The Role of Percutaneous Coronary Intervention in the Treatment of Chronic Total Occlusions: Rationale and Review of the Literature

Agrawal, Harsh; Lange, Richard A.; Montanez, Ruben; Wali, Soma; Mohammad, Khan O.; Kar, Subrata; Teleb, Mohamed; Mukherjee, Debabrata

doi:10.2174/1570161116666180117100635

Cited by 5 publications

(5 citation statements)

References 89 publications

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“…CTO-PCIs compared to interventions on non-occluded arteries are technically more challenging, more time-consuming, and have a lower success rate [ 7 ]. The operators need specific training and to become accustomed to managing dedicated devices and techniques to overcome different obstacles they could encounter during the intervention [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Angiographic Characteristics and Outcomes of Percutaneous Coronary Intervention of Reattempted Chronic Total Occlusion: Potential Contributing Factors to Procedural Success

Mohandes

Moreno

Fuertes

et al. 2021

JCM

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This study aimed to analyze angiographic characteristics of new attempted percutaneous coronary intervention (PCI) on chronic total occlusion (CTO) compared to first attempt group. The cohort of 527 CTO-PCIs was divided into first-attempt and re-attempt groups, and angiographic characteristics, level of complexity, and contributing factors to failure were analyzed. Between-group success rate difference and potential angiographic and technical aspects contributing to the success in new attempts were scrutinized. A total of 47 new PCIs in 39 patients were performed. The reattempt group showed higher J-CTO score compared to the first-attempt group (2.4 ± 1.06 vs. 1.2 ± 1.06; p < 0.001). The use of more complex techniques and devices such as retrograde approach (29.8% vs. 12.9%) and IVUS (48.9 vs. 27.3%; p: 0.002) were more frequent in the reattempt group. Both procedural and fluoroscopy time were higher in the reattempt group (197 ± 83.9 vs. 150.1 ± 72.3 and 97.7 ± 55.4 vs. 68.7 ± 43, respectively; p < 0.001). There was no between-group difference in terms of technical success (79.8 vs. 76.6% for first attempt vs. reattempt group, respectively; p: 0.6). The overall success rate increased by 6.1%, achieving 85.9% in the entire cohort. Reattempted CTO-PCIs required more complex techniques and had comparable technical success rate with regard to the first-attempt group.

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Section: Discussionmentioning

confidence: 99%

Angiographic Characteristics and Outcomes of Percutaneous Coronary Intervention of Reattempted Chronic Total Occlusion: Potential Contributing Factors to Procedural Success

Mohandes

Moreno

Fuertes

et al. 2021

JCM

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“…Although PCI for chronic total occlusions renders the treatment more expensive, benefits have been demonstrated in cases appropriately indicated for this procedure, such as situations in which the vessel involved is definitely responsible for ischemic symptoms, or in some patients with silent ischemia and a large myocardial area at risk, in whom the intervention has a good chance of success. [13][14][15] With the development of new strategies, in addition to the techno-logical evolution of the various devices, the success rate in high-volume centers with high experience reaches approximately 90%. 16 However, many definitions still need to be established and ascertained, and further studies in the area are needed.…”

Section: Discussionmentioning

confidence: 99%

Brazilian registry of percutaneous coronary intervention in chronic total occlusions

Medeiros¹,

Pintón²,

Ybarra³

2019

J Transcat Intervent

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Background: Coronary chronic total occlusion is present in approximately one third of patients with coronary artery disease, and its management is challenging. Brazilian reports on percutaneous coronary intervention in this scenario are scarce. The objective of this study was to present contemporary data on percutaneous coronary intervention in chronic total occlusions. Methods: We analyzed the clinical, angiographic and procedural characteristics of all coronary interventions in chronic total occlusions of the Central Nacional de Intervenções Cardiovasculares (CENIC) performed between June 2006 and March 2016. In-hospital clinical events were also considered. For time trend analysis, the data were divided into periods/groups: 2006-2008 (Group 1), 2009-2011 (Group 2) and 2012-2016 (Group 3). Results: A total of 2,018 procedures were performed in 2,009 patients with chronic total occlusions. The mean age was 60.4±10.8 years, with an increase from the first to the third period (59.6±11.0 and 61.2±10.6 years, respectively; p<0.05), 21.9% of patients were diabetic, and 62.8% had single-vessel disease. There was an increase in the use of drug-eluting stents between the first and third periods (19.4% and 35.7%; p<0.0001). In the multivariate analysis, females (OR: 13.77; 95%CI 1.55-122.39; p=0.01) and use of glycoprotein IIb/IIIa inhibitors (OR: 32.29; 95%CI 6.03-172.75; p<0.0001) were associated with an increased risk of death. Conclusion: There was a temporal increase in the use of drug-eluting stents in the management of chronic total occlusions. Furthermore, female sex and the need for glycoprotein IIb/ IIIa inhibitors were associated with a higher risk of death.

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“…These complex lesions are identified in approximately 15% to 30% of all coronary angiography. [1][2][3][4] Among these CTOs, the prevalence of IS-CTO is approximately 5% to 10%. 1,5 Albeit the procedural success rate has improved during the past few years, PCI in IS-CTOs have been associated with suboptimal success rates.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of Percutaneous Coronary Intervention for Patients With In-Stent Chronic Total Occlusion Versus De Novo Chronic Total Occlusion

Gao

Zhang³

et al. 2021

Angiology

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Limited data are available on long-term outcomes and health status in the treatment of in-stent coronary chronic total occlusion (IS-CTO) and de novo coronary chronic total occlusion (de novo CTO). This study compared the long-term clinical outcomes and health status of percutaneous coronary intervention (PCI) for patients with IS-CTO versus patients with de novo CTO in the drug-eluting stent era. We screened 483 consecutive patients with 1 CTO lesion, including 81 patients with IS-CTO and 402 patients with de novo CTO. Propensity score matching was used to balance baseline characteristics between the 2 groups. The clinical end point was major adverse cardiac events (MACE). The success rates of CTO lesion revascularization were similar in both groups. In the propensity score-matched patients, after a median follow-up of 36 months, MACE was observed in 32.8% of patients with IS-CTO versus 13.5% of the patients with de novo CTO ( P < .001), mainly driven by target-vessel revascularization (21.9% vs 6.7%; P < .01). Moreover, patients with IS-CTO had significantly worse Seattle Angina Questionnaire anginal stability scores than the patients with de novo CTO. In conclusion, patients with IS-CTO after PCI had a worse clinical outcome, mainly MACE, and a poorer anginal stability in the long term than patients with de novo CTO.

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The Role of Percutaneous Coronary Intervention in the Treatment of Chronic Total Occlusions: Rationale and Review of the Literature

Cited by 5 publications

References 89 publications

Angiographic Characteristics and Outcomes of Percutaneous Coronary Intervention of Reattempted Chronic Total Occlusion: Potential Contributing Factors to Procedural Success

Angiographic Characteristics and Outcomes of Percutaneous Coronary Intervention of Reattempted Chronic Total Occlusion: Potential Contributing Factors to Procedural Success

Brazilian registry of percutaneous coronary intervention in chronic total occlusions

Long-Term Outcomes of Percutaneous Coronary Intervention for Patients With In-Stent Chronic Total Occlusion Versus De Novo Chronic Total Occlusion

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