Related Experiment Video
Updated: Aug 13, 2026
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
In-stent versus de novo chronic total occlusion PCI: Similar acute success but distinct procedural and treatment
Semi Ozturk1, Ahmet Seyfeddin Gurbuz2, Sefa Sural3
1Department of Cardiology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye. semi_ozturk@yahoo.com.
Background:
Whether in-stent chronic total occlusion (ISR-CTO) reflects lower CTO percutaneous coronary intervention (PCI) efficacy or a distinct procedural profile remains uncertain.
Aims:
To compare acute outcomes, strategy, and treatment pattern between ISR-CTO and de novo CTO.
Methods:
We performed a retrospective procedure-level analysis of a prospectively maintained three-center CTO PCI registry from Türkiye, including consecutive procedures between January 2019 and February 2026. The primary endpoint was procedural success, defined as technical success without in-hospital major procedural complications. Technical success was final TIMI 3 flow with residual stenosis < 30%. Major procedural complications included death, stroke, emergency repeat PCI or coronary artery bypass grafting (CABG), donor-vessel complication, and coronary or collateral perforation requiring active treatment. Multivariable logistic regression and prespecified sensitivity analyses were performed.
Results:
Among 2375 CTO PCI procedures, 296 (12.5%) involved ISR-CTO. Technical success was 92.9% in ISR-CTO and 91.7% in de novo CTO (P = 0.49). Procedural success was 90.2% and 89.0% (P = 0.55), and major procedural complications were similar (3.4% vs. 3.9%, P = 0.66). After adjustment, ISR-CTO was not associated with lower technical success (OR, 1.26; 95% CI, 0.77-2.05), lower procedural success (OR, 1.20; 95% CI, 0.79-1.83), or higher complication risk (OR, 0.84; 95% CI, 0.43-1.66). ISR-CTO was associated with less actual retrograde involvement, greater IVUS/DCB use, and a lower observed DES implantation rate.
Conclusions:
ISR-CTO showed acute procedural results comparable to de novo CTO in this selected multicenter cohort. Its main differences were procedural and treatment-related, including less actual retrograde involvement and different IVUS/DCB/DES use.
