Causes of Procedural Failure Investigated in CTO PCI

June 8, 2015—James Sapontis, MBBCH, et al published findings from an investigation of the procedural failure of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in Catheterization and Cardiovascular Interventions (2015;85:1115–1122).

The investigators noted that the hybrid approach to CTO PCI has significantly increased procedural success rates, but some cases still fail; therefore they sought to evaluate the causes of failure in a contemporary CTO PCI registry.

The investigators examined 380 consecutive patients who underwent CTO PCI using the hybrid approach at four high-volume CTO PCI centers in the United States. Clinical, angiographic, complication, and efficiency outcomes were compared between successful and failed cases. An independent reviewer individually evaluated failed cases to determine the cause of failure.

As summarized in Catheterization and Cardiovascular Interventions, procedural success was 91.3%. Compared with patients in whom CTO PCI was successful, those in whom CTO PCI failed had similar baseline clinical characteristics andwere more likely to have longer occlusion length, more tortuosity, more proximal cap ambiguity and blunt stump, higher mean J-CTO (Multicenter CTO Registry of Japan) scores (2.8 vs 3.5), and less likely to have collaterals suitable for the retrograde approach (66% vs 45%). In 10 cases (30%), failure was caused by a complication (30%). In the remaining 23 cases (70%), failure was caused by inability to wire the lesion (n = 21), four of which were CTOs caused by in-stent restenosis), or poor antegrade flow after PCI (n = 5). Development of novel CTO crossing techniques is needed to further increase CTO PCI success rates, concluded the investigators in Catheterization and Cardiovascular Interventions.