Related Experiment Video
Updated: Jul 31, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Procedural Time and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention
Athanasios Rempakos1, Spyridon Kostantinis1, Bahadir Simsek1
1Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
Insights
Procedural time in chronic total occlusion (CTO) percutaneous coronary interventions (PCI) impacts outcomes. Shorter guidewire crossing times correlate with less complex lesions and fewer complications, suggesting efficiency is key for successful CTO PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusion (CTO) percutaneous coronary interventions (PCI) are complex procedures.
- Understanding the impact of procedural time on CTO PCI outcomes is crucial for optimizing patient care and success rates.
Purpose of the Study:
- To investigate the relationship between procedural time and outcomes in CTO PCI.
- To analyze the time spent on different stages of CTO PCI procedures.
Main Methods:
- Retrospective analysis of 6,442 CTO PCI procedures from 40 centers (2012-2022).
- Examination of procedural times for access to wire insertion, guidewire manipulation, and post-crossing.
- Correlation of procedural times with lesion complexity (Japanese CTO score) and success rates.
Main Results:
- Mean procedure time was 129 ± 76 minutes, with no significant change over time.
- Lesions crossed in <30 minutes had significantly lower Japanese CTO scores (1.89 ± 1.19) compared to those not crossed (2.88 ± 1.22) or crossed in ≥30 minutes (2.85 ± 1.13).
- Likelihood of successful crossing decreased significantly with longer guidewire manipulation times (76.7% at 30 min, 60.7% at 90 min, 42.7% at 180 min).
- Factors associated with longer guidewire manipulation time included specific lesion characteristics and prior failed attempts.
Conclusions:
- Procedural time, particularly guidewire manipulation, is a critical factor in CTO PCI success.
- Shorter guidewire crossing times are associated with less complex lesions and better outcomes.
- Optimizing procedural efficiency may improve success rates in complex CTO PCI cases.
Abstract:
Chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) can be lengthy procedures. We sought to investigate the effect of procedural time on CTO PCI outcomes. We examined the procedural time required for the various steps of CTO PCI in 6,442 CTO PCIs at 40 US and non-US centers between 2012 and 2022. The mean and median procedure times were 129 ± 76 and 112 minutes, respectively, with no significant change over time. The median times from access to wire insertion, guidewire manipulation time, and post crossing were 20, 32, and 53 minutes, respectively. Lesions crossed in <30 minutes were less complex, as reflected by lower Japanese CTO score (1.89 ± 1.19, p <0.001) than lesions that were not successfully crossed (2.88 ± 1.22) and lesions that were crossed in ≥30 minutes (2.85 ± 1.13). The likelihood of successful crossing if crossing was not achieved after 30, 90, and 180 minutes were a 76.7%, 60.7%, and 42.7%, respectively. The parameters independently associated with ≥30 minutes guidewire manipulation time in patients with a primary antegrade approach included left anterior descending target vessel, proximal cap ambiguity, blunt/no stump, occlusion length, previous failed attempt, medium/severe calcification, and medium/severe tortuosity. The mean duration of CTO PCI is approximately 2 hours (∼20% of time for access to wire insertion, ∼30% wire manipulation time, and ∼50% postwiring time). Guidewire crossing time was shorter in less complex lesions and in cases without complications.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
12:00Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:24Cardiac Catheterization III: Left Heart Catheterization
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:30Acute Coronary Syndrome III: Diagnostic Studies