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Multicenter Study
. 2019 Oct 1;94(4):516-524.
doi: 10.1002/ccd.28315. Epub 2019 May 6.

Assessment of reattempted percutaneous coronary intervention strategy for chronic total occlusion after prior failed procedures: Analysis of the Japanese CTO-PCI Expert Registry

Makoto Sekiguchi  1 , Toshiya Muramatsu  2 , Koichi Kishi  3 , Makoto Muto  4 , Yuji Oikawa  5 , Tomohiro Kawasaki  6 , Tsutomu Fujita  7 , Yuji Hamazaki  8 , Hisayuki Okada  9 , Etsuo Tsuchikane  10
Affiliations
Multicenter Study

Assessment of reattempted percutaneous coronary intervention strategy for chronic total occlusion after prior failed procedures: Analysis of the Japanese CTO-PCI Expert Registry

Makoto Sekiguchi et al. Catheter Cardiovasc Interv. .

Abstract

Objectives: We aimed to investigate strategies for reattempted percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs) by highly skilled operators after a failed attempt.

Background: Development of complex techniques and algorithms has been standardized for CTO-PCI. However, there is no appropriate strategy for CTO-PCI after a failed procedure.

Method: From 2014 to 2016, the Japanese CTO-PCI Expert Registry included 4,053 consecutive CTO-PCIs (mean age: 66.8 ± 10.9 years; male: 85.6%; Japanese CTO [J-CTO] score: 1.92 ± 1.15). Initial outcomes and strategies for reattempted CTO-PCIs were evaluated and compared with first-attempt CTO-PCIs.

Results: Reattempt CTO-PCIs were performed in 820 (20.2%) lesions. The mean J-CTO score of reattempt CTO-PCIs was higher than that of first-attempt CTO-PCIs (2.86 ± 1.03 vs. 1.68 ± 1.05, p < .001). The technical success rate of reattempt CTO-PCIs was lower than that of first-attempt CTO-PCIs (86.7% vs. 90.8%, p < .001). Regarding successful CTO-PCIs, the strategies comprised antegrade alone (reattempt: 36.1%, first attempt: 63.8%), bidirectional approach (reattempt: 54.4%, first attempt: 30.3%), and antegrade approach following a failed bidirectional approach (reattempt: 9.4%, first attempt: 5.4%). Parallel wire technique, intravascular ultrasound guide crossing, and bidirectional approach technique were frequently performed in reattempt CTO-PCIs. Reattempt CTO-PCIs showed higher rates of myocardial infarction (2.1% vs. 0.9%, p < .001) and coronary perforation (6.9% vs. 4.2%, p = .002) than first-attempt CTO-PCIs.

Conclusions: The technical success rate of reattempt CTO-PCIs is lower than that of first-attempt CTO-PCIs. However, using more complex strategies, the success rate of reattempt CTO-PCI can be improved by highly skilled operators.

Keywords: chronic total occlusion; percutaneous coronary intervention; retry; strategy.

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Comment in

  • CTO PCI: When at first you don't succeed….
    Riley RF, Henry TD. Riley RF, et al. Catheter Cardiovasc Interv. 2019 Oct 1;94(4):525-526. doi: 10.1002/ccd.28518. Catheter Cardiovasc Interv. 2019. PMID: 31602803 No abstract available.

References

REFERENCES

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