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Aorto-Ostial Right Coronary Artery Chronic Total Occlusion Percutaneous Coronary Intervention: Technical Outcomes and

Ioannis Skalidis1,2, Luca Esposito2,3, Thomas Hovasse2

  • 1Department of Cardiology HFR - Fribourg Cantonal Hospital and University Fribourg Switzerland.

Journal of the American Heart Association
|July 17, 2026
PubMed

Insights

Percutaneous coronary intervention for aorto-ostial right coronary artery chronic total occlusions (CTO PCI) has lower technical success rates. Lesion anatomy, including tortuosity and calcification, predicts failure in these complex cases.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Aorto-ostial chronic total occlusions (CTOs) of the right coronary artery (RCA) are challenging subsets of percutaneous coronary interventions (PCI).
  • Limited dedicated data exist for aorto-ostial RCA CTO PCI outcomes.
  • This study evaluates technical success and failure predictors in aorto-ostial RCA CTO PCI.

Purpose of the Study:

  • To compare technical outcomes of aorto-ostial versus non-aorto-ostial RCA CTO PCI.
  • To identify independent predictors of technical failure specifically in aorto-ostial RCA CTO lesions.

Main Methods:

  • Analysis of 26,374 patients from the European Registry of Chronic Total Occlusion (ERCTO) registry (2016-2024).
  • Inclusion of 2850 patients with aorto-ostial RCA CTO and 23,524 with non-aorto-ostial RCA CTO.
  • Multivariable logistic regression used to determine predictors of technical failure.

Main Results:

  • Technical success was significantly lower for aorto-ostial RCA CTO PCI (79.6%) compared to non-aorto-ostial (89.7%).
  • Aorto-ostial location was an independent predictor of technical failure (OR, 1.85).
  • Factors predicting failure in aorto-ostial CTOs included stumpless proximal cap morphology, moderate-to-severe tortuosity, severe calcification, and peripheral artery disease.

Conclusions:

  • Aorto-ostial RCA CTO PCI demonstrates lower technical success rates, even with advanced techniques.
  • Lesion-specific anatomical features are primary drivers of technical failure.
  • Tailored strategies and refined risk stratification are crucial for managing aorto-ostial RCA CTOs.
Abstract

Keywords:
CTOPCIRCAcoronary disease

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