Chronic total occlusion lesions

Despite the potential for improved outcome in patients treated percutaneously for chronic total occlusion, in many laboratories, these procedures are undertaken sparingly. Abbott et al. (12) analyzed 2000 patients undergoing PCI in four sequential waves of patients from 1997 to 2004. In this group, 5173 lesions were attempted. In the first cohort treated from 1997 to 1998, 9.6% of treated lesions were chronic total occlusions in the last cohort from 2004, the percentage of lesions treated that were chronic total occlusions had decreased to 5.7% (p < 0.0001) (Fig. 2). Procedural success declined from 79,7% to 71,4% during those same time periods, Procedural success rates such as this may be an over estimate because series of chronic total occlusion cases contain only patients in whom the... 

Suzuki S, Furui S, Kohtake H, et al. Radiation exposure to patient s skin during percutaneous coronary intervention for various lesions including chronic total occlusion. Circulation 2006 70 44-48. 

PCI for Multivessel Disease and Complex Lesions 49 PCI for Left Main Disease 49 Bifurcation Stenting 51 PCI for Chronic Total Occlusions 51 PCI and CABG Complementary Rather than Competitive Strategies 54 Antiplatelet and Antithrombotic Therapies in PCI 54 Role of Newer Imaging Strategies and PCI 55... 

Constrictive bronchiolitis is characterized by subepithehal acellular fibrosis in the walls of membranous and respiratory bronchioles causing concentric narrowing or complete obliteration of the airway lumen (Fig. 1) smooth muscle hyperplasia may also be present. Progressive concentric narrowing is associated with distortion of the lumen, mucostasis, and patchy chronic inflammation. Cicatritial bronchiolitis may be a very subtle lesion, the only clue present in the biopsy specimen being the reduction of the number of bronchioles compared with that of centrilobular arterial branches. A peculiar form of constrictive bronchiolitis, neuroendocrine cell hyperplasia with bronchiolar fibrosis has been reported by Aguayo et al. in 1992 (6). The mildest lesion consists of linear zones of neuroendocrine cell hyperplasia in the bronchiolar mucosa with focal sub-epithelial fibrosis. In more obvious lesions, plaque of eccentric fibrous tissue partially occludes the lumen. In most severe stage there is a total occlusion of the lumen by fibrous tissue with few visible neuroendocrine cells. 

Cool wet dressings or total body wraps placed directly onto the skin can be effective in relieving itching, particularly at night. Wet wraps used in conjunction with topical corticosteroids can be used for acute flares or chronic, lichenified lesions." " Skin maceration, fissures, and subsequent infections can occur, and thus these occlusive dressings should be limited to severe, chronic lesions. Tepid compresses applied to skin for 20 minutes four to six times daily can aid in drying out the oozing lesions. 

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