The rise of chronic total occlusions (CTO) percutaneous coronary interventions (PCI) goes hand in hand with technological development, through still posing a great challenge, one not exactly exempt from complications.
An important criterion to successful CTO PCI is length: ≥20 mm lesions lower the odds, according to J-CTO Score. However, increasing operator experience and the development of new guidewires and micro-catheters is gradually changing the situation.
The study looked at 10335 CTO PCI performed between 2012 and 2022. 7208 of these interventions were ≥20 mm long (69.7%) and 3127 <20 mm long (30.3%).
Mean age was similar in both groups, but those with ≥20 mm occlusions were more often men, smokers, presenting hypertension, dyslipidemia, diabetes, peripheral vascular disease, cardiac failure, lower ejection fraction, MI, and CABG.
The artery that more frequently presented CTO was the right coronary (57.3%), followed by the anterior descending (23.4%) and the circumflex.
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≥20 mm occlusions presented more unfavorable angiographic characteristics, more tortuosity, and severe calcification. Also, the dissection and reentry technique was more often used in the group, as well as the retrograde strategy.
Crossing success rate was lower in patients presenting longer lesions, who also needed more stents, longer fluoroscopy time and longer procedures.
≥20 mm lesions were associated to lower technical and procedural success (84.4% vs. 91.8%; p < 0.001 and 81.9% vs. 90.3%; p < 0.001 respectively). In hospital MACE was higher in this group (3.4% vs. 1.9%; p < 0.001), as was AMI (0.7% vs. 0.26%; p = 0.009), perforations (5.15% vs. 3.87%; p = 0.007) and the presence of thrombi and dissection (0.84% vs. 0.35%; p = 0.008).
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A 10 mm increase in occlusion length was associated to lower technical success rate.
After multivariable analysis, (shorter) lesion length was associated to reduced MACE and technical success.
Conclusion
CTO PCI of long occlusions is independently associated with lower rates of technical success and higher rates of in-hospital MACE.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Impact of lesion length on the outcomes of chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS‐CTO registry.
Reference: Athanasios Rempakos, et al. Catheter Cardiovasc Interv. 2023;101:747–755.
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