Related Experiment Video
Updated: Mar 27, 2026
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Procedural Outcome of Modern Percutaneous Coronary Intervention in Proximal Chronic Total Occlusions
Emil N Holck1,2, Guiseppe Vadalá3, Mohamed Ayoub4
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Percutaneous coronary intervention for chronic total occlusions (CTO PCI) is highly successful in proximal lesions. Treatment in the left anterior descending (LAD) and left circumflex (LCX) arteries is more successful and safer than in the right coronary artery (RCA).
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Biology
Background:
- Long-term patient outcomes for chronic total occlusions (CTO) are influenced by the specific target vessel and lesion location.
- Understanding these factors is crucial for optimizing treatment strategies and improving patient prognosis.
Purpose of the Study:
- To evaluate the impact of the target vessel on procedural success and safety in patients undergoing percutaneous coronary intervention (PCI) for proximal chronic total occlusions (CTO).
- To compare outcomes across different native coronary arteries (left anterior descending [LAD], left circumflex [LCX], and right coronary artery [RCA]).
Main Methods:
- Analysis of data from the European CTO registry (ERCTO) between January 2021 and December 2023.
- Inclusion of patients with proximal CTO lesions, categorized by the treated vessel.
- Assessment of co-primary endpoints: procedural success (technical success without in-hospital major adverse cardiac events) and 30-day safety.
Main Results:
- Out of 7128 patients with proximal CTO PCI, technical success rates were high: 91.0% (LAD), 92.1% (LCX), and 88.5% (RCA).
- Adjusted analysis showed higher procedural success probability for LCX versus RCA (OR 1.35), but not for LAD versus RCA (OR 1.06).
- Adjusted 30-day safety was significantly better for LAD versus RCA (OR 0.69), but not for LCX versus RCA (OR 0.77).
Conclusions:
- Modern CTO PCI for proximal lesions demonstrates high procedural success rates across native vessels.
- The left circumflex (LCX) artery and left anterior descending (LAD) artery territories show a trend towards higher procedural success compared to the right coronary artery (RCA).
- Treatment of LAD lesions represents the safest option among the evaluated proximal CTOs.
Background:
Long-term outcome in patients with chronic total occlusions (CTO) depends on the target vessel and proximity of the lesion.
Aims:
To investigate of the target vessel was associated with procedural efficacy and safety in patients with proximal CTO lesions.
Methods:
Patients treated for a CTO lesion in the European CTO registry (ERCTO) between January 1, 2021, and December 31, 2023, were included in the study. Patients were categorized based on the treated vessel and the proximity of the lesion. The outcome was compared between proximal lesions in the three native vessels. The co-primary endpoints were procedural success and 30-day safety. Procedural success was defined as technical success without in-hospital major adverse cardiac events.
Results:
A total of 14,744 patients were screened, and 7128 were included in the analysis of proximal CTO PCI. Technical success rates proximal in the three native vessel territories were 91.0% (left anterior descending [LAD]), 92.1% (left circumflex [LCX]), and 88.5% (right coronary artery [RCA]). In the adjusted analysis, the probability of procedural success was higher for LCX compared to RCA, but not for the LAD (OR (95% CI): LCX: 1.35, (1.05-1.75); LAD: 1.06 [0.86-1.31]). The adjusted 30-day safety was better in the LAD, but not LCX, compared with RCA (LAD: OR 0.69, 95% CI: 0.50; 0.94, LCX: OR 0.77, 95% CI 0.54; 1.09).
Conclusions:
Modern CTO PCI for proximal lesions generally yields a very high success rate. The procedure tends to be more successful in the LAD and LCX territories compared to the RCA, with LAD lesion treatment being the safest option.
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care