Related Experiment Video
Updated: Apr 19, 2026
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Procedural failure of chronic total occlusion percutaneous coronary intervention: Insights from a multicenter US
James Sapontis1, Georgios Christopoulos2, J Aaron Grantham1
1Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Missouri.
Insights
The hybrid approach for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has high success rates, but failures are linked to complex lesion characteristics and insufficient collaterals. Novel techniques are needed to improve outcomes in challenging CTO PCI cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- The hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has improved success rates.
- Despite advancements, some CTO PCI procedures still fail, necessitating an evaluation of failure causes.
Purpose of the Study:
- To evaluate the causes of failure in contemporary CTO PCI using a hybrid approach.
- To identify factors associated with procedural failure in CTO PCI.
Main Methods:
- A registry of 380 consecutive patients undergoing CTO PCI with the hybrid approach was analyzed.
- Clinical, angiographic, and outcome data were compared between successful and failed cases.
- Failed cases were independently reviewed to determine the specific cause of failure.
Main Results:
- Procedural success for CTO PCI was 91.3%.
- Failed cases exhibited longer occlusion length, increased tortuosity, ambiguous proximal caps, and higher J-CTO scores compared to successful cases.
- Failure was primarily due to inability to wire the lesion (70%) or poor antegrade flow (30%), with complications occurring in 10 cases.
Conclusions:
- Higher J-CTO scores, complex lesion morphology (longer occlusion, ambiguous cap), and lack of suitable collaterals for retrograde crossing are associated with CTO PCI failure.
- Further development of novel crossing techniques is crucial to enhance success rates in complex CTO PCI cases.
Background:
The hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly increased procedural success rates, yet some cases still fail. We sought to evaluate the causes of failure in a contemporary CTO PCI registry.
Methods:
We examined 380 consecutive patients who underwent CTO-PCI at 4 high volume CTO PCI centers in the United States using the "hybrid" approach. Clinical, angiographic, complication, and efficiency outcomes were compared between successful and failed cases. Failed cases were individually reviewed by an independent reviewer to determine the cause of failure.
Results:
Procedural success was 91.3%. Compared with patients in whom CTO PCI was successful, those in whom CTO PCI failed had similar baseline clinical characteristics, but were more likely to have longer occlusion length, more tortuosity, more proximal cap ambiguity and blunt stump, and higher mean J-CTO scores (2.8 ± 1.1 vs. 3.5 ± 1.0, P < 0.001), and less likely to have collaterals suitable for the retrograde approach (66% vs. 45%, P = 0.021). Failure was due to a complication in 10 cases (30%). In the remaining 23 cases (70%) failure was due to inability to wire the lesion (n = 21, 4 of which were CTOs due to in-stent restenosis), or poor antegrade flow after PCI (n = 5).
Conclusions:
Compared with successful cases, failed CTO-PCI cases are more likely to have higher J-CTO scores, longer occlusion length, ambiguous proximal cap and no appropriate collaterals for retrograde crossing. Development of novel CTO crossing techniques is needed to further increase CTO PCI success rates.
More Related Videos
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction