Abstract
Objective The initial recanalization rate of coronary chronic total occlusions (CTOs) is >85% when performed by experienced operators, but only 10% of prior failed CTO patients receive reattempted recanalization. This retrospective study analyzed the success rate and strategies used in reattempt percutaneous coronary intervention (PCI) of CTOs after prior failures. Methods Overall, 206 patients with 212 CTOs were enrolled. All patients with prior recanalization failures received reattempt PCIs from January 2015 to March 2019 at Zhongshan Hospital, Fudan University. Data on clinical factors (age, sex, comorbidities, left ventricular ejection fraction, history of cigarette usage, and revascularization), angiographic characteristics of CTOs (target lesion, Japanese Chronic Total Occlusion (J-CTO) score, the morphology of CTO lesions, and collateral channel scale), strategies (procedural approach and use of devices), and major adverse events were obtained and analyzed. Results The mean age of enrolled patients was 60.96 ± 12.36 years, with a male predominance of 90.3%. Of the patients, 47.1% had a prior myocardial infarction and 70.4% underwent stent implantation previously, while the in-stent occlusion rate was 6.6%. CTOs were primarily localized in the left anterior descending artery (43.9%) and the right coronary artery (43.9%). 80.7% of lesions were classified as very difficult (J-CTO score ≥3), and the overall success rate was 81.1%. In multivariable regression analysis, J-CTO score, collateral channel scale, application of coronary multispiral computed tomography angiography, dual injection, intravascular ultrasound, active greeting technique, parallel wiring, and CTO morphology were predictors of recanalization success. There were no significant differences in rates of procedural complications between the final recanalization success and failure groups. Conclusions Recanalization of complex CTOs is associated with high success rate and low complication rates when performed by high-volume CTO operators and after multiple reattempts.
Highlights
Chronic total occlusion (CTO) lesions are identified in 18%– 33% of all patients referred for coronary angiography [1, 2]
In the era of interventional therapy, the indications for CTO revascularization are similar to those for severe stenosis according to European Society of Cardiology guidelines [5]
Compared with optimal medical therapy alone, the combination of CTO revascularization with optimal medical therapy is associated with significant ischemia relief, left ventricular function improvement, and a better quality of life [6,7,8]
Summary
Chronic total occlusion (CTO) lesions are identified in 18%– 33% of all patients referred for coronary angiography [1, 2]. In the era of interventional therapy, the indications for CTO revascularization are similar to those for severe stenosis according to European Society of Cardiology guidelines [5]. The development of contemporary techniques and devices has substantially improved the initial success rate >85% for CTO-PCI in unselected clinically indicated cases with ≈3% risk for major in-hospital complications when performed by highly experienced operators [9,10,11]. Outcomes are less favorable at less-experienced centers with an initial success rate of around 60% [12, 13]; the procedural failed CTO patients either receive medical therapy still suffering symptomatic ischemia or are advised
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
