Abstract
Coronary chronic total occlusion (CTO) angioplasties are considered the most complex of angioplasties requiring experienced operators as well as many specific materials and techniques. This study aims to identify the predictors of success or failure of CTO angioplasty and to evaluate the short- and medium-term results of this procedure. This study is a single-centric retrospective comparative study including patients who underwent CTO angioplasty in the cardiology “A” department at Fattouma-Bourguiba Hospital during the period between January and 2008 and December 2015. Our study included 200 patients with attempt of CTO angioplasty. The mean age was 63 ± 8.63 years and the mean number of cardio-vascular risk factors was 2.67. Acute coronary syndrome was the main indication (57.5%) for coronarography. A multi-truncal coronary status was reported in 53.5% of the cases. The mean J-CTO score was 1.42 ± 1.3 and 44% of lesions were estimated difficult to very difficult. The anterograde approach has been the most used technique. The angiographic success of ATL has been reported in 106 patients (53%). DES were implanted in 69.9% of cases. The leading cause of angioplasty failure was the impossibility to cross the lesion by the wire. The procedural complications occurred in 11.5% of cases. The independent predictors of ATL failure were: dyslipidaemia, a bending > 45 degrees ( P < 0.001), a diameter of the occluded vessel < 3 mm ( P < 0.001) and JCTO score ≥ 2 ( P < 0.001). Short- and medium-term clinical follow-up showed that the success of ATL, compared to failure, decreased significantly the rate of angina recurrence ( P < 0.001), re-hospitalization ( P = 0.012) and major adverse cardio-vascular events “MACE” ( P = 0.006), but without significant impact on mortality. The results of our study showed a clinical benefit of CTO angioplasty in case of success and demonstrated once more many failure predicting angiographic factors.
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