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Percutaneous Coronary Intervention Outcomes for Chronic Total Occlusion in Patients on Dialysis: Analysis of the

Mayu Sakuma1, Yuji Oikawa1, Koichi Kishi2

  • 1Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|May 27, 2025
PubMed

Insights

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in dialysis patients has lower success rates but remains safe. Careful technique and specialized devices are key for managing complex lesions in this high-risk group.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Nephrology

Background:

  • Patients on dialysis face elevated risks of cardiovascular mortality.
  • Coronary complex lesions are prevalent in patients requiring dialysis.

Purpose of the Study:

  • To analyze the characteristics, outcomes, and adverse events of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) in patients undergoing dialysis.
  • To compare CTO-PCI outcomes between dialysis and non-dialysis patient groups.

Main Methods:

  • A retrospective analysis of 11,664 patients from the Japanese CTO-PCI Expert Registry (January 2014 - December 2022).
  • Comparison of technical success rates, procedure times, and complication rates between patients on dialysis and those not on dialysis.

Main Results:

  • Dialysis patients (6.9% of cohort) had lower technical success rates (85.4% vs. 92.4%) and were independent predictors of technical failure.
  • Increased procedure times and puncture site complications were observed in dialysis patients, but major adverse cardiac or cerebrovascular events (MACCE) rates were similar.
  • Specific techniques like debulking devices and hard tip load wires were frequently needed for CTO crossing in dialysis patients, even without severe calcification.

Conclusions:

  • CTO-PCI in dialysis patients is associated with reduced success rates but can be performed safely regarding MACCE.
  • The use of debulking devices for calcification and meticulous attention to prevent puncture site complications are crucial.
  • Patients on dialysis without predictors of technical failure (calcification, tortuosity, reattempts) can achieve high success rates comparable to non-dialysis patients.
Abstract

Keywords:
calcificationchronic total occlusionpatients undergoing dialysispercutaneous coronary intervention

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