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Percutaneous coronary intervention in aorto-ostial coronary chronic total occlusion: outcomes and technical

Soledad Ojeda1, Aurora Luque1, Manuel Pan1

  • 1Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.

Revista Espanola De Cardiologia (English Ed.)
|March 9, 2020
PubMed

Insights

Percutaneous coronary intervention (PCI) for aorto-ostial chronic total coronary occlusion (CTO) is challenging. Successful PCI is achievable with experienced operators, particularly when interventional collaterals enable a retrograde approach.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Aorto-ostial chronic total coronary occlusion (CTO) presents unique challenges for percutaneous coronary intervention (PCI).
  • Optimizing PCI strategies for this specific lesion subset is crucial for improving patient outcomes.

Purpose of the Study:

  • To analyze the technical aspects and outcomes of PCI in patients with aorto-ostial CTO.
  • To identify factors influencing procedural success and complications in this challenging group.

Main Methods:

  • A multicenter registry included 103 patients undergoing aorto-ostial CTO PCI between February 2013 and December 2018.
  • Technical and procedural success rates, crossing techniques, and complications were analyzed.

Main Results:

  • Technical and procedural success rates were 76.7% and 75.7%, respectively.
  • The retrograde approach was the most successful crossing technique (62.0%), particularly with interventional collaterals.
  • Absence of interventional collaterals was the only independent predictor of technical failure (OR, 12.38).
  • Complications included coronary perforation (3.9%) and stroke (1.9%).
  • At a median follow-up of 31 months, cardiovascular death occurred in 2.9% and repeat revascularization in 12.6%.

Conclusions:

  • Aorto-ostial CTOs are a difficult subset for PCI, but acceptable success rates and favorable outcomes are achievable.
  • Experienced operators and the utilization of the retrograde approach, facilitated by interventional collaterals, are key to successful PCI in this population.
Abstract

Keywords:
Abordaje retrógradoChronic total coronary occlusionIntervención coronaria percutáneaOclusión coronaria total crónicaPercutaneous coronary interventionRetrograde approach

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