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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.