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In-Hospital Outcomes After Recanalization of Ostial Chronic Total Occlusions
Jan-Erik Guelker1, Alexander Bufe2, Christian Blockhaus1
1Department of Cardiology, Heartcentre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Cologne, Germany.
Insights
Percutaneous coronary intervention for chronic total occlusion (CTO-PCI) in ostial lesions has lower success rates and longer procedure times. This indicates that ostial CTO-PCI presents unique challenges for interventional cardiologists.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains a significant challenge.
- Recanalizing ostial lesions, located near the vessel origin, is particularly complex.
- This study evaluates outcomes of ostial versus non-ostial CTO-PCI.
Purpose of the Study:
- To compare the acute and in-hospital outcomes of ostial and non-ostial CTO-PCI.
- To identify factors influencing the success and safety of CTO-PCI in different lesion locations.
- To provide insights into the procedural complexities of ostial CTO interventions.
Main Methods:
- A retrospective analysis of 600 patients undergoing CTO-PCI between 2012 and 2018.
- Ostial lesions (OL) defined as stenosis within 3 mm of the vessel origin.
- Evaluation of antegrade and retrograde CTO-PCI techniques, with a composite safety endpoint.
Main Results:
- Ostial CTO-PCI procedures were associated with significantly longer examination and fluoroscopy times.
- The retrograde approach was utilized more frequently in ostial lesion interventions.
- Overall success rates for ostial CTO-PCI (74.6%) were lower compared to non-ostial CTO-PCI (86.5%).
Conclusions:
- Recanalization of ostial CTO lesions is linked to reduced PCI success rates.
- Ostial CTO-PCI requires longer procedural times and higher fluoroscopy exposure.
- These findings highlight the distinct challenges posed by ostial CTOs in interventional cardiology.
Background:
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) still remains a major challenge in interventional cardiology. Recanalization of ostial lesions is challenging and complex. This present study aims to evaluate the outcome of patients with ostial and non-ostial CTO-PCI with regard to acute, in-hospital outcome.
Methods:
Between 2012 and 2018 we included 600 patients. Ostial lesions (OL) were defined as a coronary arterial stenosis within 3 mm of the vessel origin. Antegrade and retrograde CTO-PCI techniques were used and a composite safety endpoint comprising in-hospital death, vascular complications, cardiac tamponade, stroke and acute myocardial infarction.
Results:
The majority of the patients were male (82.3%) and the mean age was 62.1 years (±10.3 years). The right coronary artery (RCA) was the most frequent target vessel in 58.5%, followed by the left circumflex artery (LCX) (15.4%) and the left anterior descending artery (LAD) (26.2%). The success (p = .439) and complication rates (p = .169) were independent of the target vessel. We determined that examination and fluoroscopy time were longer in patients with OL (120.7 min vs. 99.0 min, p < .001 and 44.9 min vs. 34.5 min, p < .001) and that in this group of patients the retrograde approach was used more frequent (38.8% vs. 18.2%, p < .001). Overall success rates were lower in OL than compared to NOL (74.6% vs. 86.5%, p = .016).
Conclusions:
Our retrospective study suggests that recanalization of ostial CTO lesions is associated with reduced PCI success rates as well as long examination and high fluoroscopy times.
