The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Coronary interventions - Mini focus on chronic total occlusions

Occlusion patterns, strategies and procedural outcomes of percutaneous coronary intervention for in-stent chronic total occlusion

EuroIntervention 2021;17:e631-e638. DOI: 10.4244/EIJ-D-20-01151

1. Department of Cardiology, Fukaya Red Cross Hospital, Saitama, Japan; 2. Department of Cardiology, Tokyo Heart Center, Tokyo, Japan; 3. Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan; 4. Department of Cardiology for International Education and Research, Osaka University Graduate School of Medicine, Osaka, Japan; 5. Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan; 6. Department of Cardiology, The Cardiovascular Institute, Tokyo, Japan; 7. Department of Cardiology, Sanda City Hospital, Hyogo, Japan; 8. Department of Cardiology, Shin-Koga Hospital, Fukuoka, Japan; 9. Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan; 10. Department of Cardiology, Toyohashi Heart Center, Aichi, Japan

Background: In-stent chronic total occlusion (CTO) presents various occlusion patterns, which complicate percutaneous coronary intervention (PCI).

Aims: The aim of the study was to investigate the initial outcome and strategy of PCI for in-stent CTO according to the angiographic occlusion patterns.

Methods: This study assessed 791 in-stent CTOs from the Japanese CTO-PCI Expert Registry from 2015 to 2018. They were divided into four patterns: pattern A (n=419), CTO within the stent segment; pattern B (n=196), CTO beyond the distal edge; pattern C (n=85), CTO beyond the proximal edge; and pattern D (n=69) CTO beyond both the proximal and distal edges.

Results: There were significant differences in the technical success rates (96.2%, 86.2%, 92.9%, and 75.4% for patterns A–D, respectively; p<0.001), guidewire crossing times (22 [interquartile range: 10-46], 52 [24-102], 40 [20-78], and 86 [45-127] min, respectively; p<0.001), and the rates of antegrade approach alone (90.9%, 61.2%, 67.1%, and 31.9%, respectively; p<0.001).

Conclusions: PCI for CTO within the stent segment was associated with excellent initial outcomes with the antegrade approach. However, PCI for CTO beyond both the proximal and distal edges was associated with the poorest outcomes, even with the bidirectional approach.

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