Changes in absolute flow, myocardial resistance and FFR after chronic total occlusion percutaneous coronary intervention

DOI: 10.4244/EIJ-D-22-00694

Sarosh  A Khan
Sarosh A Khan1,2, MBBS; Osama Alsanjari1,2, MBBS; Daniëlle C.J. Keulards3, MD; Pieter-Jan Vlaar3, MD, PhD; Jufen Zhang2, PhD; Klio Konstantinou1,2, MBBS; Samer Fawaz1,2, MBBS; Rupert Simpson1,2, MBBS; Gerald Clesham1,2, MA, PhD; Paul A Kelly2, MD; Kare H Tang2, MBBS; Christopher M. Cook1,2, MBBS, MD; James Cockburn4, MBBS, PhD; Nico H. J. Pijls3, MD, PhD; David Hildick-Smith4, MD; Koen Teeuwen3, MD; Thomas R Keeble1,2, MBBS, MD; Grigoris V Karamasis1,2,5, MD; John R Davies1,2, MBBS, PhD
1. Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK; 2. Anglia Ruskin University, Chelmsford, UK; 3. Catharina Hospital, Eindhoven, the Netherlands; 4. Royal Sussex County Hospital, Brighton, UK; 5. Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece

Background: Randomised studies of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) have shown inconsistent outcomes, suggesting incomplete understanding of this cohort and their coronary physiology. To address this shortcoming, we designed a prospective observational study to measure the recovery of absolute coronary blood flow following successful CTO PCI

Aims: We sought to identify patient and procedural characteristics associated with a favourable physiological outcome after CTO PCI.

Methods: Consecutive patients with a CTO subtending viable myocardium underwent PCI utilising contemporary techniques and the hybrid algorithm. Immediately after PCI, and at 3-month follow-up, physiological measurements were performed utilising continuous thermodilution.

Results: A total of 81 patients were included with a mean age 63.6±8.9 years, and 66 (81.5%) were male. Physiological measurements of absolute coronary blood flow in the CTO vessel increased by 30% (p<0.001) and microvascular resistance reduced by 16% (p<0.001) from immediately post-CTO PCI to follow-up assessment. Fractional flow reserve increased by 0.02 (p=0.015) in the same period. Prior coronary artery bypass graft (CABG) and a higher estimated glomerular filtration rate (eGFR) were associated with a larger change in absolute flow. An extraplaque strategy was associated with a smaller change in absolute flow.

Conclusions: Post-CTO PCI, there is a continued augmentation in absolute coronary blood flow and reduction in microvascular resistance from baseline to follow-up at 3 months. Prior CABG and a higher baseline eGFR were predictors of a larger change in absolute coronary flow, whilst an extraplaque final wire path strategy predicted a smaller change. Lastly, the patient characteristics and comorbidities had a larger influence than procedural factors on the observed change in absolute flow.

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chronic coronary total occlusionclinical researchother techniquestable angina
Coronary interventionsCTO
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