A Novel Algorithm for Treating Chronic Total Coronary Artery Occlusion
Hiroyuki Tanaka1, Etsuo Tsuchikane2, Toshiya Muramatsu3
1Kurashiki Central Hospital, Okayama, Japan.
Insights
Guidewire manipulation time is crucial for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). This study suggests redefining CTO PCI strategy algorithms based on guidewire time and patient characteristics.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Device Technology
Background:
- Guidewire manipulation time is an underutilized metric in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- Current CTO PCI strategies may not fully incorporate procedural time-related data.
- Optimizing guidewire use is essential for successful CTO PCI outcomes.
Purpose of the Study:
- To develop an algorithm for CTO PCI strategies incorporating angiographic characteristics and guidewire manipulation time.
- To analyze the impact of guidewire manipulation time on procedural success in CTO PCI.
- To identify predictors of guidewire failure in different CTO PCI approaches.
Main Methods:
- Analysis of 5,843 patients from the Japanese CTO-PCI expert registry (2014-2017).
- Evaluation of CTO PCI strategies, procedural outcomes, and guidewire manipulation times.
- Comparison of guidewire manipulation times between antegrade and retrograde approaches, and success/failure groups.
Main Results:
- Overall guidewire and technical success rates were 92.8% and 90.6%.
- Median guidewire manipulation time was significantly longer in cases of guidewire failure (176 min) versus success (56 min).
- Predictors of antegrade guidewire failure (reattempt, CTO length ≥20 mm, no stump) did not predict failure after retrograde approach.
Conclusions:
- Guidewire manipulation time is a significant factor in CTO PCI success.
- Current CTO PCI strategy algorithms may require redefinition based on guidewire time and patient characteristics.
- Further research into incorporating time-based metrics into CTO PCI algorithms is warranted.
Background:
Guidewire manipulation time is rarely used in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) strategies.
Objectives:
This study sought to develop an algorithm based on angiographic characteristics and guidewire manipulation time.
Methods:
This study assessed 5,843 patients undergoing CTO PCI between January 2014 and December 2017 and enrolled in the Japanese CTO-PCI expert registry and analyzed their CTO-PCI strategies, procedural outcomes, and guidewire manipulation time.
Results:
Primary retrograde approach was performed on 1,562 patients. The average Japanese CTO score of primary antegrade approach and primary retrograde approach were 1.7 ± 1.1 and 2.3 ± 1.1, respectively (p < 0.001). The overall guidewire and technical success rates were 92.8% and 90.6%, respectively. Median guidewire manipulation time of guidewire success and failure were 56 min (interquartile range [IQR]: 22 to 111 min) and 176 min (IQR: 130 to 229 min), respectively. Median successful guidewire crossing time of single wiring and parallel wiring in the antegrade alone were 23 min (IQR: 11 to 44 min) and 60 min (IQR: 36 to 97 min), and rescue retrograde approach and primary retrograde approach were 126 min (IQR: 87 to 174 min) and 107 min (IQR: 70 to 161 min), respectively (p < 0.001). Significant predictors for antegrade guidewire failure in primary antegrade approach, which were reattempt, CTO length of ≥20 mm, and no stump, did not predict guidewire failure after collateral channel crossing in primary retrograde approach.
Conclusions:
Results from a large registry with information on guidewire manipulation time as well as CTO characteristics suggest a redefinition of the current strategy algorithms.
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