Recanalization of chronic total coronary occlusions—high success rate despite a restrictive use of the retrograde approach

Bijuklic, Klaudija; Schwencke, Carsten; Schofer, Joachim

doi:10.1002/ccd.26168

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…After 2 years, the success rate of CTO-PCI greatly improved, reaching 90% in the third year [ 17 ]. In a study in 2016, a novice operator was observed for 5 years; when the retrograde utilization rate was only 18%, the operation volume of 80 cases/year was maintained, and the final success rate reached 90% [ 20 ]. A similar “inflection point” was found in a recent study.…”

Section: Discussionmentioning

confidence: 99%

“…At present, retrograde technology is recommended only in the antegrade technology, which is difficult to open and has a good side effect. The total success rate of CTO-PCI can be greatly improved with the improvement in the success rate of antegrade technology [ 20 ]. Finally, based on previous findings, the consensus of the European CTO club, and the situation of the center, the implementation period of ≥5 years and the annual operation volume of ≥60 cases were selected as the threshold of operator experience division, and the success rate of ≥90% was used to divide “experts” and other operations.…”

Section: Discussionmentioning

confidence: 99%

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A Novel Clinical Scoring Model for Interventional Therapy in Chronic Total Occlusion of the Coronary Artery

Xiao

Liu

Cai

et al. 2021

Journal of Interventional Cardiology

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Objective. With the rapid development of technology and experience, the current percutaneous coronary intervention of chronic total occlusion (CTO-PCI) preoperative scoring model needs to be updated. This study aimed to evaluate the clinical value of the operator-CTO score in predicting the outcome of interventional therapy for chronic total occlusion of the coronary artery. Methods. The data of 144 lesions in 130 patients with CTO were analyzed prospectively. The CTO procedures were performed by 10 operators with different skills and experiences. Before the procedures, J-CTO, progress, ORA, recharge, and operator-CTO scores were determined. Then, the clinical, imaging, and procedural data of patients in different operator-CTO score groups and between different operators were compared. The final focus was on comparing the predictive ability of each score on the outcome of CTO-PCI. Results. The overall technical and procedural success rates were 90.9% and 88.9%, respectively. A decreasing trend in the technical success of CTO-PCI was observed according to the operator-CTO score hierarchy of “easy (≤2 points), moderate (3 points), difficult (4 points), and extremely difficult (≥5 points)” (99.0%, 87.5%, 53.8%, and 25.0%, respectively). All five scoring models were well calibrated, and the area under the curve (AUC) for the operator-CTO score was 0.901 (95% CI: 0.821–0.982, P < 0.01 ), larger than the AUC for the remaining four scoring models, showing excellent ability to predict technical outcomes. Conclusion. The operator-CTO score is a new clinical scoring tool that can predict the outcome of CTO-PCI and can be used to grade the difficulty of the procedure, with the potential to work well with a broad group of operators.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Novel Clinical Scoring Model for Interventional Therapy in Chronic Total Occlusion of the Coronary Artery

Xiao

Liu

Cai

et al. 2021

Journal of Interventional Cardiology

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Transcatheter Intervention of Coronary Obstructions in Infants, Children, and Young Adults

et al. 2018

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This study assesses the characteristics of coronary obstructions that underwent transcatheter intervention in a pediatric catheterization laboratory, the procedural details, and patient outcomes. Acute cardiac failure due to coronary obstructions in children is rare. The role of catheter based intervention is largely unreported. Single center retrospective review between January 2000 and December 2016. Thirty-three patients (median age 2y/o [0-38], weighing 9.6 kg [2.2-91]) underwent 39 transcatheter interventions on 39 lesions, mainly left main coronary (16/39; 39%) and right coronary (9/39; 23%) arteries. Most patients had congenital heart disease (29/33; 88%). Cath indications included ventricular dysfunction (17), cardiac arrest (7), failure to wean from cardiopulmonary bypass (5), and other (4). Almost half (18/39; 46%) were performed on ECMO support. Obstructions were post-surgical (16; 4 with coronary manipulation), thrombotic (13; 5 < 30 days from cardiac surgery), and miscellaneous lesions (10). Interventions included 25 bare metal stents implanted in 22 lesions in 17 patients (mainly post-surgical lesions; 3 at Damus-Kaye-Stansel anastomosis), nine balloon angioplasty only, four lytic therapy ± mechanical disruption of thrombus, and four technical failures. There were no procedure-related deaths. Most patients survived to discharge or transplant (24/33; 73%). Six patients who received stents had follow-up catheterization (median 15.5 months [1-106]); all were without restenosis. Most coronary obstructions intervened upon in a pediatric cath lab were on young, critically ill patients with congenital heart disease secondary to surgical manipulation/injury or thrombosis. Transcatheter intervention should be considered a potential treatment strategy in this population.

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Recanalization of chronic total coronary occlusions—high success rate despite a restrictive use of the retrograde approach

Abstract: A high CTO-PCI success rate of above 90% could be achieved with a restrictive use of the retrograde technique.

Cited by 2 publications

References 21 publications

A Novel Clinical Scoring Model for Interventional Therapy in Chronic Total Occlusion of the Coronary Artery

A Novel Clinical Scoring Model for Interventional Therapy in Chronic Total Occlusion of the Coronary Artery

Transcatheter Intervention of Coronary Obstructions in Infants, Children, and Young Adults

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