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Immediate and long-term outcome of recanalization of chronic total coronary occlusions
Federico Piscione1, Gennaro Galasso, Anton Giulio Maione
1Division of Cardiology, Federico II University, Via S. Pansini 5, 80131 Naples, Italy. piscione@unina.it
Insights
Successful coronary angioplasty for chronic total occlusions is achievable using hydrophilic guidewires, with family history of coronary artery disease and specific artery occlusions predicting success.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary total occlusions (CTO) present a significant challenge in interventional cardiology.
- Distinguishing between subacute (STO) and chronic total occlusions (CTO) is crucial for procedural planning and outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of hydrophilic guidewire-assisted coronary angioplasty for both subacute and chronic total occlusions.
- To identify predictors of procedural success in treating coronary total occlusions.
Main Methods:
- Retrospective study of 83 patients with 85 coronary total occlusions.
- Patients categorized into STO (<30 days) and CTO (>30 days) groups.
- All procedures utilized hydrophilic guidewires; success defined by lesion crossing, balloon dilatation, and stent deployment without complications.
Main Results:
- Clinical success rates were 96% for STO and 81% for CTO.
- Family history of coronary artery disease (CAD), left anterior descending, and right coronary artery occlusions were independent predictors of procedural success.
- No major periprocedural or early postprocedural events occurred.
Conclusions:
- Hydrophilic guidewires facilitate successful recanalization of CTO with a low complication rate and favorable long-term outcomes.
- Predictors of successful coronary angioplasty for total occlusions include family history of CAD and specific coronary artery involvement.
Abstract:
Eighty-three consecutive patients with 85 coronary total occlusions undergoing coronary angioplasty were retrospectively studied. Patients were divided into two groups according to the occlusion age that was < 30 days (subacute total occlusion [STO]: 25 patients; range 1-30 days) or > 30 days (chronic total occlusion [CTO]: 58 patients; range 3-144 months). All procedures were carried out using a hydrophilic guidewire. Clinical success, consisting of crossing the lesion, balloon dilatation, stent deployment without complications, was 96% in STO and 81% in CTO. Multiple stepwise logistic regression analysis identified a family history of coronary artery disease (CAD), left anterior descending and right coronary artery occlusions as independent predictors of a successful procedure. No major events occurred during or immediately after the angioplasty. After a mean follow-up of 24 +/- 2 months, no difference was found in survival or freedom from myocardial infarction or target vessel revascularization among the STO and CTO patients. Successful recanalization by using a hydrophilic guidewire was achieved in a high percentage of chronic total occlusions with a low incidence of complications and a satisfactory late clinical outcome. Family history of CAD and occlusion of left anterior descending or right coronary arteries are independent predictors of procedural success.