2018.09.035
  35. Antiplatelet drug selection in PCI to vein grafts in patients with acute coronary syndrome and adverse clinical outcomes: Insights from the British Cardiovascular Intervention Society database. Sirker A, Kwok CS, Kontopantelis E, Johnson T, Freeman P, de Belder MA, Ludman P, Zaman A, Mamas MA. Catheter Cardiovasc Interv. 2018 Oct 1;92(4):659-665. doi: 10.1002/ccd.27493. Epub 2018 Jan 22.
  36. Incidence, Determinants, and Outcomes of Left and Right Radial Access Use in Patients Undergoing Percutaneous Coronary Intervention in the United Kingdom: A National Perspective Using the BCIS Dataset. Rashid M, Lawson C, Potts J, Kontopantelis E, Kwok CS, Bertrand OF, Shoaib A, Ludman P,Kinnaird T, de Belder M, Nolan J, Mamas MA. JACC Cardiovasc Interv. 2018 Jun 11;11(11):1021-1033. doi: 10.1016/j.jcin.2018.01.252. Epub 2018 May 16
  37. Association of different antiplatelet therapies with mortality after primary percutaneous coronary intervention. Olier I, Sirker A, Hildick-Smith DJR,Kinnaird T, Ludman P, de Belder MA, Baumbach A, Byrne J, Rashid M, Curzen N, Mamas MA; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Heart. 2018 Oct;104(20):1683-1690. doi: 10.1136/heartjnl-2017-312366. Epub 2018 Feb 2.
  38. Temporal changes in radial access use, associates and outcomes in patients undergoing PCI using rotational atherectomy between 2007 and 2014: results from the British Cardiovascular Intervention Society national database.Kinnaird T, Cockburn J, Gallagher S, Choudhury A, Sirker A, Ludman P, de Belder M, Copt S,Mamas M, de Belder A. Am Heart J. 2018 Apr;198:46-54. doi: 10.1016/j.ahj.2018.01.001. Epub 2018 Jan 7.
  39. Health Economic Analysis of Access Site Practice in England During Changes in Practice: Insights From the British Cardiovascular Interventional Society. Mamas MA, Tosh J, Hulme W, Hoskins N, Bungey G, Ludman P, de Belder M, Kwok CS, Verin N,Kinnaird T, Bennett E, Curzen N, Nolan J, Kontopantelis E. Circ Cardiovasc Qual Outcomes. 2018 May;11(5):e004482. doi: 10.1161/CIRCOUTCOMES.117.004482.
  40. Vascular Access Site and Outcomes in 58,870 Patients Undergoing Percutaneous Coronary Intervention With a Previous History of Coronary Bypass Surgery: Results From the British Cardiovascular Interventions Society National Database.Kinnaird T, Anderson R, Gallagher S, Cockburn J, Sirker A, Ludman P, de Belder M, Copt S, Nolan J, Zaman A,Mamas M. JACC Cardiovasc Interv. 2018 Mar 12;11(5):482-492. doi: 10.1016/j.jcin.2017.12.020.
  41. Procedural Success and Outcomes With Increasing Use of Enabling Strategies for Chronic Total Occlusion Intervention. Kinnaird T, Gallagher S, Cockburn J, Sirker A, Ludman P, de Belder M, Smith E, Anderson R, Strange J, Mamas M, Hildick-Smith D; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Circ Cardiovasc Interv. 2018 Oct;11(10):e006436. doi: 10.1161/CIRCINTERVENTIONS.118.006436.
  42. Retroperitoneal Hemorrhage After Percutaneous Coronary Intervention: Incidence, Determinants, and Outcomes as Recorded by the British Cardiovascular Intervention Society. Kwok CS, Kontopantelis E,Kinnaird T, Potts J, Rashid M, Shoaib A, Nolan J, Bagur R, de Belder MA, Ludman P, Mamas MA; British Cardiovascular Intervention Society (BCIS) and National Institute of Cardiovascular Outcomes Research (NICOR). Circ Cardiovasc Interv. 2018 Feb;11(2):e005866. doi: 10.1161/CIRCINTERVENTIONS.117.005866.
  43. Impact of Access Site Practice on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention Following Thrombolysis for ST-Segment Elevation Myocardial Infarction in the United Kingdom: An Insight From the British Cardiovascular Intervention Society Dataset. Rashid M, Rushton CA, Kwok CS, Kinnaird T, Kontopantelis E, Olier I, Ludman P, De Belder MA, Nolan J, Mamas MA. JACC Cardiovasc Interv. 2017 Nov 27;10(22):2258-2265. doi: 10.1016/j.jcin.2017.07.049.
  44. Coronary Perforation Complicating Percutaneous Coronary Intervention in Patients With a History of Coronary Artery Bypass Surgery: An Analysis of 309 Perforation Cases From the British Cardiovascular Intervention Society Database. Kinnaird T, Anderson R, Ossei-Gerning N, Cockburn J, Sirker A, Ludman P, de Belder M, Johnson TW, Copt S, Zaman A, Mamas MA; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Circ Cardiovasc Interv. 2017 Sep;10(9). pii: e005581. doi: 10.1161/CIRCINTERVENTIONS.117.005581.
  45. Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction. Brogan RA, Alabas O, Almudarra S, Hall M, Dondo TB, Mamas MA, Baxter PD, Batin PD, Curzen N, de Belder M, Ludman PF, Gale CP. Eur Heart J Acute Cardiovasc Care. 2017 Jul 1:2048872617710790. doi: 10.1177/2048872617710790. [Epub ahead of print]
  46. Variation in emergency percutaneous coronary intervention in ventilated patients in the UK: Insights from a national database. Rawlins J, Ludman PF, O’Neil D,Mamas MA, de Belder M, Redwood S, Banning A, Whittaker A, Curzen N. Cardiovasc Revasc Med. 2017 Jun;18(4):250-254. doi: 10.1016/j.carrev.2017.02.005. Epub 2017 Feb 13.
  47. Radial Versus Femoral Access for Rotational Atherectomy: A UK Observational Study of 8622 Patients. Watt J, Austin D, Mackay D, Nolan J, Oldroyd KG. Circ Cardiovasc Interv. 2017 Dec;10(12). pii: e005311. doi: 10.1161/CIRCINTERVENTIONS.117.005311.
  48. The Relationship of Body Mass Index to Percutaneous Coronary Intervention Outcomes: Does the Obesity Paradox Exist in Contemporary Percutaneous Coronary Intervention Cohorts? Insights From the British Cardiovascular Intervention Society Registry. Holroyd EW, Sirker A, Kwok CS, Kontopantelis E, Ludman PF, De Belder MA, Butler R, Cotton J, Zaman A, Mamas MA; British Cardiovascular Intervention Society and National Institute of Cardiovascular Outcomes Research. JACC Cardiovasc Interv. 2017 Jul 10;10(13):1283-1292. doi: 10.1016/j.jcin.2017.03.013.
  49. United Kingdom: coronary and structural heart interventions from 2010 to 2015. Ludman PF, de Belder MA, Redwood S, Banning A. 2017 May 15;13(Z):Z83-Z88. doi: 10.4244/EIJ-D-16-00833.
  50. Legacy Effect of Coronary Perforation Complicating Percutaneous Coronary Intervention for Chronic Total Occlusive Disease: An Analysis of 26 807 Cases From the British Cardiovascular Intervention Society Database. Kinnaird T, Anderson R, Ossei-Gerning N, Cockburn J, Sirker A, Ludman P, deBelder M, Walsh S, Smith E, Hanratty C, Spratt J, Strange J, Hildick-Smith D, Mamas MA; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Circ Cardiovasc Interv. 2017 May;10(5). pii: e004642. doi: 10.1161/CIRCINTERVENTIONS.116.004642.
  51. Choice of Stent for Percutaneous Coronary Intervention of Saphenous Vein Grafts. Iqbal J, Kwok CS, Kontopantelis E, de Belder MA, Ludman PF, Large A, Butler R, Gamal A, Kinnaird T, Zaman A, Mamas MA; British Cardiovascular Intervention Society (BCIS) and National Institute of Cardiovascular Outcome Research (NICOR). Circ Cardiovasc Interv. 2017 Apr;10(4). pii: e004457. doi: 10.1161/CIRCINTERVENTIONS.116.004457.
  52. Vascular Access Site and Outcomes Among 26,807 Chronic Total Coronary Occlusion Angioplasty Cases From the British Cardiovascular Interventions Society National Database. Kinnaird T, Anderson R, Ossei-Gerning N, Gallagher S, Large A, Strange J, Ludman P, de Belder M, Nolan J, Hildick-Smith D, Mamas M. JACC Cardiovasc Interv. 2017 Apr 10;10(7):635-644. doi: 10.1016/j.jcin.2016.11.055.
  53. Increased Radial Access Is Not Associated With Worse Femoral Outcomes for Percutaneous Coronary Intervention in the United Kingdom. Hulme W, Sperrin M, Kontopantelis E, Ratib K, Ludman P, Sirker A, Kinnaird T, Curzen N, Kwok CS, De Belder M, Nolan J, Mamas MA; British Cardiovascular Intervention Society and the National Institute of Cardiovascular Outcomes Research. Circ Cardiovasc Interv. 2017 Feb;10(2):e004279. doi: 10.1161/CIRCINTERVENTIONS.116.004279.
  54. Impact of call-to-balloon time on 30-day mortality in contemporary practice. Varcoe RW, Clayton TC, Gray HH, de Belder MA, Ludman PF, Henderson RA; British Cardiovascular Intervention Society (BCIS) and the National Institute for Cardiovascular Outcomes Research (NICOR). Heart. 2017 Jan 15;103(2):117-124. doi: 10.1136/heartjnl-2016-309658. Epub 2016 Jul 13.
  55. Incidence, Determinants, and Outcomes of Coronary Perforation During Percutaneous Coronary Intervention in the United Kingdom Between 2006 and 2013: An Analysis of 527 121 Cases From the British Cardiovascular Intervention Society Database. Kinnaird T, Kwok CS, Kontopantelis E, Ossei-Gerning N, Ludman P, deBelder M, Anderson R, Mamas MA; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Circ Cardiovasc Interv. 2016 Aug;9(8). pii: e003449. doi: 10.1161/CIRCINTERVENTIONS.115.003449.
  56. Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication. Myint PK, Kwok CS, Roffe C, Kontopantelis E, Zaman A, Berry C, Ludman PF, de Belder MA, Mamas MA; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Stroke. 2016 Jun;47(6):1500-7. doi: 10.1161/STROKEAHA.116.012700. Epub 2016 May 10.
  57. Is There a Relationship of Operator and Center Volume With Access Site-Related Outcomes? An Analysis From the British Cardiovascular Intervention Society. Hulme W, Sperrin M, Rushton H, Ludman PF, De Belder M, Curzen N, Kinnaird T, Kwok CS, Buchan I, Nolan J, Mamas MA. Circ Cardiovasc Interv. 2016 May;9(5):e003333. doi: 10.1161/CIRCINTERVENTIONS.115.003333.
  58. Total Center Percutaneous Coronary Intervention Volume and 30-Day Mortality: A Contemporary National Cohort Study of 427 467 Elective, Urgent, and Emergency Cases. O’Neill D, Nicholas O, Gale CP, Ludman P, de Belder MA, Timmis A, Fox KA, Simpson IA, Redwood S, Ray SG. Circ Cardiovasc Qual Outcomes. 2017 Mar;10(3). pii: e003186. doi: 10.1161/CIRCOUTCOMES.116.003186.
  59. Gender Differences in Outcomes and Predictors of All-Cause Mortality After Percutaneous Coronary Intervention (Data from United Kingdom and Sweden). Kunadian V, Qiu W, Lagerqvist B, Johnston N, Sinclair H, Tan Y, Ludman P, James S, Sarno G; National Institute for Cardiovascular Outcomes Research and Swedish Coronary Angiography and Angioplasty Registries. Am J Cardiol. 2017 Jan 15;119(2):210-216. doi: 10.1016/j.amjcard.2016.09.052. Epub 2016 Oct 7.
  60. Outcomes Following Primary Percutaneous Coronary Intervention in Patients With Previous Coronary Artery Bypass Surgery. Iqbal J, Kwok CS, Kontopantelis E, de Belder MA, Ludman PF, Giannoudi M, Gunning M, Zaman A, Mamas MA; British Cardiovascular Intervention Society (BCIS) and the National Institute for Cardiovascular Outcomes Research (NICOR). Circ Cardiovasc Interv. 2016 Apr;9(4):e003151. doi: 10.1161/CIRCINTERVENTIONS.115.003151.
  61. Changes in Arterial Access Site and Association With Mortality in the United Kingdom: Observations From a National Percutaneous Coronary Intervention Database. Mamas MA, Nolan J, de Belder MA, Zaman A, Kinnaird T, Curzen N, Kwok CS, Buchan I, Ludman P, Kontopantelis E; British Cardiovascular Intervention Society (BCIS) and the National Institute for Clinical Outcomes Research (NICOR). Circulation. 2016 Apr 26;133(17):1655-67. doi: 10.1161/CIRCULATIONAHA.115.018083. Epub 2016 Mar 11.
  62. A contemporary risk model for predicting 30-day mortality following percutaneous coronary intervention in England and Wales. McAllister KS, Ludman PF, Hulme W, de Belder MA, Stables R, Chowdhary S, Mamas MA, Sperrin M, Buchan IE; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Int J Cardiol. 2016 May 1;210:125-32. doi: 10.1016/j.ijcard.2016.02.085. Epub 2016 Feb 17.
  63. Outcomes From Selective Use of Thrombectomy in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: An Analysis of the British Cardiovascular Intervention Society/National Institute for Cardiovascular Outcomes Research (BCIS-NICOR) Registry, 2006-2013. Sirker A, Mamas M, Kwok CS, Kontopantelis E, Ludman P, Hildick-Smith D; British Cardiovascular Intervention Society (BCIS). JACC Cardiovasc Interv. 2016 Jan 25;9(2):126-34. doi: 10.1016/j.jcin.2015.10.047.
  64. Relationship Between Femoral Vascular Closure Devices and Short-Term Mortality From 271 845 Percutaneous Coronary Intervention Procedures Performed in the United Kingdom Between 2006 and 2011: A Propensity Score-Corrected Analysis From the British Cardiovascular Intervention Society. Farooq V, Goedhart D, Ludman P, de Belder MA, Harcombe A, El-Omar M; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Circ Cardiovasc Interv. 2016 Jun;9(6). pii: e003560. doi: 10.1161/CIRCINTERVENTIONS.116.003560.
  65. Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention. Alabas OA, Brogan RA, Hall M, Almudarra S, Rutherford MJ, Dondo TB, Feltbower R, Curzen N, de Belder M, Ludman P, Gale CP; National Institute for Cardiovascular Outcomes Research. Heart. 2016 Aug 15;102(16):1287-95. doi: 10.1136/heartjnl-2015-308739. Epub 2016 Apr 7.
  66. Outcomes of Percutaneous Coronary Intervention Performed at Offsite Versus Onsite Surgical Centers in the United Kingdom. Garg S, Anderson SG, Oldroyd K, Berry C, Emdin CA, Peters SA, West NE, Kelly D, Balachandran K, McDonald J, Singh R, Devadathan S, Redwood S, Ludman PF, Rahimi K, Woodward M; British Cardiovascular Intervention Society; National Institute for Cardiovascular Outcomes Research. J Am Coll Cardiol. 2015 Jul 28;66(4):363-72. doi: 10.1016/j.jacc.2015.05.052.
  67. Effect of access site, gender, and indication on clinical outcomes after percutaneous coronary intervention: Insights from the British Cardiovascular Intervention Society (BCIS). Kwok CS, Kontopantelis E, Kunadian V, Anderson S, Ratib K, Sperrin M, Zaman A, Ludman PF, de Belder MA, Nolan J, Mamas MA; British Cardiovascular Intervention Society; National Institute for Cardiovascular Outcomes Research. Am Heart J. 2015 Jul;170(1):164-72, 172.e1-5. doi: 10.1016/j.ahj.2015.04.018. Epub 2015 Apr 18.
  68. Stroke following percutaneous coronary intervention: type-specific incidence, outcomes and determinants seen by the British Cardiovascular Intervention Society 2007-12. Kwok CS, Kontopantelis E, Myint PK, Zaman A, Berry C, Keavney B, Nolan J, Ludman PF, de Belder MA, Buchan I, Mamas MA; British Cardiovascular Intervention Society; National Institute for Cardiovascular Outcomes Research. Eur Heart J. 2015 Jul 1;36(25):1618-28. doi: 10.1093/eurheartj/ehv113. Epub 2015 Apr 20.
  69. Impact of age on access site-related outcomes in 469,983 percutaneous coronary intervention procedures: Insights from the British Cardiovascular Intervention Society. Anderson SG, Ratib K, Myint PK, Keavney B, Kwok CS, Zaman A, Ludman PF, de Belder MA, Nolan J, Mamas MA; British Cardiovascular Intervention Society; National Institute for Cardiovascular Outcomes Research. Catheter Cardiovasc Interv. 2015 Nov 15;86(6):965-72. doi: 10.1002/ccd.25896. Epub 2015 Feb 25.
  70. Access site practice and procedural outcomes in relation to clinical presentation in 439,947 patients undergoing percutaneous coronary intervention in the United kingdom. Ratib K, Mamas MA, Anderson SG, Bhatia G, Routledge H, De Belder M, Ludman PF, Fraser D, Nolan J; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. JACC Cardiovasc Interv. 2015 Jan;8(1 Pt A):20-9. doi: 10.1016/j.jcin.2014.06.026.
  71. Impact of age on the prognostic value of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. Kwok CS, Anderson SG, McAllister KS, Sperrin M, O’Kane PD, Keavney B, Nolan J, Myint PK, Zaman A, Buchan I, Ludman PF, de Belder MA, Mamas MA; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Catheter Cardiovasc Interv. 2015 May;85(6):944-51. doi: 10.1002/ccd.25732. Epub 2014 Nov 27.
  72. Baseline bleeding risk and arterial access site practice in relation to procedural outcomes after percutaneous coronary intervention. Mamas MA, Anderson SG, Carr M, Ratib K, Buchan I, Sirker A, Fraser DG, Hildick-Smith D, de Belder M, Ludman PF, Nolan J; British Cardiovascular Intervention Society; National Institute for Cardiovascular Outcomes Research. J Am Coll Cardiol. 2014 Oct 14;64(15):1554-64. doi: 10.1016/j.jacc.2014.05.075.
  73. Impact of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. Mamas MA, Anderson SG, O’Kane PD, Keavney B, Nolan J, Oldroyd KG, Perera D, Redwood S, Zaman A, Ludman PF, de Belder MA; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Eur Heart J. 2014 Nov 14;35(43):3004-12a. doi: 10.1093/eurheartj/ehu303. Epub 2014 Aug 28.
  74. Arterial access site utilization in cardiogenic shock in the United Kingdom: is radial access feasible? Mamas MA, Anderson SG, Ratib K, Routledge H, Neyses L, Fraser DG, Buchan I, de Belder MA, Ludman P, Nolan J; British Cardiovascular Intervention Society; National Institute for Cardiovascular Outcomes Research. Am Heart J. 2014 Jun;167(6):900-8.e1. doi: 10.1016/j.ahj.2014.03.007. Epub 2014 Mar 27.
  75. Mortality in South Asians and Caucasians after percutaneous coronary intervention in the United Kingdom: an observational cohort study of 279,256 patients from the BCIS (British Cardiovascular Intervention Society) National Database. Jones DA, Gallagher S, Rathod KS, Redwood S, de Belder MA, Mathur A, Timmis AD, Ludman PF,Townend JN, Wragg A; NICOR (National Institute for Cardiovascular Outcomes Research). JACC Cardiovasc Interv. 2014 Apr;7(4):362-71. doi: 10.1016/j.jcin.2013.11.013.
  76. Long-term follow-up of elective chronic total coronary occlusion angioplasty: analysis from the U.K. Central Cardiac Audit Database. George S, Cockburn J, Clayton TC, Ludman P, Cotton J, Spratt J, Redwood S, de Belder M, de Belder A, Hill J, Hoye A, Palmer N, Rathore S, Gershlick A, Di Mario C,Hildick-Smith D; British Cardiovascular Intervention Society; National Institute for Cardiovascular Outcomes Research. J Am Coll Cardiol. 2014 Jul 22;64(3):235-43. doi: 10.1016/j.jacc.2014.04.040. Erratum in: J Am Coll Cardiol. 2014 Oct 7;64(14):1538.
  77. Outcomes in patients with cardiogenic shock following percutaneous coronary intervention in the contemporary era: an analysis from the BCIS database (British Cardiovascular Intervention Society). Kunadian V, Qiu W, Ludman P, Redwood S, Curzen N, Stables R, Gunn J, Gershlick A; National Institute for Cardiovascular Outcomes Research. JACC Cardiovasc Interv. 2014 Dec;7(12):1374-85. doi: 10.1016/j.jcin.2014.06.017.
  78. Outcomes after emergency percutaneous coronary intervention in patients with unprotected left main stem occlusion: the BCIS national audit of percutaneous coronary intervention 6-year experience. Patel N, De Maria GL, Kassimis G, Rahimi K, Bennett D, Ludman P, Banning AP. JACC Cardiovasc Interv. 2014 Sep;7(9):969-80. doi: 10.1016/j.jcin.2014.04.011.
  79. Comparative outcomes after unprotected left main stem percutaneous coronary intervention: a national linked cohort study of 5,065 acute and elective cases from the BCIS Registry (British Cardiovascular Intervention Society). Almudarra SS, Gale CP, Baxter PD, Fleming SJ, Brogan RA, Ludman PF, de Belder MA, Curzen NP; National Institute for Cardiovascular Outcomes Research (NICOR). JACC Cardiovasc Interv. 2014 Jul;7(7):717-30. doi: 10.1016/j.jcin.2014.03.005.
  80. Contemporary clinical outcomes of patients treated with or without rotational coronary atherectomy–an analysis of the UK central cardiac audit database. Cockburn J,Hildick-Smith D, Cotton J, Doshi S, Hanratty C, Ludman P, Robinson D, Redwood S, de Belder M, de Belder A. Int J Cardiol. 2014 Jan 1;170(3):381-7. doi: 10.1016/j.ijcard.2013.11.018. Epub 2013 Nov 13.
  81. Influence of arterial access site selection on outcomes in primary percutaneous coronary intervention: are the results of randomized trials achievable in clinical practice? Mamas MA, Ratib K, Routledge H, Neyses L, Fraser DG, de Belder M, Ludman PF, Nolan J; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. JACC Cardiovasc Interv. 2013 Jul;6(7):698-706. doi: 10.1016/j.jcin.2013.03.011. Epub 2013 Jun 14
  82. Influence of access site choice on incidence of neurologic complications after percutaneous coronary intervention. Ratib K, Mamas MA, Routledge HC, Ludman PF, Fraser D, Nolan J. Am Heart J. 2013 Mar;165(3):317-24. doi: 10.1016/j.ahj.2012.10.015. Epub 2012 Dec 22.
  83. British Cardiovascular Intervention Society Registry for audit and quality assessment of percutaneous coronary interventions in the United Kingdom. Ludman PF; British Cardiovascular Intervention Society. Heart. 2011 Aug;97(16):1293-7. doi: 10.1136/heartjnl-2011-300299. Epub 2011 Jun 30.

    Live Case ACI 2019 – Essex Cardiac Centre – PCI in a patient with previous coronary artery bypass grafting (2)

    Written by

    Live Case ACI 2019 – Essex Cardiac Centre – PCI in a patient with previous coronary artery bypass grafting (2)

    Dr Paul KellyPCI in a patient with previous coronary artery bypass grafting – native CTO-RCA PCI

    Presentation

    17th January 2019

    Related Article Overview

    Authors:
    Gerald J Clesham, Grigorios Karamasis, Paul Kelly, James Spratt, Thomas Keeble

    Presented:
    ACI 2019

    Published:
    January 2019

    Article Title:
    Live Case ACI 2019 – Essex Cardiac Centre – PCI in a patient with previous coronary artery bypass grafting (2)

    Live Case ACI 2019 – Essex Cardiac Centre – PCI in a patient with previous coronary artery bypass grafting (2)

    The team from Essex Cardiothoracic Centre perform a case of percutaneous coronary intervention in a patient with a degenerated saphenous vein graft to the right coronary artery . The proposed target is the native RCA chronic total occlusion. What is the rationale for CTO-PCI over vein graft intervention, or medical therapy? What is the optimal PCI strategy?

    Download PDF

    Live Case ACI 2019 – Essex Cardiac Centre – PCI in a patient with previous coronary artery bypass grafting

    Written by

    Live Case ACI 2019 – Essex Cardiac Centre – PCI in a patient with previous coronary artery bypass grafting

    Dr Paul KellyPCI in a patient with previous coronary artery bypass grafting – native CTO-RCA PCI

    Webcast / Audiocast

    17th January 2019

    Related Article Overview

    Authors:
    Gerald J Clesham, Grigorios Karamasis, Paul Kelly, James Spratt, Thomas Keeble

    Presented:
    ACI 2019

    Published:
    January 2019

    Article Title:
    Live Case ACI 2019 – Essex Cardiac Centre – PCI in a patient with previous coronary artery bypass grafting

    Live Case ACI 2019 – Essex Cardiac Centre – PCI in a patient with previous coronary artery bypass grafting (2)

    The team from Essex Cardiothoracic Centre perform a case of percutaneous coronary intervention in a patient with a degenerated saphenous vein graft to the right coronary artery . The proposed target is the native RCA chronic total occlusion. What is the rationale for CTO-PCI over vein graft intervention, or medical therapy? What is the optimal PCI strategy?

    Download PDF