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Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
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Published on: September 15, 2023

Outcomes of chronic total occlusion percutaneous coronary intervention in patients ineligible for surgical

Joseph Park1, Enrico Poletti1, Sudhir Thotakura1

  • 1Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.

International Journal of Cardiology
|August 5, 2026
PubMed

Insights

Surgically ineligible patients with chronic total occlusion (CTO) coronary artery disease undergoing percutaneous coronary intervention (PCI) have complex conditions but similar outcomes. CTO PCI offers a viable treatment option for these complex patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Many patients with chronic total occlusion (CTO) and multivessel coronary artery disease are unsuitable for coronary artery bypass grafting due to comorbidities or complex anatomy.
  • Limited data exist on the outcomes of percutaneous coronary intervention (PCI) for CTO in surgically ineligible patients.

Purpose of the Study:

  • To compare the outcomes of CTO PCI in surgically ineligible patients versus other patients undergoing CTO PCI.
  • To assess the safety and efficacy of CTO PCI in a complex, high-risk patient cohort.

Main Methods:

  • A retrospective analysis of 1135 patients undergoing CTO PCI at a high-volume center (2019-2023).
  • Comparison of outcomes between 75 surgically ineligible patients and other CTO PCI patients.
  • Overlap weighting was used to adjust for baseline differences, with all-cause mortality at 30 days and 1 year as primary outcomes.

Main Results:

  • Surgically ineligible patients had higher comorbidity burden, lower ejection fraction, and more extensive coronary artery disease.
  • Technical success rates were similar between groups (94.7% vs 91.1%).
  • Adjusted analyses showed no significant difference in 30-day or 1-year all-cause mortality between the groups.

Conclusions:

  • Surgically ineligible patients undergoing CTO PCI exhibit greater clinical complexity.
  • CTO PCI achieves similar technical success and adjusted outcomes in surgically ineligible patients compared to other CTO PCI patients.
  • CTO PCI is a feasible treatment option for patients with CTO and multivessel coronary artery disease who are not candidates for bypass surgery.
Abstract

Keywords:
Chronic total occlusionCoronary artery bypass graftingCoronary artery diseasePercutaneous coronary interventionRevascularizationSurgical ineligibility

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