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Fate of lumen size in distal coronary segment following successful chronic total occlusion recanalization
Osung Kwon1, Pil Hyung Lee2, Seung-Whan Lee2
1Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea.
Insights
Successful revascularization of chronic total occlusion (CTO) significantly increases distal lumen diameter. This finding impacts stent selection and management strategies for CTO lesions.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Vascular biology
Background:
- Restoring blood flow after chronic total occlusion (CTO) can alter vascular wall stress.
- These changes may affect the lumen size in segments downstream from the CTO lesion.
Purpose of the Study:
- To evaluate changes in lumen diameter distal to the stent in patients with successfully recanalized CTO.
- To understand the impact of revascularization on distal vascular segments.
Main Methods:
- Analysis of 507 consecutive CTO cases with stent implantation and follow-up angiography.
- Quantitative coronary angiography used to measure lumen diameters in segments distal to the stent (≤40 mm).
- Follow-up averaged 13.5 months post-procedure.
Main Results:
- Significant lumen diameter increases were observed distal to the stent (e.g., 18.2% change at 5 mm).
- Lumen enlargement was consistent across different degrees of distal vessel disease and in-stent narrowing.
- Left ventricle dysfunction predicted greater lumen enlargement, while low hematocrit was associated with less enlargement.
Conclusions:
- Successful CTO revascularization leads to significant distal lumen enlargement.
- Distal lumen changes are independent of the distal vessel's diseased status or in-stent narrowing.
- Findings suggest optimizing stent sizing, coverage, and distal vessel management strategies.
Background:
Restoration of anterograde blood flow leads to alterations in vascular wall stress that may influence lumen size distal to chronic total occlusion (CTO) lesions. We sought to assess changes in lumen diameter of segments distal to the stent segment of successfully recanalized CTO.
Methods:
We analyzed 507 consecutive CTO cases with stent implantation that underwent follow-up angiography at a single high-volume center (mean follow-up of 13.5 months). Segments ≤40 mm distal to the stent edge were analyzed using quantitative coronary angiography.
Results:
At follow-up, lumen diameters significantly increased; diameter changes of 0.26 ± 0.47 (percent diameter change of 18.2%) at 5 mm distal, mean lumen diameter changes of 0.23 ± 0.35 (14.3%) and minimal lumen diameter changes of 0.22 ± 0.80 (24.7%) (all p < 0.001). Lumen enlargement was similar between visually shrunken and stenosed vessels (degree of stenosis ≥20% with luminal irregularities) distal to stents; 5 mm distal (0.32 ± 0.48 vs. 0.30 ± 0.48, p = 0.76), mean lumen diameter changes (0.26 ± 0.37mm vs. 0.26±0.33 mm, p = 0.94), minimal lumen diameter changes (0.28 ± 0.43 mm vs. 0.22 ± 1.30 mm, p = 0.48). There was no association between degree of in-stent narrowing and changes in distal lumen diameter (Spearman r = -0.02, p = 0.59). Multivariate logistic regression for the predictors of greater lumen enlargement indicated that patients with left ventricle dysfunction (ejection fraction ≤45%) had greater enlargement [odds ratio (OR): 2.53, 95% confidence interval (CI): 1.23-5.23, p = 0.01]. Conversely, a low hematocrit (male <40%, and female <35%) was associated with attenuated lumen enlargement (OR: 0.68 95% CI: 0.47-0.98; p = 0.04).
Conclusions:
Lumen diameter distal to CTO lesions significantly increased following successful revascularization, regardless of diseased status of the distal bed or degree of in-stent narrowing. These findings implicate appropriate determination of stent size, stent coverage length, as well as management strategies of distal vessels.
