In‐stent chronic total occlusion angioplasty in the LATAM‐CTO registry

Abstract

Objectives: To inform about contemporary PCI practice of in-stent (IS) chronic total occlusions (CTO) from a large international registry in Latin America. Background: IS-CTO represent a distinctive challenge for PCI, but literature is limited and restricted to high-resource regions of the world. Methods: Patients undergoing CTO PCI enrolled in the LATAM CTO registry from 42 centers in eight countries were included. We analyzed demographics, angiographic, procedure technique, success and postprocedural outcomes between IS-CTO and non-IS-CTO PCI. Results: From 1,565 patients IS-CTO was present in 181 patients (11.5%). IS-CTO patients had higher prevalence of diabetes and hypertension than patients without IS-CTO. IS-CTOs had less calcification (32.5 vs. 46.7%, p < .001), lower prevalence of a proximal branch (36.3 vs. 50.1%, p < .001), more likely to be ostial (24.4 vs. 18.1%, p = .042), were longer (28.5 vs. 25.2 mm, p = .062), and had less interventional collaterals (49.1 vs. 57.3%, p = .038) compared with non-IS-CTO. CTO complexity scores were similar between both groups. There was no statistically significant difference in the initial or successful strategy between IS-CTO and non-IS-CTO PCI. Technical success rates remained high in IS-CTO (86.7%) and non-IS-CTO (83.1%, p = .230). There was no independent association between IS-CTO and technical success in multivariable analysis. There were no differences between IS-CTO and non-IS-CTO groups for in-hospital clinical outcomes. Conclusion: In a contemporary, multicenter, and international registry from Latin America, IS-CTO PCI is frequent and has comparable technical success and safety profile compared to non-IS-CTO PCI.

Procedural Results and Long-Term Outcomes of Percutaneous Coronary Intervention for in-Stent Restenosis Chronic Total Occlusion Compared with de novo Chronic Total Occlusion

“…In-stent restenosis more likely occurred in patients with diabetes, and the rate of complication due to diabetes mellitus might be higher among patients who underwent ISR CTO than those who underwent de novo CTO procedures. 11,14 However, this result was not observed in our study. In the present study, all patients who underwent ISR CTO PCI received PCI for established diagnosis, while approximately 10% of patients in the de novo CTO group underwent percutaneous intervention for the indication of silent ischemia without symptoms.…”

“…14 While the fact that ISR CTOs were more likely to lack good collateral channels, or the visualized collaterals appeared extreme tortuosity, made it hard to be perceived as an interventional approach. 11 In the ISR CTO group of the present study, the prevalence of Rentrop grade 3 was lower than in the de novo CTO group. As for selecting epicardial collaterals to perform retrograde CTO PCI, even for highly experienced operators using a complex technique, it may be a challenging process.…”

“…7,8 The incidence of ISR CTO has been reported to be 11-12% among all CTOs undergoing PCI. [9][10][11] Among CTO PCIs, ISR CTO PCI is thought to be the most challenging. There are limited published data reporting suboptimal procedural success rates in ISR CTO PCI resulting from specific procedural challenges, including the presence of stent underexpansion or fracture, presence of more than one layer of stent struts, heterogeneous neoatherosclerosis of the stented segment, rather than intimal proliferation alone.…”

“…9,14 The incidence of major procedural complications was comparable between patients who underwent ISR CTO and those who underwent de novo CTO in our study, whereas the former participants had a markedly increased rate of MACE, mainly driven by a higher rate of TVR, which is consistent with prior reports. 9,11 ISR was associated with a less benign clinical outcome with respect to recurrence of unstable angina, even MI often requiring rehospitalization to receive repeat angiography. 10,24,25 In our adjusted analysis for various related variables, ISR CTO was identified as the only independent predictor of MACE with a >4-fold risk increase (HR: 4.124, 95% CI: 1.951-8.717, <0.001) in patients undergoing CTO PCI.…”

High‐speed rotational atherectomy in coronary artery calcification: The randomized ROTAXUS and PREPARE‐CALC trials

“…11 The most important and direct thing is that CAC significantly affects the delivery, expansion, and placement of stents. In contemporary multicenter registries from Latin America and Japan, in-stent restenosis after PCI is frequent, 24,25 especially with CAC. RA can ablate the calcified plaques in the coronary vessels so that the lumen is enlarged and the hardness of the plaques is also reduced, which all contribute to the delivery and expansion of the stents.…”