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Predictors of re-occlusion after successful recanalization of chronic total occlusion
M Sallam1, V Spanos, C Briguori
1Department of Interventional Cardiology, San Raffaele Hospital, Via Olgettina, 60, 20132, Milan, Italy.
Insights
Re-occlusion after stenting chronic total coronary occlusions occurs in about 11% of cases. Total stent length is the most significant predictor of re-occlusion following successful recanalization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Chronic total coronary occlusions (CTO) present a significant challenge in interventional cardiology.
- Successful recanalization and stenting improve myocardial perfusion but are associated with potential complications.
Purpose of the Study:
- To determine the incidence of re-occlusion after successful recanalization of CTO.
- To identify predictors of re-occlusion in patients treated for CTO.
Main Methods:
- Retrospective analysis of 716 coronary lesions in 665 patients with CTO.
- Repeat angiography within 6 months to assess for restenosis and re-occlusion.
- Multivariate analysis to identify independent predictors of re-occlusion.
Main Results:
- Complete re-occlusion was observed in 10.6% of lesions (43 out of 405) that underwent repeat angiography.
- Univariate analysis showed correlations between re-occlusion and several factors including stent length.
- Multivariate analysis identified total stent length as the sole independent predictor of re-occlusion (OR = 1.46).
Conclusions:
- Re-occlusion is a notable complication after stenting CTO, occurring in approximately 11% of cases.
- Total stent length is the primary independent predictor of re-occlusion in this patient cohort.
Unlabelled:
The objective of this study was to highlight the incidence and predictors of re-occlusion after successful recanalization of chronic total coronary occlusions.
Methods And Results:
Following successful recanalization and stent implantation in 716 coronary lesions (665 patients) with chronic total occlusion, four hundred and five (56.6%) lesions (375 patients) underwent repeat angiography within 6 months. Restenosis (> or = 50% lumen narrowing) was observed in 151 (37.3%) lesions; forty-three (10.6%) of these lesions had complete re-occlusion and constituted the study population. In this group, final angiographic minimal lumen diameter (MLD) was 2.6 +/- 0.51 mm and final percent diameter stenosis was 18 +/- 11. Univariate analysis revealed significant correlation between re-occlusion and restenotic lesions, final balloon diameter, final percent diameter stenosis, final angiographic MLD, number of stents per lesion and total stent length. By multivariate analysis, the only independent predictor of re-occlusion was total stent length (OR = 1.46, 95% CI = 1.12-1.82; p = 0.0069).
Conclusion:
Re-occlusion occurs in about 11% of cases after stenting chronic total occlusion. The most important predictor of re-occlusion seems to be stent length.