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Multicenter Study
. 2024 Oct 14;17(19):2243-2255.
doi: 10.1016/j.jcin.2024.08.028.

Percutaneous Coronary Intervention for Aorto-Ostial Chronic Total Occlusion: Evaluating Lesion Complexity and Procedural Outcomes

Takeshi Niizeki  1 , Etsuo Tsuchikane  2 , Tsuneo Konta  3 , Koichi Kishi  4 , Hisayuki Okada  5 , Yoshiaki Ito  6 , Yuji Oikawa  7 , Ryohei Yoshikawa  8 , Hiroyuki Tanaka  9
Affiliations
Free article
Multicenter Study

Percutaneous Coronary Intervention for Aorto-Ostial Chronic Total Occlusion: Evaluating Lesion Complexity and Procedural Outcomes

Takeshi Niizeki et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: PCI for aorto-ostial CTO remains challenging. The techniques for guidewire in aorto-ostial CTO may differ from those used in non-aorto-ostial CTOs, influenced by clinical and angiographic characteristics.

Objectives: This study aimed to assess the technical aspects and outcomes of percutaneous coronary intervention (PCI) in patients with aorto-ostial chronic total occlusion (CTO).

Methods: This analysis included 420 patients with ostial CTO from the Japanese CTO-PCI Expert Registry, spanning January 2014 to December 2022. It examined the strategies and procedural outcomes of CTO PCI.

Results: Ostial CTO represented 420 of 10,814 (3.9%) of all CTO PCI cases. Within this subset, aorto-ostial CTO accounted for 218 of 420 (52%) cases. The technical success rate for aorto-ostial CTO was 88% (191/218). Aorto-ostial CTOs exhibited longer lesion lengths and were more likely to present with challenges such as distal target lumen ambiguity, calcification, and tortuosity compared with non-aorto-ostial CTOs. The retrograde approach was more commonly used in aorto-ostial CTO, with retrograde direct crossing being the most successful technique, especially in cases of flush CTO. A multivariate logistic analysis identified several factors significantly associated with unsuccessful aorto-ostial CTO PCI, including difficulties in engaging a guiding catheter, estimating the collateral channel (as assessed by the J-Channel score), and tortuosity.

Conclusions: Aorto-ostial CTOs are more complex and frequently require a retrograde approach. The availability of suitable interventional collateral channels is crucial for the success of these procedures.

Keywords: aorto-ostial lesion; chronic total occlusion; percutaneous coronary intervention; predictors for procedural failure.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Tsuchikane has served as a consultant for Asahi Intecc, Boston Scientific Japan, and Kaneka. Dr Ito has received speaker honorarium from Boston Scientific Japan, Abbott Medical Japan, TERUMO, and Medtronic Japan. Dr Oikawa has received speaker honorarium from Abbott Medical Japan, Boston Scientific Japan, Medtronic Japan, Nipro, TERUMO, Kaneka, and OrbusNeich Medical. Dr Yoshikawa has received speaker honorarium from TERUMO, Abbott Medical Japan, Kaneka, Nipro, and OrbusNeich Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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