Management Of Chronic Total Occlusions Research Articles

Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Chronic Total Occlusion of Coronary Arteries

Background: Chronic Total Occlusion (CTO) of coronary arteries presents a significant challenge in the management of coronary artery disease (CAD), influencing treatment outcomes and patient prognosis. Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) are two predominant revascularization strategies employed, each offering distinct benefits and limitations. Objective: This study aims to compare the efficacy and safety of PCI and CABG in managing patients with CTO, to inform clinical decision-making and optimize treatment approaches. Methods: A retrospective analysis was conducted at Lady Reading Hospital, Peshawar, from January 1, 2021, to December 31, 2023. We included 145 patients diagnosed with CTO who underwent PCI (n=65) or CABG (n=80). Data were collected on patient demographics, clinical features, lesion characteristics, procedural details, and follow-up outcomes. Major Adverse Cardiac Events (MACE) and quality of life measures were the primary endpoints. Statistical analysis was performed using SPSS version 25, employing Mann-Whitney U and Chi-square tests for continuous and categorical variables, respectively. Results: The procedural success rate was 84.6% for PCI and 90% for CABG. MACE occurred in 23.1% of the PCI group and 15% of the CABG group. The average hospitalization duration was 5.8 days for PCI and 8.5 days for CABG. Quality of life assessments showed comparable scores between groups, with PCI scoring 80.6 on the Seattle Angina Questionnaire and CABG scoring 79.8. Conclusion: PCI and CABG demonstrated similar efficacy and safety profiles in the management of CTO, underscoring the need for individualized treatment strategies based on patient-specific factors. Both methods proved viable, with slightly higher procedural success in CABG and comparable quality of life outcomes.

Abstract 13874: N Terminal Pro-Brain Natriuretic Peptide Levels and Benefits of Chronic Total Occlusion Revascularization

Background: The management of chronic total occlusion (CTO) remains a subject of debate, as the mortality benefit from revascularization remains controversial. Whether specific populations gain a survival benefit from CTO revascularization remains unknown. Purpose: In this prospective study of patients with stable coronary artery disease (CAD), we investigated whether patients with CTO have higher adverse event rates and higher N terminal pro-brain natriuretic peptide (NT pro-BNP) levels than patients without CTO. We also investigated whether a higher NT pro-BNP level predicts adverse events in patients with CTO and whether those with elevated NT pro-BNP levels have a survival benefit from revascularization. Methods: In 2,253 patients with significant CAD ( > 50% coronary luminal stenosis) undergoing cardiac catheterization, all-cause mortality, cardiovascular mortality and the composite of cardiovascular death, myocardial infarction and heart failure hospitalization rates were evaluated. Unadjusted and adjusted Cox proportional and Fine and Gray sub-distribution hazard models were performed to determine the association between NT pro-BNP level and event rates. Results: Patients with CTO had higher incident event rates by > 20% and had higher NT pro-BNP levels than those without CTO (median 230.0 vs. 177.7 pg/mL, p=<0.001). In patients with CTO, every doubling of NT pro-BNP level was associated with > 25% greater risk of adverse events. In patients with elevated NT pro-BNP level (> 125 pg/mL), CTO revascularization was associated with >50% lower adverse event rates than those without CTO revascularization (adjusted cardiovascular death hazard ratio 0.24, 95% confidence interval 0.07 - 0.81). Among patients with low NT pro-BNP level (< 125 pg/mL), event rates were similar in those with and without CTO revascularization. Conclusion: Patients with CTO have higher adverse event rates than those with significant CAD without CTO. NT pro-BNP levels are higher in patients with CTO and higher levels portend a worse prognosis. Moreover, NT pro-BNP levels can help identify individuals who may benefit from CTO revascularization.

Long-term clinical outcomes of drug-coated balloon for the management of chronic total occlusions.

This study aims to compare the clinical outcomes of patients with de novo chronic total occlusion (CTO) lesions treated by hybrid strategy and drug-coated balloons (DCB)-only strategy. DCBs have been used as an alternative to or in combination with drug-eluting stents in CTO lesions. However, the clinical impact of DCB treatment on CTO lesion remains uncertain. We retrospectively enrolled 154 patients with de novo CTO lesions treated by DCB, including 57 cases in hybrid group and 97 cases in DCB-only group. The lesions in hybrid group were more complicated than those in DCB-only group as shown by higher J-CTO score, and therefore higher percentage of retrograde approach, more IVUS guidance, more CTO guidewires, and longer procedural time were demonstrated. Although the percentage of non-flow-limiting dissection and residual stenosis of more than 30% were lower in hybrid group, TIMI flow grade, satisfactory and acceptable recanalization rate were not significantly different between two groups. During a median follow-up was 470 days, the incidence of target lesion revascularization (TLR), myocardial infarction and cardiac death was 11.0%, 1.3% and 1.9%, respectively. The long-term TLR-free survival was comparable between hybrid and DCB-only groups. By multivariate analysis, DCB length and age were predictors of TLR. DCB treatment appears effective and safe in selected de novo CTO lesions during long-term follow up. The recanalization results and long-term outcomes are comparable between hybrid and DCB-only group despite more complicated lesions in hybrid group.

"Does gender equality also apply to chronic total occlusion management?"

Key Points Women are less frequently referred to CTO recanalizations according to their ambiguous presentation Gender has a great impact on technical procedural success and also on procedural complication rate It is important to adopt tricks to avoid the most common complications in women such as cardiac tamponade, access problems, and contrast nephropathy

Two life-threatening complications during chronic total occlusion management.

Two life-threatening complications during chronic total occlusion management.

Update on percutaneous coronary intervention in the management of chronic total occlusions

Update on percutaneous coronary intervention in the management of chronic total occlusions

Impact of Chronic Kidney Disease in Chronic Total Occlusion Management and Clinical Outcomes

BackgroundData on the impact of chronic kidney disease (CKD) on clinical outcomes in chronic total occlusion (CTO) patients is scarce, and the optimal treatment strategy for this population is not well established. This study aims to compare differences in CTO management and long-term clinical outcomes, including all-cause and cardiac mortalities, according to baseline glomerular filtration rate (GFR). MethodsAll patients with at least one CTO diagnosed in our center between 2010 and 2014 were included. Demographic and clinical data were registered. All-cause and cardiac mortalities were assessed during a median follow-up of 4.03 years (IQR 2.6–4.8). Clinical outcomes were compared between patients with CKD (GFR < 60 mL/min/1.73 m2) and without CKD (GFR ≥ 60 mL/min/1.73 m2). ResultsA total of 1248 patients (67.3 ± 10.9 years; 32% CKD) were identified.CKD patients were older and had a higher prevalence of hypertension, type 2 diabetes, peripheral arterial disease, and severe left ventricular dysfunction compared to patients with normal renal function (p < 0.05).Subjects with renal dysfunction were more often treated with MT alone, compared to patients without CKD (63% vs 45%; p < 0.001), who were more likely to undergo PCI or surgery. During follow-up, 386 patients [31%] died. CKD patients had a higher rate of all-cause and cardiac mortalities compared to patients without CKD (p < 0.001). The independent predictors for all-cause mortality were age, GFR < 60 mL/min/1.73 m2, Syntax Score I, and successful revascularization of the CTO (CABG or PCI-CTO). Among patients with CKD, advanced age, eGFR <30 mL/min/1.73 m2, and CTO successful revascularization were predictors of all-cause mortality. ConclusionsPatients with CKD were more often treated with MT alone. At long-term follow-up, revascularization of the CTO is associated with lower all-cause and cardiac mortalities in this population.

Management of Chronic Total Occlusion of Coronary Artery.

Chronic total occlusion (CTO) of a coronary artery is typically defined as a completely occluded artery without any antegrade flow and a duration of at least 3 months. We reviewed the current literature describing the optimal management of CTO including the role of revascularization and choice of modality, i.e., percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery. Databases (PubMed, the Cochrane Library, Embase, EBSCO, Web of Science, and CINAHL) were searched and relevant studies of patients with CTO were selected for review. The prevalence of coronary artery CTOs is approximately 25% among patients undergoing coronary angiography for angina. Available data suggests that PCI of CTO can be a technically complex procedure with relatively lower success rates compared with non-CTO PCI and typically associated with a higher complication rate especially at nonspecialized centers. Furthermore, successful CTO-PCI is associated with symptomatic improvement but does not appear to improve mortality, myocardial infarction, stroke, and repeat revascularization rates. Based on contemporary data, PCI of CTO lesions may be considered in patients with incapacitating angina despite treatment with optimal guideline-directed medical therapy and in whom based on coronary anatomy there is a reasonable chance of technical success with an acceptable risk.

Medical therapy vs early revascularization in diabetics with chronic total occlusions: A meta-analysis and systematic review.

BACKGROUNDManagement of chronic total occlusions (CTO) in diabetics is challenging, with a recent trend towards early revascularization [ER: Percutaneous coronary intervention (PCI) and bypass grafting] instead of optimal medical therapy (OMT). We hypothesize that ER improves morbidity and mortality outcomes in diabetic patients with CTOs as compared to OMT. AIMTo determine the long term clinical outcomes and to compare morbidity and mortality between OMT and ER in diabetic patients with CTOs.METHODSPotentially relevant published clinical trials were identified in Medline, Embase, chemical abstracts and Biosis (from start of the databases till date) and pooled hazard ratios (HR) computed using a random effects model, with significant P value < 0.05. Primary outcome of interest was all-cause death. Secondary outcomes included cardiac death, prompt revascularization (ER) or repeat myocardial infarction (MI). Due to scarcity of data, both Randomized control trials and observational studies were included. 4 eligible articles, containing 2248 patients were identified (1252 in OMT and 1196 in ER). Mean follow-up was 45-60 mo.RESULTSOMT was associated with a higher all-cause mortality [HR: 1.70, 95% confidence interval (CI): 0.80-3.26, P = 0.11] and cardiac mortality (HR: 1.68, 95%CI: 0.96-2.96, P = 0.07). Results were close to significance. The risk of repeat MI was almost the same in both groups (HR: 0.97, 95%CI: 0.61-1.54, P = 0.90). Similarly, patients assigned to OMT had a higher risk of repeat revascularization (HR: 1.62, 95%CI: 1.36-1.94, P < 0.00001). Sub-group analysis of OMT vs PCI demonstrated higher all-cause (HR: 1.98, 95%CI: 1.36-2.87, P = 0.0003) and cardiac mortality (HR: 1.87, 95%CI: 0.96-3.62, P = 0.06) in the OMT group. The risk of repeat MI was low in the OMT group vs PCI (HR: 0.53, 95%CI: 0.31-0.91, P = 0.02). Data on repeat revascularization revealed no difference between the two (HR: 1.00, 95%CI: 0.52-1.93, P = 1.00).CONCLUSIONIn diabetic patients with CTO, there was a trend for improved outcomes with ER regarding all-cause and cardiac death as compared to OMT. These findings were reinforced with statistical significance on subgroup analysis of OMT vs PCI.

Chronic total occlusion management in female patients: gender gap?

Abstract Background A gender gap has been known to exist in the clinical presentation, management and outcomes of coronary artery disease. Nevertheless, it is not well described how these differences pertain to the management of chronic total occlusion (CTO) of coronary arteries. The aim of this study was to compare sex-based differences in CTO management and long-term outcomes. Methods We included all consecutive patients with CTO diagnosed in an academic center between 2010 to 2014. There were no exclusion criteria. We collected demographic, clinical, and management data. All-cause and cardiac mortality were assessed during a median follow-up of 4.03 years (IQR 2.6–4.8). Results A total of 1248 consecutive patients (mean age 67.3±10.9 years; 23,5% females) with at least one CTO receiving either revascularization or optimal medical treatment (MT) were identified. The female group included 198 patients (23.5%). Women were older, had a higher prevalence of type 2 DM and a lower ventricle ejection fraction compared to their male counterparts (p&amp;lt;0.05). There were no differences in the number of CTOs depending on gender, but women had a higher Global SYNTAX II score (50±12 vs 44±22; p&amp;lt;0.001) compared to men. The female group had a higher positive result for ischemia or viability (90% vs. 77%; P=0.04) compared to the male group. Nevertheless, women were more often treated with MT alone compared to male patients (57% vs 49%; P=0.04), who were more likely to undergo PCI or surgery. There were no significant differences in CTO revascularization success between both groups (30% vs. 24%; P=0.40). During a median follow-up of 4.03 years (IQR 2.6–4.8), a total of 386 (31%) patients died. Women presented a higher rate of all-cause mortality in both MT and revascularization groups (52% vs. 39% and 17% vs 16%, respectively; p&amp;lt;0.001) compared to men. Although cardiac mortality was lower in the revascularized patients, it was significantly higher in women compared to men, regardless of CTO treatment strategy (37% vs. 23% and 11% vs 8%; p&amp;lt;0.001 for both). Multivariable analysis identified that female gender was associated with higher rates of cardiac mortality [OR 1.67, 95% confidence interval (CI) (1.10–2.57), P&amp;lt;0.001, but not with all-cause mortality [OR 1.37, 95% confidence interval (CI) (0.92–2.02), P=0.1]. Age, peripheral vascular disease, chronic kidney disease, the ACEF score, the Global SYNTAX I score, and MT of the CTO were also independent predictors for all-cause and cardiac mortality. Conclusions In our cohort, female patients with a CTO were significantly older and presented more prevalence of diabetes mellitus. Women with CTO were more often treated with MT alone, compared to their male counterparts, who were more likely to undergo invasive strategies - PCI or surgery. Female gender was associated with higher cardiac mortality on our cohort regardless of CTO treatment in a long-term follow-up. Figure 1 Cardiac Survival Rates Funding Acknowledgement Type of funding source: None

THE TRICKLING TICKER: A RARE CASE OF INTRAMYOCARDIAL HEMATOMA AFTER PERCUTANEOUS CORONARY INTERVENTION IN CHRONIC TOTAL OCCLUSIONS

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Chronic Total Occlusion (CTO) is commonly seen in patients with coronary artery disease (CAD) and is managed medically or with coronary artery bypass grafting (CABG). Some cases with refractory symptoms can be managed with percutaneous coronary intervention (PCI). However, it is associated with complications such as intramyocardial hematoma that can lead to cardiac tamponade. This rare but serious complication can cause fatal outcomes if not recognized early. CASE PRESENTATION: A 60-year-old female presented to our hospital with recurrent substernal chest pain. She had a history of CAD previously managed with CABG. Despite optimal medical therapy and surgical intervention, she reported recurrent symptoms. A left heart catheterization demonstrated CTO for which she underwent PCI to the Right Coronary Artery (RCA). Shortly after the procedure, she developed hypotension requiring ionotropic support. Echocardiogram revealed a hematoma in the free wall of the right atrium surrounded by a complex loculated pericardial effusion which was further confirmed with a Computerized Tomography (CT) scan of the chest. Urgent PCI did not reveal any dye extravasation in the RCA or its branches, ruling out active bleeding. Subsequently, a right heart catheterization was consistent with constrictive physiology without evidence of tamponade. It was decided to conservatively manage the patient without surgical evacuation. The patient had complete resolution of hematoma in the subsequent follow-up visit a month after the procedure. DISCUSSION: CTOs are characterized by complete occlusion of a coronary artery with thrombolysis in myocardial infarction (TIMI) score of 0 or 1, for at least 3 months [1]. Management of CTOs with PCI is associated with a multitude of complications such as coronary perforation, myocardial infarction, need for emergent CABG, and mortality [2]. Perforation of collateral vessels during PCI can lead to the formation of an intramyocardial hematoma. This rare complication has a high risk of mortality as it can potentially cause cardiac tamponade as seen in 0.3% of patients [3]. The majority of these cases present with post-procedural hypotension and hence, an immediate echocardiogram is warranted in such cases. Depending on the stability, an intramural hematoma can be managed conservatively or by surgical decompression. Physicians should be vigilant in suspecting this complication in order to avoid catastrophic outcomes. CONCLUSIONS: Intramyocardial hematoma is a rare and life-threatening complication of PCI in CTO. Urgent evaluation of post-procedural hypotension with an echocardiogram can aid in early diagnosis and prevent fatal outcomes. Reference #1: Stone GW, Kandzari DE, Mehran R, et al. Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part I. Circulation. 2005;112(15):2364-2372. doi:10.1161/CIRCULATIONAHA.104.481283 Reference #2: Rigger J, Hanratty CG, Walsh SJ. Common and Uncommon CTO Complications [published correction appears in Interv Cardiol. 2019 Feb;14(1):48]. Interv Cardiol. 2018;13(3):121–125. doi:10.15420/icr.2018.10.2 Reference #3: Slootweg AP, Louwerenburg JW, Mecozzi G, Wagenaar LJ, Verhorst PM. Obstructive intramyocardial haematoma after percutaneous coronary intervention. Neth Heart J. 2012;20(9):376–378. doi:10.1007/s12471-011-0163-8 DISCLOSURES: No relevant relationships by Naga Vaishnavi Gadela, source=Web Response No relevant relationships by Sana Hyder, source=Web Response No relevant relationships by Christian Mosebach, source=Web Response

TCT CONNECT-242 Sex-Based Differences in Chronic Total Occlusion Management and Long-Term Clinical Outcomes

TCT CONNECT-242 Sex-Based Differences in Chronic Total Occlusion Management and Long-Term Clinical Outcomes

Sex-based differences in chronic total occlusion management and long-term clinical outcomes

BackgroundSex differences in coronary artery disease presentation and outcomes have been described. The aim of this study was to compare sex disparities in chronic total occlusion (CTO) management and long-term outcomes. MethodsAll consecutive patients with at least one CTO diagnosed in our center between 2010 and 2014 were included. Demographic and clinical data were registered. All-cause and cardiac mortality were assessed during a median follow-up of 4.03 years (IQR 2.6–4.8). ResultsA total of 1248 patients (67.3 ± 10.9 years; 16% female) were identified. Women were older, had a higher prevalence of type 2 DM and a lower ventricle ejection fraction compared to men (p < .05). Although women had major proportion of positive result for severe ischemia-viability test (86% vs. 74%; p = .01), they were more often treated with MT alone compared to male (57% vs 51%; p = .02). During follow-up, 386 patients (31%) died. Women presented a higher rate of all-cause and cardiac mortality, and hospitalizations for heart failure independently of treatment strategy, compared to men (p < .001). In multivariable analysis female sex was associated with higher cardiac mortality [HR 1.67, 95% CI 1.10–2.57; p < .001]. Among women, the independent predictors for all-cause and cardiac mortalities were age, MT of the CTO and ACEF (age, creatinin and ejection fraction) score. ConclusionsA significant sex gap regarding CTO treatment was observed. Female sex was an independent predictor for cardiac mortality at long-term follow-up. More data are needed to support these findings.

Survival benefit of revascularization versus optimal medical therapy alone for chronic total occlusion management in patients with diabetes.

Chronic total occlusion (CTO) is common in patients with diabetes mellitus. Data on the long-term outcomes after treatment of CTOs in this high-risk population are scarce. To compare the long-term clinical outcomes of CTO revascularization either by coronary artery bypass graft (CABG) or successful percutaneous coronary intervention (PCI) versus optimal medical treatment (MT) alone in patients with diabetes. A total of 538 consecutive patients with diabetes and at least one CTO were identified from 2010 to 2014 in our center. In the present analysis, patients were stratified according to the CTO treatment strategy that was selected. MT was selected in 61% of patients whereas revascularization in the remaining 39%. Patients undergoing revascularization were younger, had higher left ventricular ejection fraction (LVEF), lower ACEF score, and more positive myocardial ischemia detection results compared to the MT group (p < .001).Patients referred for CABG had higher rates of left main disease compared to the PCI and MT groups (32% vs. 3% and 11%, respectively; p < .001). Complete revascularization was more often achieved in the CABG group, compared to the PCI group (62% vs. 32% p < .001). Multivariable analysis showed that revascularization with CABG was associated with lower rates of all-cause and cardiac mortality rates compared to MT, [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.25-0.70, p < .001 and HR 0.40, 95% CI 0.20-81, p = .011, respectively]. Successful CTO-PCI showed a trend towards benefit in all-cause mortality (HR 0.58, 95% CI 0.33-1.04, p = .06). In our registry, CTO revascularization in diabetic patients, especially with CABG, was associated with lower long-term mortality rates as compared to MT alone.

Retrograde popliteal and pedal access in management of superficial femoral artery occlusion after failed antegrade approach: a comparative study

Aim To evaluate feasibility, efficacy, and safety of popliteal access compared to tibial retrograde approach for management of chronic total occlusion of superficial femoral artery after failed antegrade recanalization. Patients and methods The study was carried out from January 2016 to April 2019 at Sohag University Hospitals on 30 patients experiencing chronic total occlusion of superficial femoral artery and underwent retrograde transpopliteal or transpedal approach after failed antegrade intervention. Technical success and procedure-related complications were evaluated and compared among patient groups. Results Popliteal access was performed in 14 patients, whereas pedal puncture was accessed in 16 patients. Mean age was 57 (50–64) and 63 (52–65) years in popliteal and pedal access groups, respectively. There were no significant differences in patient baseline characteristics. Arterial puncture was successful in pedal than popliteal access (94.4 vs. 92.9%, P=0.96). Technical success was higher in patients with pedal access than those with popliteal puncture (87.5 vs. 78.6%, P=0.19). Operative time was shorter in pedal access than popliteal access (90±35, 120±28 min, P=0.04). Time to achieve hemostasis was 12±4.6 and 5±1.7 min in popliteal and pedal access, respectively (P=0.022). Access-site hematoma was higher in popliteal access group than pedal access group (28.6 vs. 6.3%, respectively, P=0.042). Spasm of pedal vessels occurred in three (18.8%) patients, acute thrombosis in two (6.7%) patients, access-site occlusion in one (6.3%) patient, and wire perforation in two (12.5%) patients. Conclusion When antegrade revascularization fails, retrograde access offers another endovascular option to treat critical limb ischemia before going to open vascular surgery, especially in high surgical risk patients. When both popliteal and pedal approaches are available, pedal access procedure is more preferable as it is relatively easier with less puncture-site complication.

Contemporary perspectives on coronary chronic total occlusion: Data from a Large French Registry (CARDIO-ARSIF)

The aim of this study was to provide contemporary data on chronic total occlusion (CTO) prevalence and management in a large unselected population in the greater Paris area, and to compare percutaneous coronary intervention (PCI) features in patients with and without CTO. Contemporary data on the prevalence, clinical characteristics and management of CTO in a large unselected population are scarce. Between 2012 and 2015, 258,526 elective coronary procedures were performed in the greater Paris area and registered in the CARDIO-ARSIF (Agence régionale de santé Île de France) registry. Patients with acute coronary syndrome or previous coronary artery bypass grafting were excluded. Coronary CTO features were assessed and PCIs with and without CTO were compared. Among 128,739 included patients, 10,468 (8.1%) had at least one CTO. Cardiovascular risk-factor burden was higher in the CTO group, which had more patients with multivessel disease (73.8% vs. 23.5%) and with referral for interventional management (59% vs. 33%). In the CTO-PCI group, 86.6% of patients had documented ischemia. Of all PCIs during the study period, 5.7% involved a CTO; this proportion increased significantly over the study period. PCI success rate was 75.9% in the CTO group. CTO-PCI volume per center did not correlate with CTO-PCI success rate ( Table 1 ). CTO is common in patients undergoing scheduled coronary angiography. Invasive management is done more often in patients with than without CTO. The success rate of PCI in CTO is not associated with case volume per center.

Impact of chronic total occlusion lesion length on six-month angiographic and 2-year clinical outcomes.

BackgroundSuccessful management of chronic total occlusion (CTO)by percutaneous coronary intervention (PCI) is known to be associated with better clinical outcomes than failed PCI. However, whether angiographic and clinical outcomes following PCI for long CTO lesions differ from those following PCI for short CTO lesions in the drug eluting stent (DES) era remains unknown. We therefore investigated whether CTO lesion length can significantly influence6-month angiographic and 2-year clinical outcomes following successful CTO PCI.Methods and resultsA total of 235 consecutive patients who underwent successful CTO intervention were allocated into either the long or short CTO group according to CTO lesion length. Six-month angiographic and 2-year clinical outcomes were then compared between the 2groups. We found that baseline clinical characteristics were generally similar between the 2 groups. Exceptions were prior PCI, which was more frequent in the long CTO group, and bifurcation lesions, which were more frequent in the short CTO group. Apart from intimal dissection, which was more frequent in the long than short CTO group, in-hospital complications were also similarly frequent between the 2groups. Furthermore, both groups had similar angiographic outcomes at 6 months and clinical outcomes at 2 years. However, the incidence of repeat PCI(predominantly target vessel revascularization),was higher in the long than short CTO group, with our multivariate analysis identifying long CTO as an important predictor of repeat PCI (odds ratio, 4.26;95% confidence interval, 1.53–11.9; p = 0.006).ConclusionThe safety profile, 6-month angiographic, and 2-year clinical outcomes of CTO PCI were similar between patients with long and short CTO. However, there was a higher incidence of repeat PCI in long CTO patients despite successful PCI with DESs.

Sex-Based Differences in Chronic Total Occlusion Management.

ᅟ: Chronic total occlusions (CTOs) are an important and increasingly recognized subgroup of coronary lesions, documented in at least 30%, but up to 52% of patients with coronary artery disease (CAD) undergoing coronary angiography. Percutaneous coronary intervention (PCI) of these lesions is increasingly pursued, with excellent success rates. PURPOSE OF REVIEW: It is known that gender differences exist in the presentation of CAD, as well as in clinical outcomes after routine PCI; however, it is not well described how these differences pertain to management of CTOs. This review summarizes the available data regarding sex-based differences in CTO management and outcomes. RECENT FINDINGS: Women comprise approximately 20% of CTO registry and trial participants. As has been demonstrated in PCI studies, women comprise a minority of patients in CTO PCI registries and trials. Sex-based differences exist in complication rates, collateral formation, and outcomes and need further evaluation in future studies.

TCT-528 Impact of Revascularization versus Medical Therapy Alone for Chronic Total Occlusion Management in Elderly Patients

Chronic total occlusions (CTO) are present in more than one third of elderly patients with myocardial ischemia, and their best therapeutic approach is still controversial. AIMS: To compare the long-term survival of CTO revascularization [percutaneous coronary intervention (PCI) or coronary artery

Update on the Management of Chronic Total Occlusions in Coronary Artery Disease.

Chronic total occlusions (CTOs) are found in about a third of patients with coronary artery disease (CAD) and can pose a significant challenge during percutaneous revascularization. However, advances in CTO percutaneous coronary intervention (PCI) strategies, devices, and algorithms have led to significant improvements in successful treatment of CTOs. This review summarizes current management of CTOs in the context of modern PCI techniques and current evidence. The hybrid algorithm now provides a standardized, teachable approach to CTO PCI, and success rates are approximately 90% in experienced hands. The first randomized controlled trial in patients with CTOs recently reported that patients with ST elevation myocardial infarction (STEMI) and a CTO in the non-culprit vessel showed an improvement in ejection fraction in patients undergoing CTO PCI of the LAD, but not other vessels. Updated data from the SYNTAX trial showed a benefit with complete revascularization in patients with coronary artery disease (CAD). Incomplete revascularization of CTOs in the PCI group may explain some of the benefit seen with CABG over PCI in patients with complex coronary disease. Contemporary CTO registries have reported success rates of approximately 90%, and the OPEN-CTO registry updates our understanding of CTO PCI complication rates and outcomes. The available evidence highlights the potential benefits of CTO PCI in patients with an indication for revascularization. Technological advancements have paved the way for success rates approaching 90% at high-volume centers, but further studies evaluating outcomes following CTO PCI are needed, with several currently underway.