A Novel Classification for Predicting Chronic Total Occlusion Percutaneous Coronary Intervention

Dongfeng Zhang,Lijun Zhang,Hui Chen,Yi He,Jinfan Tian,Rui Wang,Zhiguo Ju,Xiantao Song,Haoran Xing

doi:10.3389/fcvm.2022.762351

Abstract

AimsChronic total occlusion (CTO) percutaneous coronary intervention (PCI) is characterized by a low success rate and an increase in complications. This study aimed to explore a new and simple classification method based on plaque composition to predict guidewire (GW) crossing within 30 min of CTO lesions.MethodsThis study consecutively enrolled individuals undergoing attempted PCI of CTO who underwent coronary computed tomographic angiography (CCTA) within 2 months. Lesions were divided into soft and hard CTO groups according to the necrotic core proportion.ResultsIn this study, 207 lesions were divided into soft (20.3%) and hard CTO (79.7%) groups according to a necrotic core percentage cutoff value of 72.7%. The rate of successful GW crossing within 30 min (57.6 vs. 85.7%, p = 0.004) and final success (73.3 vs. 95.2%, p = 0.001) were much lower in the hard CTO group. For patients with hard CTO, previous failed attempt, proximal side branch, bending > 45 degrees calcium ≥ 50% cross-sectional area (CSA), and distal reference diameter ≤ 2.5 mm were demonstrated to be associated with GW failure within 30 min. For patients with soft CTO, only blunt entry was proved to be an independent predictive factor of GW failure within 30 min.ConclusionsGrouping CTO lesions according to the proportion of necrotic core is reasonable and necessary in predicting GW crossing within 30 min. A soft CTO with a necrotic core is more likely to be recanalized compared with a hard CTO with fibrous and/or dense calcium. Different plaque types have variable predictive factors.

Highlights

A coronary chronic total occlusion (CTO) is generally accepted as 100% occlusion of a coronary artery for a duration ≥ 3 months
Several systems were developed to determine the grade of difficulty likely to be encountered in CTO percutaneous coronary intervention (PCI) [4–9], using scoring systems helped in selecting the appropriate candidates and optimizing treatment strategies
Lesions with the necrotic core proportion of ≥72.7% of the entire CTO plaque were defined as soft CTO (n = 42), whereas those with < 72.7% were defined as hard CTO (n = 165)

Summary

Introduction

A coronary chronic total occlusion (CTO) is generally accepted as 100% occlusion of a coronary artery for a duration ≥ 3 months. One-third of coronary artery disease (CAD) is partly due to CTO lesions that are identified by coronary angiography [1]. CTO was once treated as the last frontier of interventional cardiology because of its lower success rate and higher risk of CTO PCI Preprocedural Assessment complications. Continuous efforts have been made to increase the success rate of CTO percutaneous coronary intervention (PCI) in view of numerous clinical benefits, including reduced angina pectoris, increased ventricular function, and improved quality of life [2, 3]. In the past few decades, the rate of successful CTO PCI has steadily increased due to the development of equipment, progression of technology, and accumulation of operation experience. Several systems were developed to determine the grade of difficulty likely to be encountered in CTO PCI [4–9], using scoring systems helped in selecting the appropriate candidates and optimizing treatment strategies. We assume that some potential factors significantly influence CTO PCI outcomes

Methods

Results

Conclusion