Chronic Total Occlusions, challenging but very possible

Original title: Predictors of Reocclusion After Successful Drug-Eluting Stent–Supported Percutaneous Coronary Intervention of Chronic Total Occlusion. The Florence CTO PCI Registry. Reference: Renato Valenti et al. J Am Coll Cardiol 2013; article in press.

Previous registry data have shown a reduction in mortality rates in patients with successful recanalization of a Chronic Total Occlusion (CTO) compared to patients with failed CTO recanalization or to those not intervened. 

Intuitively, this survival benefit is associated to sustained vessel patency. The goal of this study was to assess reocclusion incidence and identification of predictors of reocclusion after successful DES supported chronic coronary recanalization.

Procedure was indicated when viable myocardium in the occluded vessel territory was objected, when no angiographic characteristic was considered as a contraindication for recanalization. The primary objective was reocclusion of vessel with angiographic follow up. Between 2003 and 2011 at least one CTO in 1035 consecutive patients was attempted. From this total, 802 patients (77%) of procedures were successful. Angiographic follow up was performed to 82% of the eligible population, the rest were free of angina. 

The primary end point (reocclusion rate) was 7.5% in general with a significant difference between 1st generation DES (Cypher and Taxus) vs. Xience V (10.1% vs. 3% respectively; p=0.001). At one year, mortality was 3.2%, infarction 0.9% and revascularization 12.8% for the general population. Major cardiovascular events were significantly less with Xience V vs. 1st generation DES (11.6% vs. 19% respectively; p=0.005) mainly due to a lower revascularization.

Conclusion 

Recanalization of a CTO is associated to a low incidence of reocclusion of the treated vessel.

Editorial Comment:

There are limitations, as in any other registry, the absence of randomization and the fact that the experience involves only one site; on the other hand, this is the largest evaluation of DES supported CTO with angiographic follow up. Initial success was 77% more than acceptable taking into account that no angiographic characteristic was a contraindication and that once success was achieved a revascularization rate of 10.5% with everolimus DES is better yet. This work does not encourage further attempts to gain experience in recanalization.

SOLACI.ORG

More articles by this author

Radial Patency in Coronary Procedures: Is Heparin Enough or Should We Aim for Distal Transradial Access?

Transradial access is the preferred route in most coronary procedures due to its proven reduction in mortality compared to transfemoral access. However, one of...

iFR- vs. FFR-Guided Coronary Revascularization: 5-Year Clinical Outcomes

The assessment of coronary stenosis using coronary physiology has become a key tool in guiding revascularization. The two most widely used techniques are fractional...

Patients at High Risk of Bleeding After Coronary Angioplasty: Are Risk Assessment Tools ARC-HBR and PRECISE-DAPT Useful?

Patients undergoing coronary stenting typically receive dual antiplatelet therapy (DAPT) for 6 to 12 months, consisting of a P2Y12 receptor inhibitor and aspirin. While DAPT...

ACC 2025 | WARRIOR: Ischemia in Women with Non-Obstructive Coronary Artery Disease

Approximately half of all women with symptomatic ischemia who undergo coronary angiography are found to have non-obstructive coronary artery disease ((ischemia and non-obstructive coronary...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Percutaneous Tricuspid Valve Replacement with Lux-Valve

Tricuspid regurgitation (TR) is a condition associated with poor quality of life, frequent hospitalizations due to heart failure, and increased mortality, even under optimal...

Transcatheter Pulmonary Valve Implantation with a Self-Expanding Valve: Outcomes at 3 Years

Pulmonary regurgitation (PR) is a common condition in patients who have undergone surgical repair of Tetralogy of Fallot or other pathologies involving the right...

Radial Patency in Coronary Procedures: Is Heparin Enough or Should We Aim for Distal Transradial Access?

Transradial access is the preferred route in most coronary procedures due to its proven reduction in mortality compared to transfemoral access. However, one of...