Percutaneous transluminal coronary angioplasty of chronic total occlusions. Primary success, restenosis, and long-term clinical follow-up.

Abstract

BACKGROUND Angioplasty of chronically totally occluded vessels has been associated with a success rate well below and restenosis rate well above that for angioplasty of stenosed segments. However, long-term clinical outcome after successful revascularization of a chronically totally occluded vessel has not been reported in detail. METHODS AND RESULTS Accordingly, data for 480 patients undergoing angioplasty for chronic total occlusion at Emory University Hospital, Atlanta, Ga., from 1980 to 1988 were analyzed for predictors of in-hospital procedural and clinical (procedural success and absence of in-hospital complications) success, restenosis, and 4-year clinical follow-up. The study population was grouped by procedural and clinical success and failure. The groups were then compared for outcome, both in hospital and long term. The initial clinical success rate was 66% (317 of 480 patients). Independent correlates of failure were the number of vessels diseased (p less than 0.001), vessel location of the lesion (p = 0.016), and absence of any distal antegrade filling (p = 0.002). Follow-up data revealed 98% cardiac survival and 96% overall survival at 4 years for the group as a whole. Freedom from myocardial infarction or cardiac death was significantly greater in patients with clinical success (93%) than with clinical failure (89%, p = 0.0044). In the successful group, 87% were free from coronary surgery after 4 years compared with 64% in the failure group (p less than 0.0001). Two thirds of the patients were free of angina at last follow-up. The presence of angina at follow-up was the same for patients successfully treated and for those with failed angioplasty, which may be related to the frequent use of coronary surgery in the failure group. CONCLUSIONS In well-selected cases, the success rate for angioplasty of chronic total occlusion is acceptable. Furthermore, long-term clinical benefit is suggested by the high freedom from coronary surgery, myocardial infarction, and death in the patients who underwent successful revascularization.

<b>The Clinical Outcomes of Percutaneous Coronary Intervention in Chronic Total Coronary Occlusion</b>

“…Suero, et al 11) found a better 10-year survival rate in patients admitted with stable angina pectoris who had undergone successful PCI when compared to unsuccessful PCI (74% versus 65%, P = 0.002). Bell, et al 16) and Ivanhoe, et al 17) also reported similar results. The mortality benefit of PCI in CTO may be a result of an improved ejection fraction and improvements in both systolic and diastolic functions of myocardium.…”

“…In our study, the success rate was 68.0%, which is comparable to the 60-70% success rates reported in other studies. 17,18) The number attained in our study did not appear to represent the real success rate of PCI for CTO because there was a selection bias by the physicians with respect to the decision to perform PCI. For this reason, the success rate of PCI is estimated to be less than 68% when all CTOs are taken into consideration.…”

Chronic Total Coronary Artery Occlusion Recanalisation with Percutaneous Coronary Intervention — Single Centre 10-Year Experience

“…Until 2005, the success rates of operators experienced in conventional CTO percutaneous coronary intervention (PCI) techniques has remained unchanged (60-70%), which is considerably lower than the success rates in nonocclusive coronary artery disease (Ivanhoe et al, 1992). Many techniques and devices (wires, microcatheters) have been introduced into clinical practice to improve the effectiveness of CTO revascularisation (Sumitsuji et al, 2011).…”

Clinical Applications of Intravascular Ultrasound

“…PCI of CTO results in symptomatic improvement, improved left ventricle function and reduction in adverse remodelling. In addition recanalization of CTO leads to long-term survival benefit and avoidance of bypass surgery (Melchior, Doriot et al 1987;Ivanhoe, Weintraub et al 1992;Chung, Nakamura et al 2003;Cheng, Selvanayagam et al 2008). The number of CTO interventions has risen gradually due to better operator experience, technical improvements, and newer procedural techniques (these include contra-lateral coronary injection, "parallel" wire techniques, subintimal tracking and re-entry (STAR), retrograde approach with control antegrade retrograde tracking (CART), reverse CART).…”