Procedural failure of chronic total occlusion percutaneous coronary intervention: Insights from a multicenter US registry

Background The hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly increased procedural success rates, yet some cases still fail. We sought to evaluate the causes of failure in a contemporary CTO PCI registry. Methods We examined 380 consecutiv...

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Bibliographic Details
Published in:Catheterization and cardiovascular interventions 2015-06, Vol.85 (7), p.1115-1122
Main Authors: Sapontis, James, Christopoulos, Georgios, Grantham, J. Aaron, Wyman, R. Michael, Alaswad, Khaldoon, Karmpaliotis, Dimitri, Lombardi, William L., McCabe, James M., Marso, Steven P., Kotsia, Anna P., Rangan, Bavana V., Christakopoulos, Georgios E., Garcia, Santiago, Thompson, Craig A., Banerjee, Subhash, Brilakis, Emmanouil S.
Format: Article
Language:English
Subjects:
Aged
Chronic Disease
Collateral Circulation
complex PCI
complications
Coronary Angiography
Coronary Circulation
Coronary Occlusion - diagnosis
Coronary Occlusion - physiopathology
Coronary Occlusion - therapy
Coronary Restenosis - diagnosis
Coronary Restenosis - etiology
Coronary Restenosis - physiopathology
Female
Hospitals, High-Volume
Humans
Male
Middle Aged
percutaneous coronary intervention
Percutaneous Coronary Intervention - adverse effects
Percutaneous Coronary Intervention - methods
Registries
Risk Factors
Treatment Failure
United States
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Summary:Background The hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly increased procedural success rates, yet some cases still fail. We sought to evaluate the causes of failure in a contemporary CTO PCI registry. Methods We examined 380 consecutive patients who underwent CTO‐PCI at 4 high volume CTO PCI centers in the United States using the “hybrid” approach. Clinical, angiographic, complication, and efficiency outcomes were compared between successful and failed cases. Failed cases were individually reviewed by an independent reviewer to determine the cause of failure. Results Procedural success was 91.3%. Compared with patients in whom CTO PCI was successful, those in whom CTO PCI failed had similar baseline clinical characteristics, but were more likely to have longer occlusion length, more tortuosity, more proximal cap ambiguity and blunt stump, and higher mean J‐CTO scores (2.8 ± 1.1 vs. 3.5 ± 1.0, P 
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.25807