James W. Choi M.D.

Nikolakopoulos, I., J. W. Choi, K. Alaswad, J. J. Khatri, O. Krestyaninov, D. Khelimskii, R. W. Yeh, F. A. Jaffer, C. Toma, M. Patel, E. Mahmud, N. J. Lembo, M. Parikh, A. J. Kirtane, Z. A. Ali, F. Gkargkoulas, B. Uretsky, A. M. Sheikh, E. Vemmou, I. Xenogiannis, B. V. Rangan, S. Garcia, S. Abdullah, S. Banerjee, M. N. Burke, E. S. Brilakis and D. Karmpaliotis (2020). “Equipment utilization in chronic total occlusion percutaneous coronary interventions: Insights from the PROGRESS-CTO registry.” Catheter Cardiovasc Interv Jun 29. [Epub ahead of print.].

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BACKGROUND: We examined guidewire and microcatheter utilization during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: We examined device utilization in 2,968 CTO PCIs performed in 2,936 patients at 19 US and two international center between January 2016 and January 2019. RESULTS: The median number of antegrade guidewires used per case declined (5 in 2016 vs 3 in 2019) and was higher in higher complexity lesions (2 in J-CTO 0 vs. 8 in J-CTO 4 or 5 score). In antegrade-only procedures, the most frequently used guidewires were the Pilot 200 (Abbott Vascular, 37%), Fielder XT (Asahi Intecc, 25%) and Gaia third (Asahi Intecc, 18%), while the most commonly used microcatheters were the Turnpike Spiral (Vascular Solutions, 18%) and Turnpike (Vascular Solutions, 16%). Compared with 2012-2015, during 2016-2019 use of novel equipment such as the Gaia guidewires and the Turnpike microcatheters led to decreased use of Confianza Pro 12 (Asahi Intecc) wire and Corsair (Asahi Intecc) family of microcatheters. In retrograde cases, the guidewires most commonly used were the Sion (44%), Pilot 200 (27%) and Fielder FC (26%), while the Corsair/Corsair Pro, Turnpike LP (Vascular Solutions) and Caravel (Asahi Intecc) were the most frequently used microcatheters for collateral crossing (29%, 26% and 22%, respectively). CONCLUSIONS: The most commonly used guidewires during CTO PCI are polymer-jacketed guidewires and the most commonly used microcatheters are torquable microcatheters.

Bohm, M., K. Kario, D. E. Kandzari, F. Mahfoud, M. A. Weber, R. E. Schmieder, K. Tsioufis, S. Pocock, D. Konstantinidis, J. W. Choi, C. East, D. P. Lee, A. Ma, S. Ewen, D. L. Cohen, R. Wilensky, C. M. Devireddy, J. Lea, A. Schmid, J. Weil, T. Agdirlioglu, D. Reedus, B. K. Jefferson, D. Reyes, R. D’Souza, A. S. P. Sharp, F. Sharif, M. Fahy, V. DeBruin, S. A. Cohen, S. Brar and R. R. Townsend (2020). “Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial.” Lancet Mar 27. pii: S0140-6736(20)30554-7. [Epub ahead of print].

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BACKGROUND: Catheter-based renal denervation has significantly reduced blood pressure in previous studies. Following a positive pilot trial, the SPYRAL HTN-OFF MED (SPYRAL Pivotal) trial was designed to assess the efficacy of renal denervation in the absence of antihypertensive medications. METHODS: In this international, prospective, single-blinded, sham-controlled trial, done at 44 study sites in Australia, Austria, Canada, Germany, Greece, Ireland, Japan, the UK, and the USA, hypertensive patients with office systolic blood pressure of 150 mm Hg to less than 180 mm Hg were randomly assigned 1:1 to either a renal denervation or sham procedure. The primary efficacy endpoint was baseline-adjusted change in 24-h systolic blood pressure and the secondary efficacy endpoint was baseline-adjusted change in office systolic blood pressure from baseline to 3 months after the procedure. We used a Bayesian design with an informative prior, so the primary analysis combines evidence from the pilot and Pivotal trials. The primary efficacy and safety analyses were done in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT02439749. FINDINGS: From June 25, 2015, to Oct 15, 2019, 331 patients were randomly assigned to either renal denervation (n=166) or a sham procedure (n=165). The primary and secondary efficacy endpoints were met, with posterior probability of superiority more than 0.999 for both. The treatment difference between the two groups for 24-h systolic blood pressure was -3.9 mm Hg (Bayesian 95% credible interval -6.2 to -1.6) and for office systolic blood pressure the difference was -6.5 mm Hg (-9.6 to -3.5). No major device-related or procedural-related safety events occurred up to 3 months. INTERPRETATION: SPYRAL Pivotal showed the superiority of catheter-based renal denervation compared with a sham procedure to safely lower blood pressure in the absence of antihypertensive medications. FUNDING: Medtronic.

Xenogiannis, I., F. Gkargkoulas, D. Karmpaliotis, O. Krestyaninov, D. Khelimskii, F. A. Jaffer, J. J. Khatri, D. E. Kandzari, R. M. Wyman, A. H. Doing, P. Dattilo, C. Toma, R. W. Yeh, H. Tamez, J. W. Choi, W. Jaber, H. Samady, A. M. Sheikh, S. Potluri, M. Patel, E. Mahmud, B. Elbaruni, M. P. Love, M. Koutouzis, I. Tsiafoutis, B. K. Jefferson, T. Patel, B. Uretsky, J. W. Moses, N. J. Lembo, M. Parikh, A. J. Kirtane, Z. A. Ali, A. B. Hall, M. S. Megaly, E. Vemmou, I. Nikolakopoulos, B. V. Rangan, P. W. Morley, B. Bou Dargham, S. Abdullah, S. Garcia, S. Banerjee, M. N. Burke, E. S. Brilakis and K. Alaswad (2020). “Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention via Saphenous Vein Graft.” JACC Cardiovasc Interv 13(4): 517-526.

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OBJECTIVES: The aim of this study was to examine the use of saphenous vein grafts (SVGs) for retrograde crossing during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: The use of SVGs for retrograde crossing during CTO PCI has received limited study. METHODS: A total of 1,615 retrograde CTO PCIs performed between 2012 and 2019 at 25 centers were examined. Clinical, angiographic, and technical characteristics and procedural outcomes were compared among retrograde cases via SVGs (SVG group) versus other collateral vessels (non-SVG group). RESULTS: Retrograde CTO PCI via SVGs was performed in 189 cases (12%). Patients in the SVG group were older (mean age 70 +/- 9 years vs. 64 +/- 10 years; p < 0.01) and had higher rates of prior myocardial infarction (62% vs. 51%; p < 0.01) and prior PCI (81% vs. 70%; p < 0.01). They were more likely to have moderate or severe calcification (81% vs. 65%; p < 0.01) and moderate or severe tortuosity (53% vs. 44%; p = 0.02) and had similar J-CTO (Multicenter CTO Registry in Japan) scores (3.2 +/- 1.0 vs. 3.1 +/- 1.1; p = 0.13) but higher PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores (4.7 +/- 1.7 vs. 3.1 +/- 1.1; p < 0.01). Technical (85% vs. 78%; p = 0.04) and procedural (81% vs. 74%; p = 0.04) success rates were higher in the SVG group, with no difference in in-hospital major adverse events (6.4% vs. 4.4%; p = 0.22). Contrast volume was lower in the SVG group (225 ml [173 to 325 ml] vs. 292 ml [202 to 400 ml]; p < 0.01). CONCLUSIONS: Use of SVGs for retrograde crossing is associated with higher rates of technical and procedural success and similar rates of in-hospital major adverse cardiac events compared with retrograde CTO PCI via other collateral vessels.

Xenogiannis, I., F. Gkargkoulas, D. Karmpaliotis, K. Alaswad, O. Krestyaninov, D. Khelimskii, J. W. Choi, F. A. Jaffer, M. Patel, E. Mahmud, J. J. Khatri, D. E. Kandzari, A. H. Doing, P. Dattilo, C. Toma, M. Koutouzis, I. Tsiafoutis, B. Uretsky, R. W. Yeh, H. Tamez, R. M. Wyman, B. K. Jefferson, T. Patel, W. Jaber, H. Samady, A. M. Sheikh, B. A. Malik, E. Holper, S. Potluri, J. W. Moses, N. J. Lembo, M. Parikh, A. J. Kirtane, Z. A. Ali, A. B. Hall, E. Vemmou, I. Nikolakopoulos, B. B. Dargham, B. V. Rangan, S. Abdullah, S. Garcia, S. Banerjee, M. N. Burke and E. S. Brilakis (2020). “The Impact of Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention (Insights From PROGRESS-CTO Registry).” Angiology 71(3): 274-280.

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The impact of peripheral artery disease (PAD) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We reviewed 3999 CTO PCIs performed in 3914 patients between 2012 and 2018 at 25 centers, 14% of whom had a history of PAD. We compared the clinical and angiographic characteristics and procedural outcomes of patients with versus without history of PAD. Patients with PAD were older (67 +/- 9 vs 64 +/- 10 years, P < .001) and had a higher prevalence of cardiovascular risk factors. They also had more complex lesions as illustrated by higher Japanese CTO score (2.7 +/- 1.2 vs 2.4 +/- 1.3, P < .001). In patients with PAD, the final crossing technique was less often antegrade wire escalation (40% vs 51%, P < .001) and more often the retrograde approach (23 vs 20%, P < .001) and antegrade dissection/reentry (20% vs 16%, P < .001). Technical success was similar between the 2 study groups (84% vs 87%, P = .127), but procedural success was lower for patients with PAD (81% vs 85%, P = .015). The incidence of in-hospital major adverse cardiac events was higher among patients with PAD (3% vs 2%, P = .046). In conclusion, patients with PAD undergoing CTO PCI have more comorbidities, more complex lesions, and lower procedural success.

Szerlip, M., D. N. Feldman, H. D. Aronow, J. C. Blankenship, J. W. Choi, I. Y. Elgendy, S. Elmariah, S. Garcia, B. H. Goldstein, H. Herrmann, R. S. Hira, M. R. Jaff, A. Kalra, E. Kaluski, C. J. Kavinsky, D. M. Kolansky, D. F. Kong, J. C. Messenger, D. Mukherjee, R. A. G. Patel, R. Piana, E. Senerth, M. Shishehbor, G. Singh, V. Singh, P. K. Yadav and D. Cox (2020). “SCAI publications committee manual of standard operating procedures.” Catheter Cardiovasc Interv 2020 Feb 14. [Epub ahead of print].

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Evidence-based recommendations for clinical practice are intended to help health care providers and patients make decisions, minimize inappropriate practice variation, promote effective resource use, improve clinical outcomes, and direct future research. The Society for Cardiovascular Angiography and Interventions (SCAI) has been engaged in the creation and dissemination of clinical guidance documents since the 1990s. These documents are a cornerstone of the society’s education, advocacy, and quality improvement initiatives. The publications committee is charged with oversight of SCAI’s clinical documents program and has created this manual of standard operating procedures to ensure consistency, methodological rigor, and transparency in the development and endorsement of the society’s documents. The manual is intended for use by the publications committee, document writing groups, external collaborators, SCAI representatives, peer reviewers, and anyone seeking information about the SCAI documents program.