Current challenges and prevention strategies for chronic total occlusion (CTO) complications

Karácsonyi, Judit; Vemmou, Evangelia; Nikolakopoulos, Ilias; Ungi, Imre; Rafeh, Nidal Abi; ElGuindy, Ahmed; Azzalini, Lorenzo; Burke, M. Nicholas; Brilakis, Emmanouil S.

doi:10.1080/14779072.2021.1905521

Cited by 10 publications

(6 citation statements)

References 42 publications

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“…12 CTO PCI carries increased risk of complications compared with non-CTO PCI due to complex coronary anatomy (calcification, tortuosity, multivessel disease), difficulties with CTO crossing and comorbidities (left ventricular disfunction, particularly in the donor vessel is being instrumented during retrograde procedures). 1,[13][14][15] How can we identify patients who are more likely to need MCS? We recently developed risk scores for estimating the risk of periprocedural in-hospital major adverse cardiovascular events (MACE), mortality, pericardiocentesis, and acute myocardial infarction (MI) in patients undergoing CTO PCI 11 , but there are currently no risk scores for assessing the need for urgent MCS in CTO PCI.…”

Section: Discussionmentioning

confidence: 99%

Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention

Karácsonyi

Stanberry

Şimşek

et al. 2023

Preprint

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Background: Estimating the likelihood of urgent mechanical circulatory support (MCS) can facilitate procedural planning and clinical decision making in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We analyzed 2,784 CTO PCIs performed between 2012 and 2021 at 12 centers. The variable importance was estimated by a bootstrap applying a random forest algorithm to a propensity-matched sample (a ratio of 1:5 matching cases with controls on center). The identified variables were used to predict the risk of urgent MCS. The performance of the risk model was assessed in-sample as well as on 2411 out-of-sample procedures who did not require urgent MCS. Results: Urgent MCS was used in 62 (2.2%) of cases. Patients who required urgent MCS were older (70 [63, 77] vs. 66 [58, 73] years, p=0.003) compared with those who did not require urgent MCS. Technical (68% vs. 87%, p<0.001) and procedural successes (40% vs. 85%, p<0.001) were lower in the urgent MCS group compared with no urgent MCS cases. The risk model for urgent MCS use included retrograde crossing strategy, left ventricular ejection fraction, and lesion length. The resulting model demonstrated good calibration and discriminatory capacity with AUC (95%CI) of 0.79 (0.73, 0.86) and specificity and sensitivity of 86% and 52%, respectively. On the out-of-sample set, the specificity of the model was 87%. Conclusion: The PROGRESS CTO MCS score can help estimate the risk of urgent MCS use during CTO PCI.

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Section: Discussionmentioning

confidence: 99%

Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention

Karácsonyi

Stanberry

Şimşek

et al. 2023

Preprint

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“…A detailed description of the technical aspects of management of specific CTO PCI complications has been well described elsewhere (51). Many experienced CTO centers presently achieve high success rates (85%-90%) with low (2%-3%) risks of major periprocedural complications (52). By comparison, technical success rates >95% and complication rates <2% have been reported for non-complex non-CTO PCI-compared to success rates <60% (and >6% incidence of emergent CABG) at the dawn of PCI in the 1980s (53,54).…”

Section: Complications: Prevention Recognition and Managementmentioning

confidence: 99%

A non-interventional cardiologist’s guide to coronary chronic total occlusions

Cilia,

Megaly,

Davies

et al. 2024

Front. Cardiovasc. Med.

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Coronary chronic total occlusions (CTO) are present in up to one-third of patients with coronary artery disease (CAD). It is thus essential for all clinical cardiologists to possess a basic awareness and understanding of CTOs, including optimal evaluation and management. While percutaneous coronary intervention (PCI) for CTO lesions has many similarities to non-CTO PCI, there are important considerations pertaining to pre-procedural evaluation, interventional techniques, procedural complications, and post-procedure management and follow-up unique to patients undergoing this highly specialized intervention. Distinct from other existing topical reviews, the current manuscript focuses on key knowledge relevant to non-interventional cardiologists.

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“…Identifying patients who are more likely to have procedural complications is essential to stratify the cumulative risk. Several clinical, angiographic, and technical characteristics are related to a greater risk of periprocedural complication of CTO-PCI: elderly, chronic kidney disease (CKD), retrograde and anterograde dissection/re-entry approach, and use of rotational atherectomy, which are associated with a higher risk of coronary perforations [58]. In this context, the PROGRESS-CTO complications score has been developed to predict the risk related to a procedure of CTO recanalization.…”

Section: Cto Complicationsmentioning

confidence: 99%

“…Donor vessel injury is another serious complication occurring during CTO-PCI because it is associated with severe ischemia and hemodynamic decompensation, requiring high doses of vasopressors and/or mechanical hemodynamic support. It can be induced by catheter management, especially in long retrograde procedures [67], or it can be associated with coronary spasm [58]. Donor vessel thrombosis is principally associated with long CTO PCIs, blood stasis, or suboptimal activated clotting time (ACT) [67].…”

Section: Donor Vessel Injurymentioning

confidence: 99%

Coronary Chronic Total Occlusion Revascularization: When, Who and How?

Ricottini,

Coletti,

Nusca

et al. 2024

JCM

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Coronary chronic total occlusions (CTO) are an increasingly frequent entity in clinical practice and represent a challenging percutaneous coronary intervention (PCI) scenario. Despite data from randomized trials that have not yet demonstrated a clear benefit of CTO recanalization, the widespread of CTO-PCI has substantially increased. The improvement in operators’ techniques, equipment, and training programs has led to an improvement in the success rate and safety of these procedures, which will represent an important field of future development of PCI. The present review will summarize clinical outcomes and technical and safety issues of CTO revascularization with the aim to guide clinical daily cath-lab practice.

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Current challenges and prevention strategies for chronic total occlusion (CTO) complications

Cited by 10 publications

References 42 publications

Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention

Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention

A non-interventional cardiologist’s guide to coronary chronic total occlusions

Coronary Chronic Total Occlusion Revascularization: When, Who and How?

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