A Novel Algorithm for Treating Chronic Total Coronary Artery Occlusion.

Abstract:

BACKGROUND:Guidewire manipulation time is rarely used in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) strategies. OBJECTIVES:This study sought to develop an algorithm based on angiographic characteristics and guidewire manipulation time. METHODS:This study assessed 5,843 patients undergoing CTO PCI between January 2014 and December 2017 and enrolled in the Japanese CTO-PCI expert registry and analyzed their CTO-PCI strategies, procedural outcomes, and guidewire manipulation time. RESULTS:Primary retrograde approach was performed on 1,562 patients. The average Japanese CTO score of primary antegrade approach and primary retrograde approach were 1.7 ± 1.1 and 2.3 ± 1.1, respectively (p < 0.001). The overall guidewire and technical success rates were 92.8% and 90.6%, respectively. Median guidewire manipulation time of guidewire success and failure were 56 min (interquartile range [IQR]: 22 to 111 min) and 176 min (IQR: 130 to 229 min), respectively. Median successful guidewire crossing time of single wiring and parallel wiring in the antegrade alone were 23 min (IQR: 11 to 44 min) and 60 min (IQR: 36 to 97 min), and rescue retrograde approach and primary retrograde approach were 126 min (IQR: 87 to 174 min) and 107 min (IQR: 70 to 161 min), respectively (p < 0.001). Significant predictors for antegrade guidewire failure in primary antegrade approach, which were reattempt, CTO length of ≥20 mm, and no stump, did not predict guidewire failure after collateral channel crossing in primary retrograde approach. CONCLUSIONS:Results from a large registry with information on guidewire manipulation time as well as CTO characteristics suggest a redefinition of the current strategy algorithms.

journal_name

J Am Coll Cardiol

authors

Tanaka H,Tsuchikane E,Muramatsu T,Kishi K,Muto M,Oikawa Y,Kawasaki T,Hamazaki Y,Fujita T,Katoh O

doi

10.1016/j.jacc.2019.08.1049

subject

Has Abstract

pub_date

2019-11-12 00:00:00

pages

2392-2404

issue

19

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(19)37654-5

journal_volume

74

pub_type

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