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Determinants of percutaneous coronary intervention success in repeat chronic total occlusion procedures following an
Cecilia Cuevas1, Nicola Ryan1, Alicia Quirós1
1Cecilia Cuevas, Nicola Ryan, Alicia Quirós, Juan Gustavo Del Angel, Nieves Gonzalo, Pablo Salinas, Pilar Jiménez-Quevedo, Luis Nombela-Franco, Ivan Nuñez-Gil, Antonio Fernandez-Ortiz, Carlos Macaya, Javier Escaned, Cardiovascular Institute, Hospital Clinico San Carlos, 28040 Madrid, Spain.
Insights
Repeat percutaneous coronary intervention (PCI) significantly improves chronic total occlusion (CTO) revascularization success rates. Key predictors for successful repeat PCI include intravascular ultrasound (IVUS) guidance and operator experience.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Chronic total occlusions (CTOs) present a challenge in percutaneous coronary intervention (PCI).
- Initial CTO-PCI attempts have a notable failure rate, necessitating further investigation into repeat procedures.
Purpose of the Study:
- To determine the success rates of repeat PCI for CTOs after an initial failed attempt.
- To identify factors influencing the success of repeat CTO-PCI procedures.
Main Methods:
- Retrospective analysis of 64 repeat PCI procedures in 58 patients following failed initial CTO-PCI.
- Data collected included clinical, angiographic, and procedural details.
Main Results:
- Procedural success was achieved in 64% of repeat CTO-PCI procedures.
- Intravascular ultrasound (IVUS) guidance, experienced CTO operators, and CTO location were significant predictors of success.
- Severe calcification and high J-CTO scores were associated with failure.
Conclusions:
- Repeat PCI is effective in increasing overall CTO revascularization success.
- Utilizing IVUS, engaging experienced CTO operators, and considering CTO location are crucial for successful repeat interventions.
Aim:
To investigate the rates and determinants of success of repeat percutaneous coronary intervention (PCI) following an initial failed attempt at recanalising the chronic total occlusions (CTO) percutaneously.
Methods:
In 445 consecutive first attempt CTO-PCI procedures in our institution, procedural failure occurred in 149 (33.5%). Sixty-four re-PCI procedures were performed in 58 patients (39%) all had a single CTO. Procedural and outcome data in the re-PCI population was entered into the institutional database. A retrospective analysis of clinical, angiographic and procedural data was performed.
Results:
Procedural success was achieved in 41 (64%) procedures. Univariate analysis of clinical and angiographic characteristics showed that re-PCI success was associated with intravascular ultrasound (IVUS) guidance (19.5% vs 0%, P = 0.042), while failure was associated with severe calcification (30.4% vs 9.7%, P = 0.047) and a JCTO score > 3 (56.5% vs 17.1% P = 0.003). Following multiple regression analysis the degree of lesion complexity (J-CTO score > 3), IVUS use, involvement of an experienced CTO operator and LAD CTO location were significant predictors of successful re-PCI. Overall the complication rate was low, with the only MACCE two periprocedural MI's neither of which required intervention.
Conclusion:
Re-PCI substantially increases the overall success rate of CTO revascularization. Predictors of re-PCI success included the use of IVUS, the involvement of an experienced CTO operator in the repeat attempt and the location of the CTO.
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