Can tapered-tip guidewires improve the success rate of percutaneous coronary intervention in chronic total occlusion?

Chronic total occlusion recanalization still represents the final frontier in percutaneous coronary intervention. Retrograde recanalization is one of the greatest amendments of this technique. At present, it has become an integral complement to the traditional antegrade approach. Despite being most frequently used in complex patients, it has the highest success rate with the lowest incidence of complications. Since its inception, significant iterations have occurred that made this technique safer, faster, and even more successful.

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Retrograde Approach to Chronic Total Occlusion Percutaneous Coronary Intervention

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.119.008900 ◽

2020 ◽

Vol 13 (5) ◽

Author(s):

Michael Megaly ◽

Iosif Xenogiannis ◽

Nidal Abi Rafeh ◽

Dimitri Karmpaliotis ◽

Stephane Rinfret ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Success Rate ◽

Chronic Total Occlusion ◽

Coronary Intervention ◽

Retrograde Approach ◽

Total Occlusion ◽

Antegrade Approach ◽

Percutaneous Coronary ◽

Complex Lesions

The retrograde approach has increased the success rate of chronic total occlusion percutaneous coronary intervention but has also been associated with a higher risk of complications. The retrograde approach is usually performed in complex lesions, in which the antegrade approach is not feasible or has failed previously. Using a systematic 10-step approach can maximize the likelihood of success and minimize the risks of retrograde chronic total occlusion interventions.

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Nomogram to Predict Successful Septal Collateral Crossing during Percutaneous Coronary Intervention of Chronic Total Occlusion by retrograde approach: The Sep-CTO score

10.21203/rs.3.rs-386483/v1 ◽

2021 ◽

Author(s):

Tong Liu ◽

Yuchao Zhan ◽

Zheng Wu ◽

Yun Lv ◽

Wenzheng Li ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Success Rate ◽

Chronic Total Occlusion ◽

Multivariate Logistic Regression Analysis ◽

Coronary Intervention ◽

Syntax Score ◽

Clinical Tool ◽

Total Occlusion ◽

Technical Success Rate ◽

Percutaneous Coronary

Abstract Septal collaterals are the main collaterals used in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, there is little evidence regarding the selection of an interventional septal collateral (SC). we aimed to identify the predictors of successful guidewire crossing using clinical and anatomical characteristics. Overall, 216 derivation cases and 86 validation cases that included retrograde CTO PCI were analyzed. The technical success rate was 79.1% and there were no significant differences in the Gensini score, SYNTAX score, J-CTO score and Progress Score between two groups. Multivariate logistic regression analysis revealed that diabetes, small size, corkscrew, and side branch at tortuosity were independent factors of success in crossing SCs. We developed a nomogram to predict the success rate, which demonstrates favorable calibration and formed the Sep-CTO score. The calibration and decision curve analysis also demonstrated the reliability and accuracy of this clinical prediction model. The receiver-operating characteristic area of the nomogram was 0.870. Compared to the aforementioned scoring systems, Sep-CTO score was the most powerful. The nomogram may be a useful clinical tool. We found four independent variables to predict the successful guidewire crossing in septal collaterals.

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Angiographic Characteristics and Outcomes of Percutaneous Coronary Intervention of Reattempted Chronic Total Occlusion: Potential Contributing Factors to Procedural Success

Journal of Clinical Medicine ◽

10.3390/jcm10235661 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5661

Author(s):

Mohsen Mohandes ◽

Cristina Moreno ◽

Mónica Fuertes ◽

Sergio Rojas ◽

Alberto Pernigotti ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Success Rate ◽

Chronic Total Occlusion ◽

Coronary Intervention ◽

Technical Success ◽

Contributing Factors ◽

Total Occlusion ◽

Entire Cohort ◽

Technical Success Rate ◽

Percutaneous Coronary

This study aimed to analyze angiographic characteristics of new attempted percutaneous coronary intervention (PCI) on chronic total occlusion (CTO) compared to first attempt group. The cohort of 527 CTO-PCIs was divided into first-attempt and re-attempt groups, and angiographic characteristics, level of complexity, and contributing factors to failure were analyzed. Between-group success rate difference and potential angiographic and technical aspects contributing to the success in new attempts were scrutinized. A total of 47 new PCIs in 39 patients were performed. The reattempt group showed higher J-CTO score compared to the first-attempt group (2.4 ± 1.06 vs. 1.2 ± 1.06; p < 0.001). The use of more complex techniques and devices such as retrograde approach (29.8% vs. 12.9%) and IVUS (48.9 vs. 27.3%; p: 0.002) were more frequent in the reattempt group. Both procedural and fluoroscopy time were higher in the reattempt group (197 ± 83.9 vs. 150.1 ± 72.3 and 97.7 ± 55.4 vs. 68.7 ± 43, respectively; p < 0.001). There was no between-group difference in terms of technical success (79.8 vs. 76.6% for first attempt vs. reattempt group, respectively; p: 0.6). The overall success rate increased by 6.1%, achieving 85.9% in the entire cohort. Reattempted CTO-PCIs required more complex techniques and had comparable technical success rate with regard to the first-attempt group.

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Application of the Hybrid Approach to Chronic Total Coronary Occlusion Percutaneous Coronary Intervention

10.14232/phd.10230 ◽

2019 ◽

Author(s):

Péter Tajti

Keyword(s):

Percutaneous Coronary Intervention ◽

Success Rate ◽

Chronic Total Occlusion ◽

Hybrid Approach ◽

Coronary Intervention ◽

Complication Rates ◽

Total Occlusion ◽

Technical Success Rate ◽

Percutaneous Coronary ◽

Chronic Total Coronary Occlusion

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) continues to evolve constantly with developing equipment and techniques. The hybrid approach to CTO PCI advocates dual coronary injection, careful and structured review of the angiogram, and flexibility. Use of all crossing strategies [antegrade wire escalation, antegrade dissection re-entry and retrograde approach] is encouraged, with initial and subsequent choices influenced by the CTO anatomic characteristics and the outcomes of the originally selected approach. Application of the hybrid approach to CTO PCI has been associated with good outcomes in US and European registries, although CTO PCI outcomes in non-selected populations have been less optimal with approximately 60% success rate. We analyzed the clinical, angiographic, and procedural characteristics of 3,122 CTO PCIs performed in 3,055 patients to determine the techniques and outcomes of hybrid CTO PCI in a diverse group of patients and operators in two continents (at eighteen US, one European, and one Russian centers ) enrolled in the PROGRESS-CTO (PROspective Global REgiStry for the Study of Chronic Total Occlusion Intervention, NCT02061436) registry between January 2012 and November 2017. Technical success rate was 87% and the risk for in-hospital major complications was 3%, providing important benchmarks to use when discussing with patients and providers the risk/benefit ratio of CTO PCI. The final successful crossing strategy was antegrade wire escalation in 52%, retrograde in 27%, and antegrade dissection reentry in 21%; more than 1 crossing strategies were required in 41% of the cases. CTO PCI is currently being performed with high success and acceptable complication rates among various experienced centers in the US and Europe. Bridging the gap between what is currently achieved and what can be achieved in chronic total occlusion intervention should be a major focus of upcoming research and education efforts.

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A Novel Risk Score in Predicting Failure or Success for Antegrade Approach to Percutaneous Coronary Intervention of Chronic Total Occlusion: Antegrade CTO Score

International Journal of Angiology ◽

10.1055/s-0036-1593394 ◽

2016 ◽

Vol 26 (02) ◽

pp. 089-094 ◽

Cited By ~ 4

Author(s):

Mohammad Namazi ◽

Ali Serati ◽

Hosein Vakili ◽

Morteza Safi ◽

Saeed Parsa ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Success Rate ◽

Failure Rate ◽

Risk Score ◽

Chronic Total Occlusion ◽

Coronary Intervention ◽

Total Occlusion ◽

Antegrade Approach ◽

Percutaneous Coronary ◽

Retrograde Filling

AbstractTotal occlusion of a coronary artery for more than 3 months is defined as chronic total occlusion (CTO). The goal of this study was to develop a risk score in predicting failure or success during attempted percutaneous coronary intervention (PCI) of CTO lesions using antegrade approach.This study was based on retrospective analyses of clinical and angiographic characteristics of CTO lesions that were assessed between February 2012 and February 2014. Success rate was defined as passing through occlusion with successful stent deployment using an antegrade approach.A total of 188 patients were studied. Mean ± SD age was 59 ± 9 years. Failure rate was 33%. In a stepwise multivariate regression analysis, bridging collaterals (OR = 6.7, CI = 1.97–23.17, score = 2), absence of stump (OR = 5.8, CI = 1.95–17.9, score = 2), presence of calcification (OR = 3.21, CI = 1.46–7.07, score = 1), presence of bending (OR = 2.8, CI = 1.28–6.10, score = 1), presence of near side branch (OR = 2.7, CI = 1.08–6.57, score = 1), and absence of retrograde filling (OR = 2.5, CI = 1.03–6.17, score = 1) were independent predictors of PCI failure. A score of 7 or more was associated with 100% failure rate whereas a score of 2 or less was associated with over 80% success rate.Most factors associated with failure of CTO-PCI are related to lesion characteristics. A new risk score (range 0–8) is developed to predict CTO-PCI success or failure rate during antegrade approach as a guide before attempting PCI of CTO lesions.

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Mastering retrograde coronary chronic total occlusion intervention in 2021

Journal of Transcatheter Interventions ◽

10.31160/jotci202129a202101 ◽

2021 ◽

Vol 29 ◽

pp. 1-12

Author(s):

Debrabata Dash

Keyword(s):

Percutaneous Coronary Intervention ◽

Success Rate ◽

Chronic Total Occlusion ◽

Coronary Intervention ◽

High Success Rate ◽

Total Occlusion ◽

Antegrade Approach ◽

Complex Patients ◽

Percutaneous Coronary ◽

Initial Description

Chronic total occlusion recanalization still represents the last frontier in percutaneous coronary intervention. Retrograde recanalization is one of the most significant amendments of the technique, and has recently become an essential complement to the classical antegrade approach. It has a high success rate with a low complication profile, despite frequent utilization in the most complex patients. Since its initial description, important iterations have occurred and made the technique safer, faster and more successful.

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Optimal use of fielder XT guidewire enhances the success rate of chronic total occlusion percutaneous coronary intervention

World Journal of Clinical Cases ◽

10.12998/wjcc.v7.i8.928 ◽

2019 ◽

Vol 7 (8) ◽

pp. 928-939

Author(s):

Qian-Cheng Wang ◽

Hai-Ruo Lin ◽

Yuan Han ◽

Hai Dong ◽

Kai Xu ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Success Rate ◽

Chronic Total Occlusion ◽

Coronary Intervention ◽

Total Occlusion ◽

Percutaneous Coronary

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Predicting the success rate of elective percutaneous coronary intervention for prior failure chronic total occlusion: a novel scoring

10.21203/rs.3.rs-436948/v1 ◽

2021 ◽

Author(s):

Wenzheng Li ◽

Zheng Wu ◽

Hongyu Peng ◽

Donghui Zhao ◽

Yejing Zhao ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Logistic Regression ◽

Success Rate ◽

Chronic Total Occlusion ◽

Coronary Intervention ◽

Technical Success ◽

Multivariate Logistic Regression ◽

Total Occlusion ◽

Technical Success Rate ◽

Percutaneous Coronary

Abstract Background: There is limited data on percutaneous coronary intervention for chronic total occlusion (CTO) with previous failed attempt. The objective of this study is to investigate a risk score for prediction of successful percutaneous coronary intervention for prior failure CTO. Methods: Patients with previous attempt were enrolled in our study retrospectively from Jan. of 2016 to Dec. of 2019. All clinical and procedural data was collected and analyzed. Univariate and multivariate logistic regression was performed to investigate the predictors of technical success. Results: A total of 194 patients/CTO lesions were studied. The technical success rate was 66.0%. The multivariate logistic regression showed that occlusion length <20mm (OR= 2.94, 95% CI= 1.36±6.37, score= 1), non-calcification (OR= 2.93, 95% CI= 1.36±6.30, score=1), adequate distal landing zone (OR= 4.46, 95% CI= 2.06±9.66, score=1), Rentrop grade ≥2 (OR= 5.98, CI= 2.46±14.51, score =1), and retrograde approach as initial strategy (OR= 10.28, 95% CI= 3.58±29.50, score =2) was the predictor of re-attempt success of PCI. The technical success rate for a score from 0 to ≥4 was 0%, 17.9%, 46.2%, 77.8%, 93.3% respectively. The area under the receiver operating characteristic curve for the five predictors and integers was 0.837 and 0.832 respectively. Conclusions: The technical success rate for CTO PCI with previous failure was acceptable. Our score system can be used to predict the success rate of re-attempt CTO PCI.

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Conquering Retrograde Coronary Chronic Total Occlusion Intervention: Review of recent Developments

10.37179/rijccm.000012 ◽

2021 ◽

Vol 02 (01) ◽

pp. 042-052

Author(s):

Rohit Mody

Keyword(s):

Percutaneous Coronary Intervention ◽

Success Rate ◽

Chronic Total Occlusion ◽

Coronary Intervention ◽

Tips And Tricks ◽

Total Occlusion ◽

Antegrade Approach ◽

Complex Patients ◽

Percutaneous Coronary ◽

Recent Developments

Chronic total occlusion recanalization still represents the final frontier in percutaneous coronary intervention. Retrograde recanalization is one of the greatest amendments of this technique. At present, it has become an integral complement to the traditional antegrade approach. Despite being most frequently used in complex patients; it has the highest success rate with the lowest incidence of complications. Since its inception, significant iterations have occurred that made this technique safer, faster, and even more successful. In this article, we describe various tips and tricks which can help in increasing the success rate of retrograde CTO PCI. Various complications, their preventions, and treatments, if they occur, have been described.

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