Technical failure patterns during chronic total occlusion percutaneous coronary intervention: a multicenter registry analysis
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Published on: February 26, 2013
Ahmet S Gurbuz1, Sefa Sural2, Semi Ozturk3
1Department of Cardiology, Necmettin Erbakan University, Konya, Turkey.
Introduction:
Technical failure during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is usually reported as a binary outcome, although failed procedures may follow different procedural courses.
Aim:
To describe procedural patterns of technical failure during CTO PCI and assess their association with conventional CTO complexity scores.
Material And Methods:
We analyzed 2,375 CTO PCI procedures from a multicenter registry. Technical failure was classified as Pattern A (crossing- or device-delivery failure) or Pattern B (dissection- or flow-related failure). Multivariable logistic regression was used to examine correlates of overall and pattern-specific failure.
Results:
Technical failure occurred in 192 (8.1%) procedures: 148 (77.1%) were Pattern A and 44 (22.9%) were Pattern B. J-CTO and CASTLE/EuroCTO scores were higher in Pattern A than in Pattern B. Overall technical failure was associated with blunt/absent proximal cap, CTO length ≥ 30 mm, moderate/severe calcification, previous coronary artery bypass grafting, and proximal tortuosity. In the exploratory Pattern B model, CTO length ≥ 30 mm, moderate/severe calcification, and left anterior descending versus right coronary artery target vessel were associated with Pattern B versus technical success. However, target vessel did not differentiate Pattern B from Pattern A after adjustment for J-CTO or CASTLE/EuroCTO score. Pattern B consisted mainly of persistent dissection and no/slow flow.
Conclusions:
Technical failure during CTO PCI is heterogeneous. Conventional CTO complexity scores appeared to align more closely with crossing- or device-delivery failure, while dissection- or flow-related failure remained a smaller exploratory subgroup requiring external validation.
