Cuevas C, Ryan N, Quirós A, Del Angel JG, Gonzalo N, Salinas P, Jiménez-Quevedo P, Nombela-Franco L, Nuñez-Gil I, Fernandez-Ortiz A, Macaya C, Escaned J. Determinants of percutaneous coronary intervention success in repeat chronic total occlusion procedures following an initial failed attempt. World J Cardiol 2017; 9(4): 355-362 [PMID: 28515854 DOI: 10.4330/wjc.v9.i4.355]
Corresponding Author of This Article
Javier Escaned, MD, PhD, Cardiovascular Institute, Hospital Clinico San Carlos, Calle del Profesor Martín Lagossn, 28040 Madrid, Spain. escaned@secardiologia.es
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Apr 26, 2017; 9(4): 355-362 Published online Apr 26, 2017. doi: 10.4330/wjc.v9.i4.355
Determinants of percutaneous coronary intervention success in repeat chronic total occlusion procedures following an initial failed attempt
Cecilia Cuevas, Nicola Ryan, Alicia Quirós, Juan Gustavo Del Angel, Nieves Gonzalo, Pablo Salinas, Pilar Jiménez-Quevedo, Luis Nombela-Franco, Ivan Nuñez-Gil, Antonio Fernandez-Ortiz, Carlos Macaya, Javier Escaned
Cecilia Cuevas, Nicola Ryan, Alicia Quirós, Juan Gustavo Del Angel, Nieves Gonzalo, Pablo Salinas, Pilar Jiménez-Quevedo, Luis Nombela-Franco, Ivan Nuñez-Gil, Antonio Fernandez-Ortiz, Carlos Macaya, Javier Escaned, Cardiovascular Institute, Hospital Clinico San Carlos, 28040 Madrid, Spain
Author contributions: Cuevas C designed and performed the research and wrote the initial paper; Ryan N revised the initial data and paper; Quirós A performed statistical analysis; Del Angel JG contributed to data collection and the initial paper; Gonzalo N, Salinas P, Jiménez-Quevedo P, Nombela-Franco L, Nuñez-Gil I, Fernandez-Ortiz A and Macaya C provided clinical advice; Escaned J supervised the report.
Institutional review board statement: As this paper was a retrospective review of a database it does not require ethical approval in our Institution.
Informed consent statement: All patients provided informed consent for the procedures and the inclusion of their data in the database.
Conflict-of-interest statement: The authors report no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Javier Escaned, MD, PhD, Cardiovascular Institute, Hospital Clinico San Carlos, Calle del Profesor Martín Lagossn, 28040 Madrid, Spain. escaned@secardiologia.es
Telephone: +34-91-3303438
Received: August 24, 2016 Peer-review started: August 25, 2016 First decision: October 8, 2016 Revised: January 10, 2017 Accepted: February 8, 2017 Article in press: February 13, 2017 Published online: April 26, 2017
Abstract
AIM
To investigate the rates and determinants of success of repeat percutaneous coronary intervention (PCI) following an initial failed attempt at recanalising the chronic total occlusions (CTO) percutaneously.
METHODS
In 445 consecutive first attempt CTO-PCI procedures in our institution, procedural failure occurred in 149 (33.5%). Sixty-four re-PCI procedures were performed in 58 patients (39%) all had a single CTO. Procedural and outcome data in the re-PCI population was entered into the institutional database. A retrospective analysis of clinical, angiographic and procedural data was performed.
RESULTS
Procedural success was achieved in 41 (64%) procedures. Univariate analysis of clinical and angiographic characteristics showed that re-PCI success was associated with intravascular ultrasound (IVUS) guidance (19.5% vs 0%, P = 0.042), while failure was associated with severe calcification (30.4% vs 9.7%, P = 0.047) and a JCTO score > 3 (56.5% vs 17.1% P = 0.003). Following multiple regression analysis the degree of lesion complexity (J-CTO score > 3), IVUS use, involvement of an experienced CTO operator and LAD CTO location were significant predictors of successful re-PCI. Overall the complication rate was low, with the only MACCE two periprocedural MI’s neither of which required intervention.
CONCLUSION
Re-PCI substantially increases the overall success rate of CTO revascularization. Predictors of re-PCI success included the use of IVUS, the involvement of an experienced CTO operator in the repeat attempt and the location of the CTO.
Core tip: Failed percutaneous recanalization of chronic total occlusions (CTO) constitutes a clinical conundrum. While percutaneous treatment is often abandoned in favour of medical therapy, CTO-percutaneous coronary intervention (PCI) expertise and alternative techniques may contribute to improve procedural success. This study shows that with careful pre-procedural planning reattempt PCI in CTO’s is both safe and efficacious.
