Japanese Study Suggests Highly Skilled Operators Can Improve Reattempted CTO-PCI Success Rates
May 6, 2019—An analysis assessing reattempted percutaneous coronary intervention (PCI) strategy for chronic total occlusions (CTOs) after previous failed procedures in the Japanese CTO‐PCI Expert registry was published by Makoto Sekiguchi, MD, et al in Catheterization and Cardiovascular Interventions.
The background of the study is that the development of complex techniques and algorithms are standardized for CTO‐PCI, but there is no appropriate strategy for CTO‐PCI after a failed procedure. Therefore, this study aimed to investigate strategies for reattempted procedures by highly skilled operators after a failed attempt.
As summarized in Catheterization and Cardiovascular Interventions, the Japanese CTO‐PCI Expert registry included 4,053 consecutive CTO‐PCIs from 2014 to 2016. Patient characteristics included mean age (66.8 ± 10.9 years), male sex (85.6%), and 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.
The investigators reported that 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).
For successful CTO‐PCIs, the strategies were:
- Antegrade alone (reattempt, 36.1%; first attempt, 63.8%)
- Bidirectional approach (reattempt, 54.4%; first attempt, 30.3%)
- Antegrade approach after 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 versus first‐attempt CTO‐PCIs demonstrated higher rates of myocardial infarction (2.1% vs 0.9%, respectively; P < .001) and coronary perforation (6.9% vs 4.2%, respectively; P = .002).
The technical success rate of reattempted CTO‐PCIs is lower than that of first‐attempt CTO‐PCIs; however, by using more complex strategies, the success rate of reattempted CTO‐PCI can be improved by highly skilled operators, concluded the investigators in Catheterization and Cardiovascular Interventions.