Vishal G Patel's research while affiliated with University of Texas System and other places

... Patients with CTO probably have a clinical profile that is different to that of patients with chronic coronary ischemic disease in general. There not only are differences in terms of greater severity of coronary disease, but also in terms of increased non-coronary comorbidity, such as a higher rates of prevalence of diabetes, peripheral arterial disease, heart failure and a history of strokes [8] . The indications for percutaneous treatment of CTO are not well defined in the European guidelines for revascularization [9] , or in the guidelines for patients with stable chronic coronary disease [1] (Table 2). ...

... Although percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is currently associated with success rates of up to more than 90%, the mid-and long-term rate of vessel-oriented events, such as in-stent restenosis or target vessel failure, is still higher than in non-CTO-PCI [1,2]. Moreover, clinical and angiographic successful revascularization of a CTO does not always correlate with improvements in symptoms and reduction in clinical events [3,4]. ...

... 15 Although the technology of opening CTO vessels gradually matured, and the success rate of opening CTO vessels has been significantly improved, some studies still believe that opening CTO vessels does not bring obvious benefits to CTO patients. [16][17][18] At present, some studies advocate that although the patients' heart function can be improved after opening the CTO coronary artery, the incidence of adverse cardiovascular events (MACE) has not been reduced. [17][18][19][20] Whether opening CTO vessels is beneficial to patients varies from person to person, and different types of patients experience benefits of different extent. ...

... As a result, patients with ISR CTOs are often treated medically or referred for coronary artery bypass graft surgery. The recent development of the "hybrid approach" to CTO crossing has streamlined the crossing strategy selection and has increased the CTO PCI overall procedural success rates (7,8), yet its impact on the percutaneous treatment of CTOs due to ISR has not yet been evaluated and formed the focus of the present study. ...

... [1,2] They are encountered in up to 9% of chronic total occlusions (CTO) and can be also found in non-occlusive coronary lesions. [3,4] Multiple techniques have been described to face uncrossable lesions, aiming to modify the plaque or to increase the support. Multi-step algorithms have been designed, starting with support improvement and with "safer" small-balloon techniques and ending with more difficult and risky approaches, such as subintimal techniques. ...

... The lack of TIMI 3 flow at the end of the procedure accounted for 15% of procedural failures. This could be due to failure to re-enter into the distal true lumen, that was not recognized prior to stent implantation [27], poor outflow through the distal microcirculation, or diffuse distal epicardial disease that could not be completely covered with stents. Another potential reason is presence of a bifurcation at the CTO distal cap, with side branch occlusion after stenting; this is of particular importance when dissection/reentry techniques are utilized and may require use of the retrograde approach for bailout [28]. ...

... Interestingly, among coronary perforations that occurred using the retrograde approach, onethird involved collateral circulation. This finding is consistent with most of the available literature [20][21][22][23][24][25] . Similarly, in the Japanese Expert Registry and the Retrograde Summit General Registry, the channel perforation rates for the primarily retrograde approach were 10.2% and 6.2%, respectively 23 . ...

... Furthermore, except for the case with pulmonary atresia, 11) the present case had one of the largest CPF in all reports. Considering the size and deliverability of the device, the present study used the Amplatzer Vascular Plug 4 , which is one of the embolic disks for shunt flow and aneurysmal arteries 12) and is widely used for arteriovenous malformations, 13) internal iliac artery aneurysms, 14,15) arteriovenous fistulas, 16,17) and portal vein embolization. 18) Regarding a large aneurysm, such as an internal iliac artery aneurysm, the Amplatzer Vascular Plug 4 was used prior to endovascular aneurysm repair. ...

... However, there was no difference in allcause deaths between the two generation DES, which was similar to the results of a meta-analysis by Lanka et al. in 2014 (30). That meta-analysis enrolling 1,174 patients showed that the second-generation DES were associated with a lower incidence of death, target vessel revascularization compared with the firstgeneration DES, but the incidence of myocardial infarction and stent thrombosis was similar (30), while most participants in this study had multi-vessel diseases (61%) and the total length of stent implantation was more than 40 mm. Further analysis showed that the second-generation DES was better than the firstgeneration DES in these patients with multi-vessel lesion, long occlusive lesion requiring multiple stent implantation (total stent length ≥ 40 mm). ...

... Earlier studies with small numbers of patients suggested that ischemic postconditioning may reduce the infarct size estimated by CMR [353,354]. However, a 2014 meta-analysis of 15 randomized trials with 1545 patients showed no beneficial effects of ischemic postconditioning on ST-segment resolution, infarct size or any of the clinical outcomes (mortality, recurrent myocardial infarction, stent thrombosis or composite MACE) at 5 months after PCI [355]. The third Danish Study of Optimal Acute Treatment of Patients With ST Elevation Myocardial Infarction-Ischemic Postconditioning (DANAMI-3-iPOST) trial that randomized 1234 patients with STEMI presenting within 12 h from symptom onset and a baseline TIMI flow grade of 0-1 to conventional primary PCI or postconditioning (4 cycles of 30 s balloon occlusions followed by 30 s of reperfusion immediately after opening of the infarct-related artery and before stent implantation) found no difference in CMR-estimated infarct size, extent of MVO, myocardial salvage index or LVEF at 3 months or MACE (death or hospitalization for heart failure) over a median of 38 months [356]. ...