Application of the J-CTO Score to Recanalization for In-Stent Chronic Total Occlusions

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Biology

Background:

• The J-CTO score is used to predict the success of chronic total occlusion (CTO) recanalization.
• Its utility in in-stent CTO interventions compared to de novo CTOs is not well-established.

Purpose of the Study:

• To compare the effectiveness of the J-CTO score in predicting procedural success and guidewire crossing time for in-stent versus de novo CTO interventions.
• To evaluate the role of wiring-based intraplaque tracking techniques in these comparisons.

Main Methods:

• A retrospective analysis of 508 patients undergoing CTO recanalization was performed.
• Patients were divided into in-stent CTO (N=74) and de novo CTO (N=434) groups.
• The J-CTO score was assessed for procedural feasibility and guidewire crossing time using intraplaque tracking.

Main Results:

• Procedural success rates declined significantly for de novo CTOs with a J-CTO score ≥3 (85%) compared to ≤2 (97%, p < 0.001).
• However, success rates for in-stent CTOs were comparable across J-CTO scores (≥3: 96% vs ≤2: 100%, p = 0.400).
• Longer guidewire crossing times (≥30 min) were less frequent in in-stent CTOs (OR=0.40). Blunt stump and occlusion length ≥20mm were independent factors for in-stent CTO crossing time.

Conclusions:

• The J-CTO score's impact on procedural feasibility and guidewire crossing time differs between in-stent and de novo CTOs.
• The J-CTO score should be interpreted with caution in in-stent CTO interventions.
• Intraplaque guidewire tracking techniques provide insights into these differences.