A Novel Classification for Predicting Chronic Total Occlusion Percutaneous Coronary Intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) faces challenges with low success rates and increased complications.
• Predicting guidewire (GW) crossing success is crucial for effective CTO PCI.

Purpose of the Study:

• To develop and validate a simple classification method for CTO lesions based on plaque composition.
• To predict guidewire (GW) crossing success within 30 minutes during CTO PCI.

Main Methods:

• Coronary computed tomographic angiography (CCTA) was used to analyze plaque composition in 207 CTO lesions.
• Lesions were classified into 'soft' or 'hard' CTO groups based on necrotic core percentage (>72.7% for hard CTO).

Main Results:

• Hard CTO lesions (79.7%) had significantly lower successful GW crossing rates within 30 minutes (57.6%) compared to soft CTO lesions (85.7%).
• Factors predicting GW failure in hard CTO included previous failed attempts, side branches, significant calcification, and smaller distal vessel diameter.
• Blunt entry was the main predictor of GW failure in soft CTO lesions.

Conclusions:

• Classifying CTO lesions by necrotic core content is effective for predicting 30-minute GW crossing success.
• Soft CTO lesions are more amenable to recanalization than hard CTO lesions, which contain fibrous tissue and dense calcium.
• Distinct plaque compositions necessitate tailored approaches and predictive factors for CTO PCI success.