Chronic Total Occlusion - Percutaneous Coronary Intervention (CTO-PCI) Experience in a Single, Multi-operator
Vimalraj BoganaShanmugam1, Peter J Psaltis2, Dennis T Wong1
1Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine, Monash Health and Monash University, Melbourne, Vic, Australia.
Insights
This study reports modest success rates for percutaneous coronary intervention (PCI) in treating chronic total occlusions (CTOs). The findings highlight challenges and outcomes in a single Australian center before a dedicated CTO program.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusions (CTOs) present significant challenges in percutaneous coronary intervention (PCI) due to their complexity.
- Specialized techniques are often required for successful CTO treatment.
Purpose of the Study:
- To evaluate the experience and outcomes of CTO-PCI at a single Australian center.
- To analyze procedural characteristics and success rates of CTO interventions.
Main Methods:
- Retrospective review of 82 patients undergoing CTO-PCI between January 2010 and December 2012.
- Data collected included lesion characteristics, procedural details, and in-hospital adverse outcomes.
- Japanese CTO scoring system was used to classify lesion difficulty.
Main Results:
- The most common CTO sites were the right coronary artery (44%), left circumflex (30%), and left anterior descending (26%) arteries.
- Overall CTO success rate was 60%.
- In-hospital adverse events included 1.2% mortality, 9.8% myocardial infarction, and 4.9% emergency bypass surgery.
Conclusions:
- The study reports modest success rates for CTO-PCI in a conservative patient cohort.
- These findings represent early experience before the establishment of a dedicated CTO revascularization program.
Background:
Chronic total occlusions (CTOs) represent a unique set of lesions for percutaneous coronary intervention (PCI) because of the complexity of techniques required to treat them.
Methods:
We retrospectively reviewed the CTO-PCI experience between January 2010 and December 2012, in a multi-operator single centre, which is one of the largest volume PCI centres in Australia.
Results:
Eighty-two patients (62.6±11.3 years, 85% males) who had CTO-PCIs were included. The most common site of CTO was the right coronary artery (44%), followed by the left circumflex (30%) and left anterior descending (26%) arteries. Using the Japanese CTO scoring system, 34% of lesions were classified as easy, 37% intermediate, 23% difficult and 6% very difficult. All PCIs were performed by antegrade approach. Selected procedural characteristics included: re-attempt procedure 10%; multiple access sites 21%; more than one guidewire 77%; additional support modality 60%; drug-eluting stents 97%; stent number 1.6±0.8; total stent length 40.1±24.5mm; fluoroscopy time 33±17min; contrast volume 257.2±110.8mL. Overall CTO success rate was 60%. In-hospital adverse outcomes included 1.2% mortality, 9.8% peri-procedural myocardial infarction, 4.9% emergency bypass surgery, 3% cardiac tamponade and 4.9% contrast induced nephropathy.
Conclusion:
We report modest success rates in a single Australian centre experience in a relatively conservative cohort of CTO-PCI prior to the initiation of a dedicated CTO revascularisation program.
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