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Coronary Artery Disease: HELP
Articles by Georgios Sianos
Based on 10 articles published since 2010
(Why 10 articles?)

Between 2010 and 2020, George Sianos wrote the following 10 articles about Coronary Artery Disease.
+ Citations + Abstracts
1 Review Report of a European Society of Cardiology-European Association of Percutaneous Cardiovascular Interventions task force on the evaluation of coronary stents in Europe: executive summary. 2015

Byrne, Robert A / Serruys, Patrick W / Baumbach, Andreas / Escaned, Javier / Fajadet, Jean / James, Stefan / Joner, Michael / Oktay, Semih / Jüni, Peter / Kastrati, Adnan / Sianos, George / Stefanini, Giulio G / Wijns, William / Windecker, Stephan. ·Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. · Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. · Bristol Heart Institute, Bristol, UK. · Interventional Cardiology, Hospital San Carlos, Madrid, Spain. · Interventional Cardiology, Clinique Pasteur, Toulouse, France. · Clinical Research Center, Uppsala University, Uppsala, Sweden. · CVPath Institute, Inc., Gaithersburg, USA. · Cardio Med Device Consultants, Baltimore, USA. · Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. · AHEPA University Hospital, Thessaloniki, Greece. · Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. · Cardiovascular Center O.L.V.Z., Aalst, Belgium. · Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland stephan.windecker@insel.ch. ·Eur Heart J · Pubmed #26071600.

ABSTRACT: The evaluation for European Union market approval of coronary stents falls under the Medical Device Directive that was adopted in 1993. Specific requirements for the assessment of coronary stents are laid out in supplementary advisory documents. In response to a call by the European Commission to make recommendations for a revision of the advisory document on the evaluation of coronary stents (Appendix 1 of MEDDEV 2.7.1), the European Society of Cardiology (ESC) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) established a Task Force to develop an expert advisory report. As basis for its report, the ESC-EAPCI Task Force reviewed existing processes, established a comprehensive list of all coronary drug-eluting stents that have received a CE mark to date, and undertook a systematic review of the literature of all published randomized clinical trials evaluating clinical and angiographic outcomes of coronary artery stents between 2002 and 2013. Based on these data, the TF provided recommendations to inform a new regulatory process for coronary stents. The main recommendations of the task force include implementation of a standardized non-clinical assessment of stents and a novel clinical evaluation pathway for market approval. The two-stage clinical evaluation plan includes recommendation for an initial pre-market trial with objective performance criteria (OPC) benchmarking using invasive imaging follow-up leading to conditional CE-mark approval and a subsequent mandatory, large-scale randomized trial with clinical endpoint evaluation leading to unconditional CE-mark. The data analysis from the systematic review of the Task Force may provide a basis for determination of OPC for use in future studies. This paper represents an executive summary of the Task Force's report.

2 Review Treatment of the chronic total occlusion: a call to action for the interventional community. 2015

Carlino, Mauro / Magri, Caroline J / Uretsky, Barry F / Brilakis, Emmanouil S / Walsh, Simon / Spratt, James C / Hanratty, Colm / Grantham, J Aaron / Rinfret, Stéphane / Thompson, Craig A / Lombardi, William L / Galassi, Alfredo R / Sianos, George / Latib, Azeem / Garbo, Roberto / Karmpaliotis, Dimitri / Kandzari, David E / Colombo, Antonio. ·San Raffaele Scientific Institute, Milan, Italy. ·Catheter Cardiovasc Interv · Pubmed #25382239.

ABSTRACT: 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 interventionalists, clinical cardiologists, and sometimes even patients to believe that CTO recanalization is not effective, and, therefore, not needed. This perspective reviews available data regarding efficacy and safety of CTO percutaneous coronary intervention (PCI) in the current drug-eluting stent era, discusses areas where more studies are required, and encourages the interventional community to utilize CTO PCI where appropriate based on current evidence.

3 Article Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry: The EuroCTO (CASTLE) Score. 2019

Szijgyarto, Zsolt / Rampat, Rajiv / Werner, Gerald S / Ho, Claudius / Reifart, Nicolaus / Lefevre, Thierry / Louvard, Yves / Avran, Alexandre / Kambis, Mashayekhi / Buettner, Heinz-Joachim / Di Mario, Carlo / Gershlick, Anthony / Escaned, Javier / Sianos, George / Galassi, Alfredo / Garbo, Roberto / Goktekin, Omer / Meyer-Gessner, Marcus / Lauer, Bernward / Elhadad, Simon / Bufe, Alexander / Boudou, Nicolas / Sievert, Horst / Martin-Yuste, Victoria / Thuesen, Leif / Erglis, Andrejs / Christiansen, Evald / Spratt, James / Bryniarski, Lesciak / Clayton, Tim / Hildick-Smith, David. ·London School of Hygiene and Tropical Medicine, London, United Kingdom. · Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom. · Department of Cardiology & Intensive Care, Klinikum Darmstadt, Darmstadt, Germany. · Department of Cardiology, Main Taunus Heart Institute, Frankfurt am Main, Germany. · Department of Cardiology, Institut Cardiovasculaire Paris Sud, Paris, France. · Department of Cardiology, Arnault Tzanck Institut, Saint Laurent du Var, France. · Division of Cardiology and Angiology II, University Heart Center Freiburg, Freiburg, Germany. · Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy. · Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom. · Hospital Clinico San Carlos IDISSC and Complutense, Madrid, Spain. · 1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece. · Department of Experimental and Clinical Medicine, University of Catania, Catania, Italy. · Interventional Cardiology Unit, San Giovanni Bosco Hospital, Torino, Italy. · Department of Cardiology, Istanbul Memorial Hospital, Istanbul, Turkey. · Department of Cardiology, Augusta Krankenhaus, Düsseldorf, Germany. · Department of Cardiology, Kardiologie Zentralklinik, Bad Berka, Germany. · Department of Cardiology, Centre Hospitalier de Marne-la-vallée, Jossigny, France. · Helios Heart Center Krefeld, University Witten/Herdecke, Witten, Germany. · Cardiology Department, Rangueil University Hospital, Toulouse, France. · Department of Cardiology, Cardiovascular Center Frankfurt, Frankfurt am Main, Germany. · Department of Cardiology, Hospital Clínic Barcelona, Barcelona, Spain. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia. · Department of Cardiology B, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, St. George's University NHS Trust, London, United Kingdom. · Department of Cardiology, Interventional Electrocardiology and Hypertension Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland. · Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom. Electronic address: david.hildick-smith@bsuh.nhs.uk. ·JACC Cardiovasc Interv · Pubmed #30711551.

ABSTRACT: OBJECTIVES: The aim was to establish a contemporary scoring system to predict the outcome of chronic total occlusion coronary angioplasty. BACKGROUND: Interventional treatment of chronic total coronary occlusions (CTOs) is a developing subspecialty. Predictors of technical success or failure have been derived from datasets of modest size. A robust scoring tool could facilitate case selection and inform decision making. METHODS: The study analyzed data from the EuroCTO registry. This prospective database was set up in 2008 and includes >20,000 cases submitted by CTO expert operators (>50 cases/year). Derivation (n = 14,882) and validation (n = 5,745) datasets were created to develop a risk score for predicting technical failure. RESULTS: There were 14,882 patients in the derivation dataset (with 2,356 [15.5%] failures) and 5,745 in the validation dataset (with 703 [12.2%] failures). A total of 20.2% of cases were done retrogradely, and dissection re-entry was performed in 9.3% of cases. We identified 6 predictors of technical failure, collectively forming the CASTLE score (Coronary artery bypass graft history, Age (≥70 years), Stump anatomy [blunt or invisible], Tortuosity degree [severe or unseen], Length of occlusion [≥20 mm], and Extent of calcification [severe]). When each parameter was assigned a value of 1, technical failure was seen to increase from 8% with a CASTLE score of 0 to 1, to 35% with a score ≥4. The area under the curve (AUC) was similar in both the derivation (AUC: 0.66) and validation (AUC: 0.68) datasets. CONCLUSIONS: The EuroCTO (CASTLE) score is derived from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcome.

4 Article Contemporary Techniques for Coronary Chronic Total Occlusions Revascularisation: Sharing Experience in a Global World: Proceedings of a satellite symposium held at EuroPCR on May 20th - 23rd 2014 in Paris Katrina Mountfort, Medical Writer, Radcliffe Cardiology. 2014

Mountfort, Katrina / Joachim Büttner, Heinz / Yamane, Masahisa / Reifart, Nicolaus / Escaned, Javier / Sianos, Georgios / Goktekin, Omer / Garbo, Roberto. ·Universitaets-Herzzentrum Freiburg, Bad Krozingen, Germany. · Sayama Hospital, Saitama, Japan. · Main Taunus Kliniken, Bad Soden, Germany. · Clinico San Carlos University Hospital, Madrid, Spain. · AHEPA University Hospital, Thessaloniki, Greece. · Bezmialem Vakif University, Istanbul, Turkey. · Ospedale San Giovanni Bosco, Torino, Italy. ·Interv Cardiol · Pubmed #29588805.

ABSTRACT: Chronic total occlusions (CTO) are the most challenging lesions treated by interventional cardiologists. A symposium at EuroPCR 2014 discussed factors influencing the success of percutaneous intervention (PCI) in CTO. Current treatment paradigms suggest that one or two vessel disease should be treated by PCI while three-vessel disease requires surgery if complete revascularisation cannot be achieved with PCI. In patients with CTO and multi-vessel disease timing is key, and evidence of ischaemic burden and expected completeness of revascularisation is required before PCI is undertaken. Other factors affecting procedural success include the available equipment and expertise of the operator. Flexiblity in strategy selection is also important as it is frequently necessary to switch strategies during the procedure. The presentation included two live cases that illustrated the complexity of this procedure.

5 Article Prognostic value of aortic and mitral valve calcium detected by contrast cardiac computed tomography angiography in patients with suspicion of coronary artery disease. 2014

Kamperidis, Vasileios / de Graaf, Michiel A / Broersen, Alexander / Ahmed, Wehab / Sianos, Georgios / Delgado, Victoria / Dijkstra, Jouke / Bax, Jeroen J / Scholte, Arthur J. ·Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, American Hellenic Educational Progressive Association University Hospital, Thessaloniki, Greece. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, American Hellenic Educational Progressive Association University Hospital, Thessaloniki, Greece. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.j.h.a.scholte@lumc.nl. ·Am J Cardiol · Pubmed #24423898.

ABSTRACT: Aortic valve calcium (VC) detected on noncontrast cardiac computed tomography angiography (CCTA) is known to be associated with all-cause mortality in asymptomatic and primary prevention population. However, the clinical significance of aortic and mitral VC remains unknown in symptomatic patients with suspected coronary artery disease (CAD). The aim of the present study was to assess whether aortic and mitral VC is independently associated with cardiac events and all-cause mortality in symptomatic patients with suspected CAD. A total of 369 symptomatic patients (mean age 55 ± 11 years, 60% men) who were referred for CCTA because of suspected CAD were included in the study. Aortic and mitral VC was detected and quantified by volume on contrast CCTA. Median follow-up for events (coronary events and all-cause mortality) was 2.8 (interquartile range 1.6 to 4.0) with a maximum of 5.5 years. A total of 39 patients (11%) had VC. Increased age, hypertension, and increased Agatston coronary artery calcium score were associated with VC. During the follow-up, patients with VC had higher risk for a coronary event (38.8% vs 11%, log-rank p <0.001) and worse survival rate (92.3% vs 99.1%, log-rank p = 0.002) compared with those without VC. Volume of VC was independently associated with outcome after adjusting for clinical variables (hazard ratio 1.88, p <0.001), Agatston coronary artery calcium score (hazard ratio 1.47, p = 0.03), and significant CAD (hazard ratio 1.81, p = 0.001). In conclusion, aortic and mitral VC volume quantified on contrast CCTA was independently associated with coronary events and all-cause mortality in patients with suspected CAD.

6 Article The negative impact of incomplete angiographic revascularization on clinical outcomes and its association with total occlusions: the SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial. 2013

Farooq, Vasim / Serruys, Patrick W / Garcia-Garcia, Hector M / Zhang, Yaojun / Bourantas, Christos V / Holmes, David R / Mack, Michael / Feldman, Ted / Morice, Marie-Claude / Ståhle, Elisabeth / James, Stefan / Colombo, Antonio / Diletti, Roberto / Papafaklis, Michail I / de Vries, Ton / Morel, Marie-Angèle / van Es, Gerrit Anne / Mohr, Friedrich W / Dawkins, Keith D / Kappetein, Arie-Pieter / Sianos, Georgios / Boersma, Eric. ·Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands. ·J Am Coll Cardiol · Pubmed #23265332.

ABSTRACT: OBJECTIVES: The study sought to evaluate the clinical impact of angiographic complete (CR) and incomplete (ICR) revascularization and its association with the presence of total occlusions (TO), after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in the "all-comers" SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial. BACKGROUND: In patients with complex coronary artery disease undergoing PCI or CABG, the long-term prognostic implications of CR versus ICR is unsettled. METHODS: In this post hoc study, consisting of randomized (n = 1,800) and nested PCI (n = 198) and CABG (n = 649) registries, 4-year clinical outcomes were compared in groups, with and without angiographic CR, in the PCI and CABG arms. Clinical outcomes were analyzed with Kaplan-Meier estimates, log-rank comparisons, and Cox regression analyses. Multivariate predictors of ICR were determined. Similar analyses were undertaken in the TO and non-TO treated groups of both study arms. RESULTS: Angiographic CR was achieved in 52.8% of the PCI arm and 66.9% of the CABG arm. Within the PCI and CABG arms, ICR (compared with CR) seemed to be a surrogate marker of a greater burden of anatomical coronary complexity and clinical comorbidity and was associated with significantly higher frequencies of 4-year mortality, all-cause revascularization, stent thrombosis (PCI arm), and major adverse cardiac and cerebrovascular events. The presence of a TO was the strongest independent predictor of ICR after PCI (hazard ratio: 2.70, 95% confidence interval: 1.98 to 3.67, p < 0.001). Eight hundred and forty patients (PCI: 26.3%, CABG: 36.4%, p < 0.001) were identified to have 1,007 TOs, with 68.1% of TOs located in the proximal-mid coronary vasculature. The findings associating ICR (compared with CR) with higher frequencies of 4-year mortality and major adverse cardiac and cerebrovascular events remained consistent in the TO-treated groups in the PCI and CABG arms. CONCLUSIONS: Within the PCI and CABG arms of the all-comers SYNTAX trial, angiographically determined ICR has a detrimental impact on long-term clinical outcomes, including mortality. This effect remained consistent in patients with and without TOs.

7 Article Five-year optical coherence tomography follow-up of an everolimus-eluting bioresorbable vascular scaffold: changing the paradigm of coronary stenting? 2012

Karanasos, Antonios / Simsek, Cihan / Serruys, Patrick / Ligthart, Jurgen / Witberg, Karen / van Geuns, Robert-Jan / Sianos, George / Zijlstra, Felix / Regar, Evelyn. ·Department of Interventional Cardiology, Thoraxcentre, Erasmus University Medical Centre, Rotterdam, The Netherlands. ·Circulation · Pubmed #22891170.

ABSTRACT: -- No abstract --

8 Article Eight-year clinical outcome after radioactive stent implantation: a treatment failure without irreversible long-term clinical sequelae. 2011

Sianos, Georgios / Papafaklis, Michail I / van Domburg, Ron / Adams, Denise / van Nierop, Josephine Wi / van der Giessen, Willem J / Serruys, Patrick W. ·Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands. gsianos@guth.gr ·EuroIntervention · Pubmed #21205589.

ABSTRACT: AIMS: To assess the long-term outcome of patients who underwent radioactive stent (RS) implantation. METHODS AND RESULTS: The RS study population consisted of 133 consecutive patients who underwent RS implantation between November 1997 and July 2000. They were matched using the propensity score method with 266 patients who underwent bare metal stenting (BMS) in the same span. Long-term survival status and information on MACE (death, non-fatal myocardial infarction or any re-intervention) was retrospectively obtained. Eight-year cumulative survival (90.2% vs. 87.4%, p = 0.57) was similar between the RS and BMS group respectively, while 8-year cumulative MACE-free survival was significantly lower in RS patients (42.1% vs. 64.3%, p < 0.001) due to the difference in events (mainly target lesion revascularisations [TLRs]) during the first year of follow-up (cumulative 1-year MACE-free survival: 59.4% vs. 86.7%, p < 0.001); there was no difference in the MACE rate after the first year (p = 0.71). The TLR rate at six months in the RS group was 29.3%, mainly due to edge restenosis and at one year 36.2% (control group: 9.5%, p < 0.001). CONCLUSIONS: A high incidence of MACE and re-intervention was observed during the first year following RS implantation, mainly related to TLR for edge restenosis. After the first year, the clinical outcome of RS patients was similar to the control group indicating that there are no late adverse effects related to low dose-rate intracoronary radiation therapy.

9 Article Jailed balloon protection: a new technique to avoid acute side-branch occlusion during provisional stenting of bifurcated lesions. Bench test report and first clinical experience. 2010

Burzotta, Francesco / Trani, Carlo / Sianos, Georgios. ·Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. ·EuroIntervention · Pubmed #20142195.

ABSTRACT: AIMS: Provisional stenting with drug-eluting-stents is actually adopted to treat most of bifurcated lesions. A major drawback of this technique is the risk of side-branch (SB) closure after main vessel (MV) stenting. METHODS AND RESULTS: We set-up, and bench tested, a novel technique for SB protection based on the placement of a balloon in the SB during MV stenting. The uninflated balloon, which remains jailed under the stent struts, serves to reduce both carina and plaque shifts due to its SB ostium spatial occupation. If SB flow is preserved after MV stenting, the jailed balloon is removed uninflated. If the SB becomes occluded after MV stenting, the jailed balloon may either be used as a marker and a favourable angle modifier to facilitate rewiring or can be dilated to try to restore SB flow. SB rewiring and kissing balloon inflation must be performed to correct stent deformation or malapposition. This novel technique has been successfully adopted in 20 patients with complex (55% unprotected left main, 85% Medina 1,1,1 lesions) true bifurcated lesions undergoing drug-eluting-stent implantation. CONCLUSIONS: The jailed balloon protection is a novel technique aimed at improving SB protection during provisional stenting of bifurcated lesions considered at high risk of SB compromise after MV stenting.

10 Minor Bifurcation CTO recanalization with contemporary antegrade and retrograde techniques in a patient with two chronically occluded coronary arteries. 2016

Konstantinidis, Nikolaos V / Sofidis, Georgios / Kolettas, Vasileios / Karvounis, Haralambos / Sianos, Georgios. ·1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece. · 1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece. Electronic address: gsianos@auth.gr. ·Hellenic J Cardiol · Pubmed #27903448.

ABSTRACT: -- No abstract --