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D A Khelimskii1, O V Krestyaninov, A G Badoyan
1National Medical Research Center named after acad. E. N. Meshalkin.. dkhelim@mail.ru.
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Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) in ischemic heart disease (IHD) showed low adverse events. However, success rates for CTO PCI require improvement through dedicated algorithms.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusions (CTO) are a significant challenge in patients with ischemic heart disease (IHD).
- Percutaneous coronary intervention (PCI) using contemporary endovascular techniques offers a revascularization option for CTO.
- Assessing the procedural and in-hospital outcomes of CTO PCI is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the outcomes of percutaneous coronary intervention (PCI) for chronic total coronary artery occlusions (CTO) in patients with ischemic heart disease (IHD).
- To analyze procedural success and complication rates associated with contemporary endovascular techniques for CTO recanalization.
Main Methods:
- Retrospective analysis of 456 patients undergoing 477 CTO PCI procedures between 2014-2016.
- CTO locations included right (61.2%), LAD (23.2%), and circumflex (15.3%) arteries; J-CTO scores categorized lesion complexity.
- Antegrade and retrograde approaches were utilized, with radial artery access being most common.
Main Results:
- Technical and procedural success rates were 78.4% and 76.7%, respectively.
- Antegrade approach was predominant (79.2%), while retrograde was used in 20.7% of cases.
- Mean fluoroscopy time was 36.2±31 minutes, with an average of 1.6±0.98 stents per lesion.
Conclusions:
- Procedural adverse events for CTO PCI were low and comparable to non-CTO PCI procedures.
- Despite advancements, CTO PCI success rates in this cohort were lower than in specialized centers, indicating a need for improvement.
- Development and implementation of a dedicated CTO recanalization algorithm may enhance procedural success rates.
Purpose:
to assess results of percutaneous coronary intervention (PCI) with contemporary endovascular techniques of recanalization of chronic total coronary artery occlusions (CTO) in patients with ischemic heart disease (IHD). Occlusion (CTO) he procedural and in-hospital outcomes of consecutive patients undergoing chronic total occlusion percutaneous coronary intervention.
Materials And Methods:
We retrospectively analyzed data from 456 consecutive patients (mean age 59.9±7.1 years, 18.2 % women) who underwent CTO PCI procedures (n=477) during 2014-2016 in the E. N. Meshalkin National Medical Research Center. CTO was localized in the right (61.2 %), left anterior descending (23.2 %) and left circumflex (15.3 %) coronary arteries. In one patient CTO was located in the left main coronary artery. According to the J-CTO score, 30 % of lesions were classified as easy, 36.4 % intermediate, 23.7 % difficult, and 18.9 % very difficult.
Results:
Technical and procedural successes were achieved in 374 (78.4 %) and 366 patients (76.7 %), respectively. Antegrade approach was used in 378 (79.2 %), retrograde approach - in 99 (20.7 %) cases. Retrograde approach as primary strategy was used in 27 cases (5.7 %). Most frequent access for CTO PCI was radial artery, contralateral injection was used in 151 cases (31.6 %). Total number of stents per lesion was 1.6±0.98. The mean fluoroscopy time was 36.2±31 min.
Conclusions:
The rate of procedural adverse events in our study was low and similar to the non-CTO PCI series. However, despite the large number of CTO PCIs, the procedural success rate was still lower than in centers with dedicated programs for the management of such patients. Thus, further work is required to overcome this difference. Possible solution of this problem might be development and introduction in clinical practice of an algorithm for CTO recanalization.