Advertisement

Procedural Outcomes of Revascularization of Chronic Total Occlusion of Native Coronary Arteries (from a Multicenter United States Registry)

      Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) is a rapidly evolving area of interventional cardiology. We sought to examine the immediate procedural and in-hospital clinical outcomes of native coronary artery CTO PCI from a multicenter United States (US) registry. We retrospectively examined the procedural outcomes of 1,361 consecutive native coronary artery CTO PCIs performed at 3 US institutions from January 2006 to November 2011. Mean age was 65 ± 11 years, 85% of patients were men, 40% had diabetes, 37% had previous coronary artery bypass graft surgery, and 42% had previous PCI. The CTO target vessel was the right coronary artery (55%), circumflex (23%), left anterior descending artery (21%), and left main or bypass graft (1%). The retrograde approach was used in 34% of all procedures. The technical and procedural success rates were 85.5% and 84.2%, respectively. The mean procedural time, fluoroscopy time, and contrast utilization were 113 ± 61 minutes, 42 ± 29 minutes, and 294 ± 158 ml, respectively. In multivariate analysis, female gender, no previous coronary artery bypass surgery, and years since initiation of CTO PCI at each center were independent predictors of procedural success. Major complications occurred in 24 patients (1.8%). In conclusion, among selected US-based institutions with experienced operators, native coronary artery CTO PCI can be performed with high success and low major complication rates.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Joyal D.
        • Afilalo J.
        • Rinfret S.
        Effectiveness of recanalization of chronic total occlusions: a systematic review and meta-analysis.
        Am Heart J. 2010; 160: 179-187
        • Prasad A.
        • Rihal C.S.
        • Lennon R.J.
        • Wiste H.J.
        • Singh M.
        • Holmes Jr., D.R.
        Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the mayo clinic.
        J Am Coll Cardiol. 2007; 49: 1611-1618
        • Ivanhoe R.J.
        • Weintraub W.S.
        • Douglas Jr., J.S.
        • Lembo N.J.
        • Furman M.
        • Gershony G.
        • Cohen C.L.
        • King III, S.B.
        Percutaneous transluminal coronary angioplasty of chronic total occlusions. Primary success, restenosis, and long-term clinical follow-up.
        Circulation. 1992; 85: 106-115
        • Mehran R.
        • Claessen B.E.
        • Godino C.
        • Dangas G.D.
        • Obunai K.
        • Kanwal S.
        • Carlino M.
        • Henriques J.P.
        • Di Mario C.
        • Kim Y.H.
        • Park S.J.
        • Stone G.W.
        • Leon M.B.
        • Moses J.W.
        • Colombo A.
        Long-term outcome of percutaneous coronary intervention for chronic total occlusions.
        JACC Cardiovasc Interv. 2011; 4: 952-961
        • Karmpaliotis D.
        • Michael T.T.
        • Brilakis E.S.
        • Papayannis A.C.
        • Tran D.L.
        • Kirkland B.L.
        • Lembo N.
        • Kalynych A.
        • Carlson H.
        • Banerjee S.
        • Lombardi W.
        • Kandzari D.E.
        Retrograde coronary chronic total occlusion revascularization: procedural and in-hospital outcomes from a multicenter registry in the United States.
        JACC Cardiovasc Interv. 2012; 5: 1273-1279
        • Rathore S.
        • Matsuo H.
        • Terashima M.
        • Kinoshita Y.
        • Kimura M.
        • Tsuchikane E.
        • Nasu K.
        • Ehara M.
        • Asakura Y.
        • Katoh O.
        • Suzuki T.
        Procedural and in-hospital outcomes after percutaneous coronary intervention for chronic total occlusions of coronary arteries 2002 to 2008: impact of novel guidewire techniques.
        JACC Cardiovasc Interv. 2009; 2: 489-497
        • Morino Y.
        • Kimura T.
        • Hayashi Y.
        • Muramatsu T.
        • Ochiai M.
        • Noguchi Y.
        • Kato K.
        • Shibata Y.
        • Hiasa Y.
        • Doi O.
        • Yamashita T.
        • Morimoto T.
        • Abe M.
        • Hinohara T.
        • Mitsudo K.
        In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J-CTO Registry (Multicenter CTO Registry in Japan).
        JACC Cardiovasc Interv. 2010; 3: 143-151
        • Galassi A.R.
        • Tomasello S.D.
        • Reifart N.
        • Werner G.S.
        • Sianos G.
        • Bonnier H.
        • Sievert H.
        • Ehladad S.
        • Bufe A.
        • Shofer J.
        • Gershlick A.
        • Hildick-Smith D.
        • Escaned J.
        • Erglis A.
        • Sheiban I.
        • Thuesen L.
        • Serra A.
        • Christiansen E.
        • Buettner A.
        • Costanzo L.
        • Barrano G.
        • Di Mario C.
        In-hospital outcomes of percutaneous coronary intervention in patients with chronic total occlusion: insights from the ERCTO (European Registry of Chronic Total Occlusion) registry.
        EuroIntervention. 2011; 7: 472-479
        • Hoye A.
        • van Domburg R.T.
        • Sonnenschein K.
        • Serruys P.W.
        Percutaneous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992-2002.
        Eur Heart J. 2005; 26: 2630-2636
        • Suero J.A.
        • Marso S.P.
        • Jones P.G.
        • Laster S.B.
        • Huber K.C.
        • Giorgi L.V.
        • Johnson W.L.
        • Rutherford B.D.
        Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience.
        J Am Coll Cardiol. 2001; 38: 409-414
        • Olivari Z.
        • Rubartelli P.
        • Piscione F.
        • Ettori F.
        • Fontanelli A.
        • Salemme L.
        • Giachero C.
        • Di Mario C.
        • Gabrielli G.
        • Spedicato L.
        • Bedogni F.
        • Investigators T-G
        Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE).
        J Am Coll Cardiol. 2003; 41: 1672-1678
        • Ge L.
        • Qian J.Y.
        • Liu X.B.
        • Qin Q.
        • Cui S.J.
        • Yao K.
        • Shen L.
        • Ma J.Y.
        • Huang D.
        • Xu S.K.
        • Zhang F.
        • Wang X.F.
        • Wang Q.B.
        • Fan B.
        • Yan Y.
        • Feng Q.
        • Wang H.
        • Shen A.
        • Zhu M.H.
        • Ge J.B.
        Retrograde approach for the recanalization of coronary chronic total occlusion: preliminary experience of a single center.
        Chin Med J (Engl). 2010; 123: 857-863
        • Whitlow P.L.
        • Burke M.N.
        • Lombardi W.L.
        • Wyman R.M.
        • Moses J.W.
        • Brilakis E.S.
        • Heuser R.R.
        • Rihal C.S.
        • Lansky A.J.
        • Thompson C.A.
        Use of a novel crossing and re-entry system in coronary chronic total occlusions that have failed standard crossing techniques: results of the FAST-CTOs (Facilitated Antegrade Steering Technique in Chronic Total Occlusions) trial.
        JACC Cardiovasc Interv. 2012; 5: 393-401
        • Brilakis E.S.
        • Grantham J.A.
        • Rinfret S.
        • Wyman R.M.
        • Burke M.N.
        • Karmpaliotis D.
        • Lembo N.
        • Pershad A.
        • Kandzari D.E.
        • Buller C.E.
        • Demartini T.
        • Lombardi W.L.
        • Thompson C.A.
        A percutaneous treatment algorithm for crossing coronary chronic total occlusions.
        JACC Cardiovasc Interv. 2012; 5: 367-379
        • Brilakis E.S.
        • Grantham J.A.
        • Thompson C.A.
        • DeMartini T.J.
        • Prasad A.
        • Sandhu G.S.
        • Banerjee S.
        • Lombardi W.L.
        The retrograde approach to coronary artery chronic total occlusions: a practical approach.
        Catheter Cardiovasc Interv. 2012; 79: 3-19
        • Thompson C.A.
        • Jayne J.E.
        • Robb J.F.
        • Friedman B.J.
        • Kaplan A.V.
        • Hettleman B.D.
        • Niles N.W.
        • Lombardi W.L.
        Retrograde techniques and the impact of operator volume on percutaneous intervention for coronary chronic total occlusions an early U.S. experience.
        JACC Cardiovasc Interv. 2009; 2: 834-842
        • Fefer P.
        • Knudtson M.L.
        • Cheema A.N.
        • Galbraith P.D.
        • Osherov A.B.
        • Yalonetsky S.
        • Gannot S.
        • Samuel M.
        • Weisbrod M.
        • Bierstone D.
        • Sparkes J.D.
        • Wright G.A.
        • Strauss B.H.
        Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions registry.
        J Am Coll Cardiol. 2012; 59: 991-997
        • Jones D.A.
        • Weerackody R.
        • Rathod K.
        • Behar J.
        • Gallagher S.
        • Knight C.J.
        • Kapur A.
        • Jain A.K.
        • Rothman M.T.
        • Thompson C.A.
        • Mathur A.
        • Wragg A.
        • Smith E.J.
        Successful recanalization of chronic total occlusions is associated with improved long-term survival.
        JACC Cardiovasc Interv. 2012; 5: 380-388
        • Brilakis E.S.K.D.
        • Patel V.
        • Banerjee S.
        Complications of chronic total occlusion angioplasty.
        Intervent Cardiol Clin. 2012; 1: 373-389
        • Mitsudo K.
        • Yamashita T.
        • Asakura Y.
        • Muramatsu T.
        • Doi O.
        • Shibata Y.
        • Morino Y.
        Recanalization strategy for chronic total occlusions with tapered and stiff-tip guidewire. The results of CTO new techniQUE for STandard procedure (CONQUEST) trial.
        J Invasive Cardiol. 2008; 20: 571-577