PCI Strategies Studied for Right Coronary Artery CTOs
December 16, 2016—Findings from a study that sought to describe the procedural characteristics, strategy selection, and associated technical and efficiency outcomes for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of the right coronary artery (RCA) was published by Aris Karatasakis, MD, et al in EuroIntervention (2016;12:e1326–e1335).
The investigators examined the clinical and angiographic characteristics of patients who underwent RCA CTO PCI between 2012 and 2015 at 11 centers in the United States. The RCA was the CTO target vessel in 739 of 1,308 CTO PCIs (56%).
The investigators reported overall technical and procedural success rates of 90% and 88%, respectively. A major adverse cardiovascular event (MACE) occurred in 19 patients (2.6%). Technical success was most frequently achieved using antegrade wire escalation (38% of successful procedures,) followed by retrograde (36%) and antegrade dissection/reentry (26%).
Technical success was similar between various locations of RCA CTOs (P = .11). Compared with antegrade-only procedures, utilization of any retrograde approach was associated with lower technical and procedural success (85% vs 95% and 82% vs 94%, respectively; both P < .001) and a higher MACE rate (3.8% vs 1.4%; P = .037).
RCA CTOs represent the majority of CTO target lesions, can be treated with high success and acceptable complication rates, and require frequent use of the retrograde approach and antegrade dissection/reentry, concluded the investigators in EuroIntervention.