Published online Apr 26, 2017. doi: 10.4330/wjc.v9.i4.355
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
Processing time: 247 Days and 17.4 Hours
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.
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.
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.
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.