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Hemodynamic improvement immediately following percutaneous recanalization of chronic total occlusions
Rajesh Sachdeva1, Noah Towbin2, Billy Mullinax2
1Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, United States of America; Atlanta Veteran Affairs Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, United States of America.
Insights
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) significantly improved hemodynamic indices and normalized microvascular function. These findings suggest PCI is beneficial for CTO revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Physiology
Background:
- Established hemodynamic indices like Pd/Pa, RFR, FFR, CFR, and IMR are crucial for diagnosing obstructive coronary artery disease.
- These indices are less understood in the context of chronic total occlusions (CTOs).
- Assessing immediate hemodynamic shifts post-CTO revascularization may indicate procedural success and patient benefit.
Purpose of the Study:
- To evaluate the immediate hemodynamic changes following percutaneous coronary intervention (PCI) in patients with chronic total occlusions (CTOs).
- To assess the impact of CTO revascularization on key hemodynamic indices and microvascular function.
Main Methods:
- A retrospective analysis of hemodynamic data from 20 patients undergoing CTO PCI was performed.
- Measurements of Pd/Pa, RFR, FFR, CFR, and IMR were taken pre- and post-PCI using the CoroFlow system.
- Clinical outcomes including death, MI, TLR, and angina were recorded.
Main Results:
- Significant improvements were observed in Pd/Pa, RFR, and FFR post-PCI.
- Post-PCI CFR and IMR indicated normalized microvascular function.
- No peri-procedural complications occurred; low rates of MI and TLR were noted at follow-up.
Conclusions:
- CTO revascularization via PCI leads to substantial improvements in hemodynamic indices.
- Microvascular function is restored immediately after successful CTO revascularization.
- These hemodynamic improvements may serve as a marker for successful CTO intervention.
Background:
Resting distal-to-aortic coronary pressure (Pd/Pa), resting full-cycle ratio (RFR), fractional flow reserve (FFR), coronary flow reserve (CFR), and index of microvascular resistance (IMR) are established tools for assessing obstructive coronary artery disease but remain poorly characterized in chronic total occlusion (CTO). Evaluating immediate hemodynamic changes after CTO revascularization may serve as a marker of benefit from intervention.
Methods:
We retrospectively analyzed hemodynamic data from patients undergoing CTO percutaneous coronary intervention (PCI) at a Veterans Affairs hospital between January 2024 and July 2025. Measurements (Pd/Pa, RFR, FFR, CFR, IMR) were obtained after successful CTO crossing and compared pre- and post-PCI using the CoroFlow system (Abbott Vascular, Lake County, IL). Demographics, procedural characteristics, and clinical outcomes-including death, myocardial infarction (MI), target lesion revascularization (TLR), and angina improvement-were recorded.
Results:
Twenty patients were included. CTO locations were the left anterior descending (35%), right coronary artery (35%), and left circumflex (25%). Mean lesion length was 47.6 ± 23.1 mm, with a median J-CTO score of 2 ± 1. Pre-PCI Pd/Pa (0.60 ± 0.14), RFR (0.51 ± 0.18), and FFR (0.46 ± 0.10) improved significantly post-PCI to 0.96 ± 0.04, 0.95 ± 0.04, and 0.87 ± 0.08, respectively. Post-PCI CFR was 3.30 ± 2.74 and IMR 23.9 ± 33.5. No peri-procedural complications occurred; 5% experienced MI and 10% required TLR at 7.2 ± 3.5 months.
Conclusion:
There was marked improvement in hemodynamic indices after PCI of the evaluated CTO lesions, and microvascular function was normalized immediately following revascularization.
