Chronic Total Occlusion Vessel Research Articles

Predictors of outcomes after PCI with incomplete revascularization: Impact of CTO and LAD vessel.

Incomplete revascularization (ICR) after percutaneous coronary intervention (PCI) is associated with mortality and morbidity. We sought to investigate whether ICR in the left anterior descending artery (LAD) is worse than ICR of the right coronary artery (RCA) or left circumflex artery (LCX); and whether ICR in patients with a chronic total occlusion (CTO) is worse than in those without. In the RIVER-PCI trial, 2651 patients with ICR after PCI were randomly assigned to ranolazine or placebo. Angiograms were assessed at an independent core laboratory in 2501 patients (94.3%). The primary endpoint was the composite of ischemia-driven revascularization or hospitalization. A total of 1664 patients (66.5%) had ICR involving the LAD, whereas 837 (33.5%) had ICR limited to the RCA or LCX. At median follow-up of 643 days, the primary endpoint occurred in 26.9% versus 26.5% of patients (adjusted HR [aHR]: 1.03, 95% confidence interval [CI]: 0.88-1.21). A nonrecanalized CTO was present in 854 patients (34.1%) with ICR after PCI. The primary endpoint occurred in 28.6% versus 25.9% of ICR patients with versus without a CTO (aHR: 1.10, 95%CI: 0.94-1.29). However, patients with a CTO had higher rates of ischemia-driven hospitalization without revascularization (aHR: 1.27, 95%CI: 1.04-1.56), heart failure hospitalization (aHR: 2.69, 95%CI: 1.61-4.59) and myocardial infarction (aHR: 1.46, 95%CI: 1.11-1.92) compared with those without. The 2-year prognosis was similar in post-PCI patients with ICR whether the LAD was versus was not involved. ICR patients with a CTO had more frequent hospitalizations for ischemia and myocardial infarctions compared with those without.

Abstract 14203: Speckle Tracking Analysis During Dobutamine Stress Echocardiography in Patients Undergoing Percutaneous Coronary Intervention for Chronic Total Occlusion

Background: Dobutamine stress echocardiography (DSE) is often used as a non-invasive diagnostic modality for detection of myocardial ischemia and viability. A “biphasic response” in DSE can occur, in which contractility improves in dysfunctional segments with low dose stage and then becomes dysfunctional again at higher doses due to ischemia. We investigated if speckle tracking analysis during DSE can evaluate patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Methods: DSE was performed one day before CTO-PCI in consecutive 30 patients (18 female, age=71±11 years). Since 27 patients had 1 vessel, and 3 patients had 2 vessel CTO lesions, total of 33 regions were analyzed. Global (GLS) and regional longitudinal strain (RLS) were calculated as an averaged value of peak longitudinal strain in the apical 4-, 2-chamber, and long axis views at baseline echo, at low-dose, at high-dose DSE, and 6 months after CTO-PCI using available software (QLAB, Philips Medical Systems). Results: CTO-PCI was successfully done in all patients. GLS and RLS were feasible in all regions. Overall, GLS (-15.5±2.8 at baseline v.s. -17.3±3.8, p<0.001) and left ventricular ejection fraction (LVEF) (56±6% v.s. 58±7%, p<0.01) significantly improved 6 months after CTO-PCI. There was also significant improvement of RLS for the obstructed CTO regions (-13.8±3.6 v.s. -16.5±4.2, p<0.005). Although in 24 patients (26 regions) with biphasic response during DSE (Figure), GLS (-15.7±2.5 v.s. -17.9±3.6, p<0.01), LVEF (54±6% v.s. 56±7%, p<0.05), and RLS (-13.8±3.5 v.s. -16.8±4.0, p<0.01) improved significantly, GLS (-14.9±4.2 v.s. -15.8±5.0, p=n.s.), LVEF (59±3% v.s. 60±3%, p=n.s.), and RLS (-13.9±4.5 v.s. -15.5±5.7, p=n.s.) didn’t change in 6 patients (7 regions) without biphasic response. Conclusion: Speckle tracking analysis is feasible during DSE. CTO-PCI may improve both global and regional cardiac functions in patients with myocardial viability.

Clinical feasibility of endovascular recanalization with intravascular ultrasound-guided wiring for chronic total occlusion of below-the-knee arteries

BackgroundRevascularization with endovascular therapy (EVT) for complex below-the-knee (BTK) chronic total occlusion (CTO) remains a challenging problem. The Japanese-BTK (J-BTK) CTO score is reported as an indicator of the difficulty of BTK CTO, with the guidewire (GW) passage success rate decreasing as the grade increases. We previously reported an effective GW crossing method for the intravascular ultrasound (IVUS)-guided parallel wiring of complex BTK CTO. In this study, we investigated the feasibility of EVT using IVUS-guided wiring for BTK CTO.Materials and methodsThis single center, retrospective study analyzed 65 consecutive BTK CTO vessels in which IVUS-guided wiring was attempted after the failure of a conventional antegrade wiring approach from November 2020 to November 2022. The primary endpoint was the clinical success of the target CTO vessel. The secondary endpoints were the GW success rate per grade based on the J-BTK CTO score, number of GW used for CTO crossing, fluoroscopy time, and complications.ResultsTarget vessels were the anterior tibial artery (66.2% of cases), peroneal artery (9.2%), and posterior tibial artery (24.6%). Blunt type CTO entry was performed in 55.4% of cases, calcification of entry was observed in 24.6% of cases, the mean occlusion length was 228.2 ± 93.7 mm, mean reference vessel diameter was 2.1 ± 0.71 mm, and outflow was absent in 38.5% of cases. J-BTK CTO scores of 0/1 (grade A), 2/3 (grade B), 4/5 (grade C), and 6 (grade D) were seen in 18.5%, 43.1%, 36.3%, and 1.5% of cases, respectively. The clinical success rate was 95.4%. The GW success rate by J-BTK CTO grade was as follows: grade A (100%), B (100%), C (91.7%), and D (0%). The mean number of GW used was 3.4 ± 1.4, the mean fluoroscopy time was 72.3 ± 32.5 min, and complications occurred in 7.7% of cases.ConclusionThis study showed a very high clinical success rate despite the difficulty of BTK CTO. IVUS-guided EVT might be a feasible strategy for complex BTK CTO.

Effectiveness, safety, and patient reported outcomes of a planned investment procedure in higher-risk chronic total occlusion percutaneous coronary intervention:Rationale and design of the invest-CTO study.

The anatomical complexity of a chronic total occlusion (CTO) correlates with procedural failure and complication rates. CTO modification after unsuccessful crossing has been associated with subsequent higher technical success rates, but complication rates remain high with this approach. While successful CTO percutaneous coronary intervention (PCI) has been associated with improved angina and quality of life (QOL) this has not been demonstrated in anatomically high-risk CTOs. Whether a planned CTO modification procedure, hereafter named Investment procedure, could improve patient outcomes has never been investigated. Invest-CTO is a prospective, single-arm, international, multicenter study, evaluating the effectiveness and safety of a planned investment procedure, with a subsequent completion CTO PCI (at 8-12 weeks), in anatomically high-risk CTOs. We will enroll 200 patients with CTOs defined as high-risk according to our Invest CTO criteria at centers in Norway and United Kingdom.Patients with aorto-ostial lesions, occlusion within a previous stent, or a prior attempt at target vessel CTO PCI within 6 months will be excluded. The co-primary endpoints are cumulative procedural success (%) after both procedures, and a composite safety endpoint at 30 days after completion CTO PCI. Patient reported outcomes (PROs), treatment satisfaction, and clinical endpoints will be reported. This study will prospectively evaluate the effectiveness and safety of a planned two staged PCI procedure in the treatment of high-risk CTOs and may have the potential to change current clinical practice.

TCT-128 Saphenous Vein Graft Occlusion Following Native Vessel Chronic Total Occlusion Percutaneous Coronary Intervention

TCT-128 Saphenous Vein Graft Occlusion Following Native Vessel Chronic Total Occlusion Percutaneous Coronary Intervention

The comparison of efficacy and safety between transradial and transfemoral approach for chronic total occlusions intervention: a meta-analysis

This meta-analysis compared the outcomes of transradial access (TRA) and transfemoral access (TFA) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in recent decades. We searched multiple databases for articles published between January 1, 2015, and December 31, 2020. Six observational studies with 11,736 patients were analyzed. Data included baseline demographics, Japan-chronic total occlusion (J-CTO) score, sheath size, PCI vessel, retrograde method, procedural time, fluoroscopy time, and contrast volume. The more prevalent target CTO vessel was the left coronary artery in the TRA group and the right coronary artery in the TFA group. Higher J-CTO score, longer procedural time, and more contrast volume were seen in the TFA group. In comparison, the TRA group had better procedural success rate (odds ratio (OR), 0.846; 95% confidence interval (CI) 0.749–0.956) and less vascular complications (OR, 0.323; 95% CI 0.203–0.515), but similar retrograde success rate (OR, 0.965; 95% CI 0.382–2.435). In-hospital death (OR, 0.527; 95% CI 0.187–1.489) and major adverse cardiovascular events (OR, 0.729; 95% CI 0.504–1.054) did not differ between the groups. Overall, fewer vascular complications and higher procedural success rates were noted in the TRA CTO PCI population. However, similar retrograde success rates and clinical outcomes were noted between the groups.

E-22 | Comparison of Cost of Hospitalization Between Use of Intravascular Imaging and No Imaging for Single Vessel Chronic Total Occlusion Percutaneous Coronary Intervention

The purpose of this study is to analyze the cost associated with the use of intravascular imaging including Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) in patients undergoing single vessel chronic total occlusion percutaneous coronary intervention (SV CTO PCI).

TCTAP C-118 A Case of Small Vessel Chronic Total Occlusion Treated With Drug-Coated Balloon

TCTAP C-118 A Case of Small Vessel Chronic Total Occlusion Treated With Drug-Coated Balloon

Prevalence and correlated factors for chronic total occlusion in patients with coronary artery disease in Iraqi Kurdistan

Patients with significant coronary artery disease often have at least one vessel with Chronic Total Occlusion (CTO) as demonstrated by coronary angiography. However, the prevalence and determinants of CTO differ according to ethnicity. We aimed to investigate the prevalence and determinants of CTO in the Iraqi Kurdistan population in 2015. Clinical and angiographic data were collected in consecutive patients that underwent coronary angiography at our institution between January and December 2015. Coronary artery disease (CAD) was determined as 50% diameter stenosis in one coronary artery and CTO as total coronary artery occlusion of 3-month duration. Among 260 patients diagnosed with ischemic coronary artery disease and undergone coronary angiography, 28.5% (n=74) were diagnosed to have at least one CTO vessel and 69 (26.5%) patients had a previous history of myocardial infarction. CTOs were located in the left anterior descending coronary artery in 45% of patients while in the right coronary artery in 32%. CTO patients were substantially older (61 vs 56 years; p <0.0001) and more likely to live in non-urban areas. They frequently had more hypertension, dyslipidemia, diabetes mellitus, previous myocardial revascularization, being an exsmoker, and renal dysfunction as compared to patients without CTOs. At univariate analysis, a previous history of coronary artery bypass graft (CABG) surgery was the only predictor of having a diagnosis of CTO. Patients diagnosed with CTO in Iraqi Kurdistan had several comorbidities including cardiovascular risk factors and renal dysfunction. Previous CABG was the only predictor of CTO diagnosis.

Ischemic Burden Assessment Using Single Photon Emission Computed Tomography in Single Vessel Chronic Total Occlusion of Coronary Artery.

Studies evaluating the nature of ischemic burden of chronic total occlusion (CTO) vessels are still lacking. A total of 165 patients with single vessel CTO >2.5 mm in an epicardial coronary artery who underwent single photon emission computed tomography (SPECT) were enrolled in the study. Ischemic burden was calculated with the use of semi-quantitative SPECT analysis, and was defined as the summed difference score (SDS) divided by the maximal limit of the score (=SDS/68). The mean age of the participants was 59.5 years and the CTO of the left anterior descending coronary artery (LAD), left circumplex coronary artery (LCX), and right coronary artery (RCA) accounted for 93 (56.4%), 18 (10.9%), and 54 (32.7%) patients, respectively. The median ischemic burden of the total population was 8.8%, and it was highest in the LAD CTO (10.3%) compared with the LCX (5.9%) and RCA CTO (5.9%, p<0.001). High-ischemic burden (ischemic burden >10%) was observed in 66 patients (40.0%), and in 47 patients (50.5%) of the LAD CTO. Ischemic burden was different according to the CTO location only in LAD CTO. The statistically significant predictors for high-ischemic burden were hypertension, baseline ejection fraction >45%, LAD CTO, proximal CTO location, and de novo CTO. Japanese-CTO score and Rentrop scale collateral grade were not associated with high-ischemic burden. Only 40% of patients with single vessel CTO had ischemic burden >10%. For CTO vessels, measurement of ischemic burden using SPECT prior to revascularization may be helpful in identifying beneficial subjects.

Prevalence and Characteristics of Acquired Coronary Fistulas After Successful Revascularization of Chronic Total Occlusion.

Background and Objectives: Acquired coronary fistulas (ACFs) are rare coronary artery abnormalities in patients with chronic total occlusion (CTO). It has been found after revascularization, and it may cause fluster during the CTO percutaneous coronary intervention (CTO PCI). How to distinguish between ACFs and coronary perforation (CP) is very important for CTO operators. Chronic total occlusion reopening may reveal the microchannel of the adventitial vascular layers. Some of ACFs have been seen after revascularization. This study aimed to investigate the characteristics of ACFs after successful CTO PCI.Methods: The clinical and procedural characteristics, medical history, and findings in electrocardiography (ECG), echocardiography, and coronary angiography were collected from 2,169 consecutive patients undergoing CTO PCI between January 2018 and December 2019 and analyzed retrospectively.Results: About 1,844 (85.02%) underwent successful CTO PCI with complete revascularization. Acquired coronary fistulas were found in 49 patients (2.66%): the majority of patients with ACFs were men (81.63 vs. 60.78%; p = 0.016) and younger (62.8 vs. 66.69 years; p = 0.003), and had a history of myocardial infarction (MI) or Q-wave (69.39 vs. 54.21%; p = 0.035); 38 (77.55%) patients had multiple fistulas (≥3), and ACFs affected multiple branches of the CTO vessel (≥3) in 29 (59.18%) patients. None had pericardial effusion, tamponade, and hemodynamic abnormality before or after PCI.Conclusion: Acquired coronary fistulas after successful CTO PCI are mainly present in young and male patients with a history of MI, and they often involve multiple fistulas and distal CTO vessels.

Ten-Year Clinical Follow-Up Following Bare-Nitinol Stent Implantation for Femoropopliteal Artery Disease.

Aim: More than 5-year clinical outcomes after femoropopliteal (FP) stenting with bare-nitinol stent (BNS) have not yet been unclear. We investigate the long-term patency and mortality following FP stenting with BNS. Methods: This study was a multicenter retrospective study of a prospectively maintained database. From April 2004 to December 2011, 1824 consecutive patients (2211 limbs) who underwent FP stenting with BNS for de novo lesions were selected and analyzed. Primary endpoint was primary patency which was defined as treated vessel without restenosis and reintervention and its associated factors. Results: The prevalence of diabetes mellitus and dialysis was 60.5% and 23.8%, respectively. Chronic limb-threatening ischemia (CLTI) accounted for 30.8%. Chronic total occlusion (CTO) was found in 52.7%, and lesion length was more than 20 cm in 22.6%. During the median follow-up of 3.8 years (interquartile range, 1.4 to 7.4 years), 1049 cases lost patency, whereas 355 cases were dead without experiencing loss of patency. The primary patency (95% CI) was estimated to be 74.8%, 47.3% and 29.1% at 1-, 5- and 10-year. On multivariate analysis, female sex, age ≥ 80 years, diabetes, dialysis, CLTI, CTO, arterial calcification, long lesion (＞20 cm), and small vessel (≤ 4 mm) were the independent predictors of primary patency after FP stenting. In addition, the prognostic impact of age ≥ 80 years, CLTI, and arterial calcification was significantly attenuated afterwards (P＜0.05). Conclusions: Ten-year patency after BNS implantation for FP disease has been continuously reducing up to 10 years and the prognostic impact of risk factors was changed over time.

Prevalence of coronary artery disease among patients with bicuspid aortic valve stenosis undergoing computed tomography before transcatheter aortic valve implantation

Abstract Introduction A lower prevalence of coronary artery disease (CAD) was previously reported among bicuspid aortic valve (BAV) patients compared with tricuspid aortic valve (TAV) patients undergoing surgical aortic valve replacement. Unknown is the prevalence of CAD among BAV patients undergoing transcatheter aortic valve implantation (TAVI). Methods Consecutive BAV patients undergoing cardiac computed tomography angiography (CCTA) before TAVI were included. Studies with insufficient imaging quality were excluded. Forty-nine patients with history of prior percutaneous coronary intervention or coronary artery bypass graft surgery were also excluded. Coronary artery stenosis was categorized as ≤50% or &amp;gt;50% luminal diameter stenosis. Results One hundred and fourteen consecutive BAV patients were enrolled (age 72±10.4 years, 64% males). BAV type 1A was the most common type (62%), followed by BAV type 0 (18%) and type 1C (10%). Cardiovascular risk factors were frequent: 23% (26) had history of diabetes mellitus, 45% (51) had dyslipidemia, 56% (64) had hypertension, and 25% (29) were current or past smokers. No correlation was found between calcium scoring of the aortic valve (3664.49±1671.01 Agatston Units) and calcium scoring of the coronary arteries (410.51±546.59 Agatston Units), correlation coefficient 0.43 (p=0.68). Obstructive coronary artery stenosis (&amp;gt;50% luminal diameter stenosis) was observed among the minority (16%) of BAV patients. A single vessel disease was found in 7% of BAV patients, two vessels disease in 5% and triple vessels disease in 4%. Three BAV patients had a single vessel chronic total occlusion. Conclusion Among patients with BAV referred for TAVI, CCTA showed a low prevalence of obstructive coronary artery disease. The absence of correlation between aortic valve and coronary artery calcium scoring suggests the possibility of two heterogeneous aspects of the complex BAV disease. Funding Acknowledgement Type of funding sources: None.

The value of fragmented QRS in predicting the prognosis of chronic total occlusion patients with myocardial infarction history undergoing percutaneous coronary intervention: A 24-months follow-up study.

BackgroundFragmented QRS (fQRS) is a marker of local myocardial scar. This study aimed to analyze the relationship between fQRS and coronary collateral circulation (CCC) and evaluate the predictive value of fQRS for long‐term clinical outcomes among patients with chronic total occlusion (CTO) and prior myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI).MethodsA total of 862 patients with a definite history of MI who had one CTO coronary artery and underwent PCI between 2013 and 2018 were continuously analyzed. Patients were divided into group A (no Q wave and fQRS, n = 206), group B (fQRS, n = 265), group C (Q wave, n = 391). All patients were followed up for 2 years.ResultsThe incidence rate of major adverse cardiovascular events (MACE) in group B was significantly lower than in group C (group B vs. C: 7.2% vs. 11.3%, P = 0.043). The percentage of good CCC was 94.2%, 88.3%, and 82.9% in group A, B, and C (p < .001), respectively. The improvement of cardiac function in group B and A were more significant than in group C. Multivariate Cox regression analysis showed fQRS was an independent protective factor of MACE after PCI within 2 years in CTO patients with prior MI (RR = 0.668, 95% CI [0.422–0.917], p = .001).ConclusionfQRS is an independent protective factor of prognosis in patients with prior MI and one CTO vessel who underwent PCI, presenting with a higher rate of good CCC, less occurrence of MACE, and better heart function than in Q wave patients.

Treatment of chronic total occlusion with percutaneous coronary intervention is associated with improved survival as compared to medical treatment alone: insights from a single-centre registry.

Symptom relief is currently the main indication to perform percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). So far, none of the randomized trials for CTO treatment have demonstrated improved survival after PCI compared to optimal medical treatment (OMT) alone. We investigated whether CTO PCI in addition to OMT could improve survival over OMT alone. Data of 1004 patients with a treated CTO was analysed. Patients with acute coronary syndrome and who underwent coronary artery bypass graft surgery (CABG) were excluded, thus final study population was 378. According to the treatment received, patients were divided into two groups: CTO PCI + OMT (n = 163) and OMT alone (n = 215). The primary endpoint was all-cause mortality during follow-up. The incidence of myocardial infarction (MI), revascularization (both CTO artery and non-CTO artery related) and stroke were also analysed as a secondary outcome. The mean follow-up period was 3.55 ± 0.93 years. Multiple regression analysis was performed to identify independent predictors of all-cause mortality. Occurrence of MI and repeat revascularization (both CTO vessel related and non-CTO vessel) and stroke did not differ significantly between groups. However, all-cause mortality was more frequent in OMT (19.1%) patients than PCI (10.4%). Patients age ≤70 years (odds ratio (OR) 0.47 [0.26; 0.84], p = 0.01) and CTO PCI (OR 0.51 [0.27; 0.94], p = 0.03) were independent predictors of reduced likelihood of all-cause death. The data from our centre registry demonstrates that CTO PCI is associated with reduced all-cause mortality as compared to medical treatment alone in a real-life setting.

Coronary physiology before and after chronic total occlusion treatment: what does it tell us?

Studies performed in the last two decades demonstrate that after successful percutaneous coronary intervention (PCI) of a chronically occluded coronary artery, the physiology of the chronic total occlusion (CTO) vessel and dependent microvasculature does not normalise immediately but improves significantly over time. Generally, there is an increase in fractional flow reserve (FFR) in the CTO artery, a decrease in collateral blood supply and an increase in FFR in the donor artery accompanied by an increase in blood flow and decrease in microvascular resistance in the myocardium supplied by the CTO vessel. Analogous to these physiological changes, positive remodelling of the distal CTO artery also occurs over time, and intravascular imaging can be helpful for analysing distal vessel parameters. Follow-up coronary angiography with physiological measurements after several weeks to months can be helpful and informative in a subset of patients in order to decide upon the necessity for treatment of residual coronary artery stenosis in the vessel distal to the CTO or in the contralateral donor artery, as well as in deciding whether stent optimisation is indicated. We suggest that such physiological guidance of CTO procedures avoids unnecessary overtreatment during the initial procedure, guides interventions at follow-up, and improves our understanding of what PCI in CTO means.

Coronary artery perforation during chronic total occlusion percutaneous coronary intervention: epidemiology, mechanisms, management, and outcomes.

The aim of this study was to describe the epidemiology, mechanisms, management, and outcomes of coronary artery perforation during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We included 1,811 consecutive patients undergoing CTO PCI at five centres between 2011 and 2018. Coronary perforation was observed in n=99 (5.5%). Patients with perforation were older, had a higher J-CTO score, more often required antegrade dissection/re-entry and the retrograde approach, and had lower success rates. The frequency of Ellis type I, II, III and III "cavity spilling" perforations was 11%, 46%, 28%, and 14%, respectively. In 48% of cases, perforation involved the CTO vessel, while the retrograde approach was responsible for 46% of cases. In 53% of cases perforations required intervention. The most frequently applied management strategies included clinical observation (47%), covered stent implantation (25%), balloon occlusion (9%), and coil/fat embolisation (9%). Tamponade was observed in 20/99 (20%) perforation cases. Ellis type III perforations were most frequently observed at the CTO site. These were accountable for 16/20 tamponades and 3/5 deaths. In-hospital mortality was 5.1% vs 0.3% in patients with versus those without perforation (p<0.001). Older age, occlusion length >20 mm, rotational atherectomy, antegrade dissection/re-entry, and the retrograde approach were independently associated with coronary perforation. Patients with perforation suffered an increased incidence of target vessel failure on short-term follow-up. Coronary perforation is observed in a non-negligible proportion of CTO PCIs, often requires intervention, and is associated with tamponade and mortality in a minority of patients. CTO vessel-related perforations are associated with the highest burden of morbidity and mortality.

Long-term outcomes post chronic total occlusion intervention-implications of completeness of revascularization.

Long term clinical outcomes post chronic total occlusion (CTO) intervention may depend not only on CTO success/failure alone but also on Completeness of revascularization. To determine long term outcomes post CTO intervention and relate them to both success versus failure and Complete Revascularization (CR) versus Incomplete Revascularization (IR). Consecutive patients taken up for CTO intervention with at-least one CTO vessel between Jan 2006 to Dec 2015 were included. Clinical, procedural and follow up details were recorded in a pre-specified custom made software. Primary endpoint of the study was survival free of major adverse event individual, death, myocardial infarction (MI), repeat revascularisation (percutaneous coronary intervention [PCI], or coronary artery bypass grafting (CABG) and recurrent or continued angina. Each individual adverse event was considered as a secondary end point. A total of 632 patients were enrolled in study with follow up data available in 549 (86%) constituting the study group with 490 (89.3%) success and 59 (11.7%) failure. Complete revascularization (CR) was obtained in 410 (74.7%). Follow up was median 2.9 years with inter-quartile range 1.1-4.8 years. Kaplan Meier survival analysis showed a better EFS with both CTO success versus failure (P = 0.03)and CR versus IR (P = 0.017). Individual adverse outcomes however were not significantly different in CTO success versus failure group but significantly better when analyzed with respect to CR versus IR including death (P = 0.049) and recurrent angina (P = 0.024). Repeat intervention and MI were not different by either analysis. Successful CTO PCI results in a better long term event free survival but the difference between the groups is more if analyzed with respect to completeness of revascularization rather than CTO success/failure alone.

Angiographic predictors of success in antegrade approach of Chronic Total Occlusion interventions in a South Indian population in the contemporary era

Chronic Total Occlusion (CTO) intervention is a challenging area in interventional cardiology. Presently about 70% of CTO interventions are successful. Materials and methodsThis was a single center prospective study of a cohort of all patients undergoing percutaneous coronary intervention (PCI) as elective or adhoc procedure for CTO from August 2014 to June 2015. Only antegrade CTO interventions were included. In all patients the following data were recorded. ResultsA total of 210 (8.9% of total PCI (2353) during the study period) CTO patients were followed up. The mean age was 56.54±8.9. In the study sixty nine patients (32.9%) presented with chronic stable angina and rest of the patients had history of acute coronary syndrome of which 22.9% (n=48) had unstable angina (UA) or non ST elevation myocardial infarction (NSTEMI) and 44.2% (n=93) had ST Elevation Myocardial Infarction (STEMI). In those with history of ACS, 64.78% (n=92) had ACS during the previous year and remaining 35.22% (n=49) had ACS prior to that. Single vessel CTO was seen in 89.5% (n=188) and two vessel CTO in 10.5% (n=22). LAD was involved in 36.7% (n=77), RCA in 48.1% (n=101), and LCX in 15.2% (n=32). Procedural success in the first attempt was 68.1% (n=143), which increased to 71.42% (n=150) after the second attempt. CTO interventions were more frequently successful when the calcium was absent or minimal (p-0.05), CTO length was <10mm (p<0.01) and good distal reformation (p<0.01).

Stepwise Intervention for Small Vessel Chronic Total Occlusion

Stepwise Intervention for Small Vessel Chronic Total Occlusion