Colm Hanratty's research while affiliated with Dublin Dental University Hospital and other places
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Publications (100)
Background
C-reactive protein (CRP) is an inflammatory biomarker and has been implicated in the pathogenesis of atherosclerotic lesion formation, plaque rupture, and coronary thrombosis. Its relationship to adverse angiographic outcomes after coronary stenting however remains uncertain.
Purpose
We aimed to test the association of baseline CRP level...
While many CTOs can be crossed using antegrade techniques, some more complex occlusions require a retrograde approach. Two strategies can be employed to cross occlusions from the retrograde approach: retrograde wiring (RW) and retrograde dissection and re-entry (RDR).Many of the principles of RW are the same as those for antegrade wiring and depend...
Background
Patients with prior coronary artery bypass grafting (CABG) frequently require repeat percutaneous revascularization due to advanced age, progressive coronary artery disease and bypass graft failure. Percutaneous coronary intervention (PCI) of either the bypass graft or the native coronary artery may be performed. Randomized trials compar...
Funding Acknowledgements
Type of funding sources: None.
Background
Patient-reported experience metric (PREM) questionnaires are an important tool for evaluating patient experience.
Purpose
Validated PREM tools may help to identify areas of quality improvement within healthcare.
Methods
A novel tool developed by the Patient Initiative Committee o...
Background
Measurement of fractional flow reserve (FFR) has an established role in guiding percutaneous coronary intervention. We tested the hypothesis that, at the stage of diagnostic invasive coronary angiography, systematic FFR-guided assessment of coronary artery disease would be superior, in terms of resource use and quality of life, to assess...
Purpose
The aim of this study was to provide 2-year clinical outcomes for patients with Medina 1,1,1 bifurcation lesions treated with a culotte technique, comparing Synergy and Xience drug eluting stent (DES) platforms. A sub-group analysis of 9-month Optical Coherence Tomography (OCT) was performed to assess stent healing.
Methods
A total of 170...
Background:
Improvements in drug-eluting stent design have led to a reduced frequency of repeat revascularisation and new biodegradable polymer coatings may allow a shorter duration of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI).
Aims:
The Improved Drug-Eluting stent for All-comers Left Main (IDEAL-LM) study a...
Objectives
The authors used the BCIS (British Cardiovascular Intervention Society) database to define the factors associated with percutaneous coronary intervention (PCI) procedural complexity.
Background
Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is an emerging concept that is poorly defined.
Methods
The BCIS (Brit...
Introduction
Patient-reported experience metric (PREM) questionnaires are important tools to evaluate the experience of patients in their interaction with healthcare systems but have not been widely used in patients undergoing cardiovascular procedures. Validated PREM tools may identify areas of improvement surrounding patient encounters and be use...
The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-ca...
Intravascular lithotripsy (IVL) has been shown to be safe and effective for calcium modification in nonocclusive coronary artery disease (CAD), but there are only case reports of its use in calcified chronic total occlusions (CTO). We report data from an international multicenter registry of IVL use during CTO percutaneous coronary intervention (PC...
Aims:
To describe the utility and safety of intravascular lithotripsy (IVL) in the setting of primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI).
Methods and results:
We performed a retrospective analysis, across six UK sites of all patients in whom IVL was used for coronary calcium modification of th...
A 46-year-old man with type 1 diabetes underwent percutaneous coronary intervention with bioresorbable scaffold implantation for a long segment of physiologically significant left anterior descending coronary artery disease. The procedure was complicated by longitudinal stent deformation (LSD). The images carry several important educational message...
Over the past 2 decades, chronic total occlusion (CTO) percutaneous coronary intervention has developed into its own subspecialty of interventional cardiology. Dedicated terminology, techniques, devices, courses, and training programs have enabled progressive advancements. However, only a few randomized trials have been performed to evaluate the sa...
Background:
The aim of this study was to evaluate the safety and efficacy of the novel NovaCross microcatheter system in patients with ischemic heart disease due to coronary chronic total occlusions (CTO).
Methods:
A total of 191 subjects between the ages of 25-80 years were recruited in 10 investigational sites. Each subject underwent a percuta...
Objectives
The aim of this study was to assess angiographic, imaging, and clinical outcomes following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with dissection and re-entry techniques (DART) and subintimal (SI) stenting compared with intimal techniques.
Background
Reliable procedural success and safety in CTO PCI requi...
Aims:
We investigated the association between the use and findings of IVUS with clinical outcomes in the PCI arm of a randomised trial of LMS PCI.
Methods and results:
The NOBLE trial randomised patients with LMS disease to treatment by PCI or CABG. Of 603 patients treated by PCI, 435(72%) underwent post-PCI IVUS assessment of which 224 were ana...
Objectives:
This study aimed to present a case series of patient treated for stent underexpansion resistant to conventional treatment with intravascular lithotripsy (IVL).
Background:
Stent underexpansion is a powerful predictor of long-term stent patency and correlates with unfavorable clinical outcomes. This case series demonstrates the utilit...
Background:
Complex high-risk and indicated revascularization using percutaneous coronary intervention (CHIP-PCI) is an emerging concept that is poorly studied.
Objective:
To define temporal changes in CHIP-PCI volumes, and the relationship between operator CHIP-PCI volume and patient outcomes.
Methods and results:
Data were analyzed on all CH...
Background:
Competitive flow from saphenous vein grafts (SVG) that remain patent following percutaneous coronary intervention (PCI) of the native vessel may compromise durability of the reconstructed vessel. SVG sacrifice has been advocated, but the safety and longer-term outcomes of this are unknown.
Methods:
We retrospectively reviewed all pos...
Background:
Percutaneous coronary intervention (PCI) is increasingly used in revascularisation of patients with left main coronary artery disease in place of the standard treatment, coronary artery bypass grafting (CABG). The NOBLE trial aimed to evaluate whether PCI was non-inferior to CABG in the treatment of left main coronary artery disease an...
Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI.
1. Ischemic symptom improvement is the primary indicatio...
Coronary chronic total occlusions (CTOs) are a commonly encountered lesion. These present in a diverse patient population with variable anatomy. Technical success rates of ~90% are achievable for CTO lesions in centers with appropriate expertise. Many lesions can be crossed with wire-based techniques. However, the most anatomically complex and tech...
Aims:
Coronary intravascular lithotripsy (IVL) is a novel approach to vascular calcium modification that restores vessel compliance allowing effective lesion expansion. In this study we report the capacity for coronary IVL to precipitate ventricular ectopics ("shocktopics") and asynchronous cardiac pacing.
Methods and results:
This was a retrosp...
Background
The benefits of chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) are being questioned. The aim of this study was to assess the effects of CTO PCI on absolute myocardial perfusion, as compared with PCI of hemodynamically significant non‐CTO lesions.
Methods
Consecutive patients with a preserved left ventric...
Improved technical equipment, dissemination of best practices, and the importance of complete coronary revascularization have led to a renewed interest in coronary chronic total occlusion (CTO) PCI. In particular, the hybrid algorithm has been associated with increasing procedural success rates in the US. However, the hybrid algorithm only covers o...
Despite the ongoing development of technical skills, increasing operator experience and improvements in medical devices, percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) are still the most challenging procedures in interventional cardiology for coronary artery disease. Due to the complexity of the procedury have a higher...
Chronic total occlusion (CTO) of a coronary artery remains one of the most challenging scenarios in cinical practice. There is much debate about whether opening a CTO is clinically indicated and the procedures are often considered too risky. As a result many patients with a clinical indication for percutaneous coronary intervention (the presence of...
The Oxford Textbook of Interventional Cardiology is the definitive text, spanning the whole spectrum of interventional cardiology procedures, including management of patients with coronary artery disease, one of the leading killers in western society. This textbook, covering key procedures and fully revised and updated to include the latest trials,...
Aims:
The aim of this study was to provide contemporary outcome data for patients with de novo coronary disease and Medina 1,1,1 lesions who were treated with a culotte two-stent technique, and to compare the performance of two modern-generation drug-eluting stent (DES) platforms, the 3-connector XIENCE and the 2-connector SYNERGY.
Methods and re...
Objectives:
A retrospective study was performed to investigate if the generation of X-ray system used was an independent factor for radiation dose in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Background:
PCI procedures for CTOs are known to be associated with higher doses of radiation. The authors suspected progress...
[This corrects the article DOI: 10.15420/icr.2018.10.2.].
Objectives:
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) has historically been associated with higher event rates during follow-up. The hybrid algorithm and contemporary wiring and dissection re-entry (DR) techniques can potentially improve long-term outcomes after CTO-PCI. This study assessed the long-term clinical ou...
Objectives:
The aim of the Hybrid Video Registry (HVR) is to assess the acute safety and efficacy of the Hybrid Approach in comparison to other contemporary methods of CTO-PCI.
Background:
Recently, multiple techniques in Percutaneous Coronary Intervention (PCI) for coronary Chronic Total Occlusions (CTO) have been synthesized into a method refe...
Background:
Small observational studies demonstrate the feasibility of transradial approach for chronic total occlusion (CTO) percutaneous coronary intervention. The aim of the current study is to assess technical success, complication rates, and procedural efficiency in fully transradial approach (fTRA) and transfemoral approach (TFA) in a large...
Aims:
To investigate if recent technical and procedural developments in percutaneous coronary intervention (PCI) significantly influence outcomes in appropriately selected patients with three-vessel (3VD) coronary artery disease.
Methods and results:
The SYNTAX II study is a multicenter, all-comers, open-label, single arm study that investigated...
Background:
Development of the CrossBoss and Stingray devices for antegrade dissection and reentry (ADR) of chronic total occlusions has improved historically suboptimal outcomes. However, the outcomes, safety, and failure modes of the technique have to be studied in a larger patient cohort. This preplanned substudy of the RECHARGE registry (Regis...
Background:
Coronary perforation (CP) during chronic total occlusion percutaneous coronary intervention for stable angina (CTO-PCI) is a rare but serious event. The evidence base is limited, and the long-term effects are unclear. Using a national PCI database, the incidence, predictors, and outcomes of CP during CTO-PCI were defined.
Methods and...
We aimed to determine clinical outcomes 1 year after successful chronic total occlusion (CTO) PCI and, in particular, whether use of dissection and re-entry strategies affects clinical outcomes. Hybrid approaches have increased the procedural success of CTO percutaneous coronary intervention (PCI) but longer-term outcomes are unknown, particularly...
Aims:
The aim of the present study was to investigate the effects of successful PCI CTO on absolute myocardial blood flow (MBF) and functional recovery.
Methods and results:
Patients with a documented CTO were prospectively examined for ischemia and viability with H215O positron emission tomography (PET) and late gadolinium enhancement cardiac m...
Aims:
As more elderly and co-morbid patients require percutaneous revascularization, 1 year of dual-antiplatelet therapy (DAPT) becomes concerning. Synergy stents (Boston Scientific) allow for early cessation of DAPT. This study assessed those in our unit who underwent percutaneous coronary intervention (PCI) with a Synergy stent to examine a mini...
To the Editor We read with interest the review by Shroff et al¹ on same-day discharge after percutaneous coronary intervention (PCI) in the May issue of JAMA Cardiology. In this review, the authors conducted a literature search of PubMed for studies on same-day discharge after PCI published in English from January 1995 to July 2015.
Aims:
A novel 'locking' microcatheter has been developed to address residual failure modes in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The aim of this study was to report the first clinical experience of this device.
Methods and results:
The microcatheter was assessed prospectively in 92 unselected CTO cases across...
Gender differences exist in clinical outcomes following routine PCI, but studies reporting such outcomes following CTO PCI are limited. We assessed the characteristics and outcomes of female patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI).We retrospectively analysed a dedicated national (United Kingdom) pr...
Background:
The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to improve procedural outcomes. Large, prospective studies validating the algorithm in a broad multicenter setting with operators of different experience levels are lacking.
Objectives:
The RECHARGE (REgistry of Crossboss and...
Background:
Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main coronary artery disease.
Methods:
In this prospec...
Objectives Treatment options for coronary chronic total occlusions (CTO) are limited, with low historical success rates from percutaneous coronary intervention (PCI). We report procedural outcomes of CTO PCI from 7 centres with dedicated CTO operators trained in hybrid approaches comprising antegrade/retrograde wire escalation (AWE/RWE) and dissect...
Background:
Chronic total occlusion (CTO) revascularisation has a crucial role in contemporary percutaneous coronary intervention (PCI). Procedural success is influenced by disease complexity, calcific burden and patient characteristics but has substantially improved with the implementation of novel hybrid strategies. However, vascular-access rela...
Background Successful recanalisation of chronic total occlusion (CTO) is associated with improved mortality but a strong correlation with burden of ischaemia and symptoms is lacking. Myocardial perfusion reserve (MPR) by first-pass perfusion cardiac magnetic resonance imaging (CMR) is an accurate non-invasive measure of myocardial ischaemia. We eva...
Aims:
Despite advances in understanding the physiological role of collaterals in coronary chronic total occlusions (CTOs), collateral anatomy remains poorly defined. Our aim was to define the anatomy and interventional utility of collaterals within a large population of patients with CTOs.
Methods and results:
We studied the coronary angiograms...
Objectives:
The aim of this first-in-human (FIH) study was to evaluate the efficacy and safety of the novel NovaCross microcatheter system in eligible consecutive patients with chronic total occlusion (CTO).
Background:
CTOs remain the most challenging lesion subset in percutaneous coronary intervention (PCI). Failure to cross to the distal true...
Objective We sought to investigate the incidence of complications associated with V2 Guideliner, understand the mechanisms and evaluate the impact of alterations made to the V3 Guideliner.
Methods Retrospective analysis of consecutive cases employing V2 Guideliner from two university teaching hospitals. Complications were identified, analysed and c...
The hybrid approach is a systematic algorithm-led percutaneous coronary intervention strategy based on the identification of key anatomical features on coronary angiography to treat chronic total occlusions. The aims of this approach are to provide a standardised tool for physician training and programme development, avoiding futile strategies to i...
Objectives
To assess the efficacy and safety of the modified contrast microinjection technique to facilitate chronic total occlusion recanalization.Background
The success rate of chronic total occlusion percutaneous coronary intervention (CTO-PCI) does not exceed 90% even in the most experienced centres. We have previously demonstrated that a large...
Aims As progressively more elderly and comorbid patients are being considered for revascularisation the need for one year of dual anti-platelets becomes of increasing concern. SYNERGY Everolimus-eluting platinum chromium coronary stents allow for early cessation of dual antiplatelet therapy (DAPT) due to complete polymer absorption and drug elution...
To assess the impact of proctoring for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in six UK centres.
We retrospectively analysed 587 CTO procedures from six UK centres and compared success rates of operators who had received proctorship with success rates of the same operators before proctorship (pre-proctored) and opera...
The development of a large hematoma impairing visualization of the distal true lumen is a recognized complication of antegrade recanalization of chronic total occlusions, often forcing the operator to abort the procedure or switch to a retrograde approach. We describe a novel technique utilizing an over-the-wire balloon inflated in the proximal occ...
There is substantial evidence that recanalization of a chronic total occlusion is beneficial; nonetheless, it is generally underutilized in clinical practice. We consider the Aesop's fable of the “Fox and the Grapes” as analogous to the current situation in interventional cardiology. The technical challenges in achieving CTO recanalization has led...
Objectives:
To define the size of the left mainstem coronary artery (LMS) in the Northern Irish population and investigate the clinical feasibility, safety, and efficacy of post dilation beyond nominal diameter of current generation Drug eluting stent (DES) when treating the LMS.
Background:
There is no prospective data examining the need, feasi...
The introduction and widespread adoption of drug-eluting stents into routine clinical practice has seen tremendous changes in the practice of interventional cardiology. For a prolonged period, manufacturers have focused research on drugs and polymers that are the key to the prevention of in-stent restenosis. However, stent platform design and its c...
In contemporary practice there are three main methods that can be employed when attempting to open a chronic
total occlusion (CTO) of a coronary artery; antegrade or retrograde wire escalation, antegrade dissection re-entry and retrograde
dissection re-entry. This editorial will attempt to clarify the anatomical features that can be identified to h...
