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Predictors of successful percutaneous coronary intervention in chronic total coronary occlusions
Ahmet Oytun Baykan1, Mustafa Gür2, Armağan Acele1
1Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey.
Insights
Percutaneous coronary intervention for chronic total occlusions (CTOs) can be successful. Lesion characteristics like calcification and collaterals predict procedural success or failure in CTO revascularization.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Procedures
Background:
- Percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTOs) presents significant challenges in interventional cardiology.
- The success rates and benefits of CTO revascularization versus risks remain debated.
Purpose of the Study:
- To investigate the correlation between specific lesion characteristics and the success rates of PCI for CTOs.
- To analyze the impact of lesion attributes on in-hospital outcomes following CTO PCI.
Main Methods:
- A retrospective analysis of 173 consecutive native coronary artery CTO PCI procedures was conducted.
- Data were collected from procedures performed between February 2012 and March 2013.
Main Results:
- Successful revascularization was achieved in 83.2% of patients; major complications occurred in 13.3%.
- Independent predictors of procedural failure included bridge collaterals, severe calcification, tortuosity, and tandem occlusions.
- The presence of micro-channels was the sole independent predictor of procedural success.
Conclusions:
- Coronary CTO revascularization can be performed with high success rates and low complication rates.
- Bridge collaterals, severe calcification/tortuosity, tandem occlusions, and micro-channels are key predictors for successful CTO revascularization.
Introduction:
Percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) is one of the most challenging procedures of interventional cardiology and is associated with increased risk of significant complications. However, debate continues in regard to which factors adversely influence the success rate of PCI and whether the benefits of revascularization of CTO outweigh the risks and challenges.
Aim:
To analyze the relationship between lesion characteristics and overall success rates as well as in-hospital outcomes after PCI for CTO.
Material And Methods:
We retrospectively examined the procedural outcomes of 173 consecutive native coronary artery CTO PCIs performed from February 2012 to March 2013 (78% men; mean age: 60.3 ±12.1 years).
Results:
The CTO target vessel was the right coronary artery (53.8%), circumflex (10.4%) and left anterior descending artery (35.8%), respectively. The retrograde approach was used in 13.9% of all procedures. Successful revascularization was achieved in 83.2% of patients. Major complications occurred in 13.3% of patients. In multivariate analysis, bridge collaterals, severe calcification and tortuosity as well as tandem occlusions were independent predictors of procedural failure, whereas existence of micro-channels was the only predictor of procedural success.
Conclusions:
Revascularization of coronary CTOs may be performed with high success and low major complication rates. Bridge collaterals, severe calcification and tortuosity, tandem/multiple occlusions and micro-channels were independent predictors of successful CTO revascularization.
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