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Percutaneous Coronary Intervention for Aorto-Ostial Chronic Total Occlusion: Evaluating Lesion Complexity and
Takeshi Niizeki1, Etsuo Tsuchikane2, Tsuneo Konta3
1Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan.
Insights
Percutaneous coronary intervention (PCI) for aorto-ostial chronic total occlusion (CTO) is complex, often requiring a retrograde approach. Success depends on interventional collateral channels and managing challenges like tortuosity.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Aorto-ostial chronic total occlusion (CTO) presents unique challenges for percutaneous coronary intervention (PCI).
- Guidewire techniques may differ significantly from non-aorto-ostial CTOs due to specific clinical and angiographic factors.
Purpose of the Study:
- To evaluate the technical aspects and procedural outcomes of PCI specifically in patients with aorto-ostial CTO.
- To identify factors influencing the success of PCI for aorto-ostial CTO.
Main Methods:
- Analysis of 420 patients with ostial CTO from the Japanese CTO-PCI Expert Registry (January 2014 - December 2022).
- Examination of PCI strategies, procedural outcomes, and factors associated with success/failure in aorto-ostial CTO cases.
Main Results:
- Aorto-ostial CTO constituted 52% of the studied ostial CTO cases, with a technical success rate of 88%.
- These lesions were longer and more complex, featuring calcification and tortuosity.
- The retrograde approach, particularly retrograde direct crossing, was more common and successful, especially for flush CTOs. Key predictors of failure included guiding catheter engagement difficulty, J-Channel score, and tortuosity.
Conclusions:
- Aorto-ostial CTOs are inherently more complex, frequently necessitating a retrograde PCI strategy.
- The presence of adequate interventional collateral channels is paramount for successful aorto-ostial CTO treatment.
Background:
PCI for aorto-ostial CTO remains challenging. The techniques for guidewire in aorto-ostial CTO may differ from those used in non-aorto-ostial CTOs, influenced by clinical and angiographic characteristics.
Objectives:
This study aimed to assess the technical aspects and outcomes of percutaneous coronary intervention (PCI) in patients with aorto-ostial chronic total occlusion (CTO).
Methods:
This analysis included 420 patients with ostial CTO from the Japanese CTO-PCI Expert Registry, spanning January 2014 to December 2022. It examined the strategies and procedural outcomes of CTO PCI.
Results:
Ostial CTO represented 420 of 10,814 (3.9%) of all CTO PCI cases. Within this subset, aorto-ostial CTO accounted for 218 of 420 (52%) cases. The technical success rate for aorto-ostial CTO was 88% (191/218). Aorto-ostial CTOs exhibited longer lesion lengths and were more likely to present with challenges such as distal target lumen ambiguity, calcification, and tortuosity compared with non-aorto-ostial CTOs. The retrograde approach was more commonly used in aorto-ostial CTO, with retrograde direct crossing being the most successful technique, especially in cases of flush CTO. A multivariate logistic analysis identified several factors significantly associated with unsuccessful aorto-ostial CTO PCI, including difficulties in engaging a guiding catheter, estimating the collateral channel (as assessed by the J-Channel score), and tortuosity.
Conclusions:
Aorto-ostial CTOs are more complex and frequently require a retrograde approach. The availability of suitable interventional collateral channels is crucial for the success of these procedures.
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