Skip to main content
SpringerLink
Log in

The evaluation of technical outcome and wire manipulation time within 30 min in patients with poor distal vessel quality on percutaneous coronary intervention for chronic total occlusion

  • Original Article
  • Published:
Cardiovascular Intervention and Therapeutics Aims and scope Submit manuscript

Abstract

The technical outcome of poor distal vessel quality (PDV) on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is yet to be clearly elucidated. PDV has not been evaluated in scoring systems. We examined 193 consecutive CTO–PCIs performed in January 2013–December 2017. The endpoint, including the technical outcomes in these patients between with and without PDV, was analyzed. Moreover, we re-evaluated the predictors for CTO–PCI difficulty according to Japan-CTO score. Out of 193 CTO–PCIs, 181 (93.8%) achieved technical success [including 101 (55.8%) with and 80 (44.2%) without PDV]. In patients with and without PDV, the success rates of guidewire crossing using only the antegrade technique were 46.5% vs. 83.8%, respectively (p < 0.0001) and using the retrograde approach were 53.5% vs. 16.3%, respectively (p < 0.0001). Moreover, there were 56 non-interventional collateral channels in 181 patients. The successful rate of primary antegrade approach was significantly lower and the rate of a rescue retrograde approach was significantly higher with PDV (37.2% vs. 62.8%, 76.9% vs. 23.1%, respectively; p < 0.0119). Significant predictors associated with successful guidewire crossings of ≤ 30 min included blunt stump, calcification, bending, occlusion length ≥ 20 mm, retry lesion following Japan-CTO score, and PDV (p < 0.05, all). Multivariate analyses demonstrated that blunt stump, calcification, bending, retry lesion, and PDV were independent predictors of unsuccessful guidewire crossing of ≤ 30 min (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13–0.71, p = 0.0039; OR 0.34, 95% CI 0.16–0.71, p = 0.0035; OR 0.17, 95% CI 0.05–0.60, p = 0.0034; OR 0.18, 95% CI 0.06–0.54, p = 0.0008; and OR 0.19, 95% CI 0.09–0.41, p < 0.0001, respectively). PDV could affect the technical outcome of CTO–PCI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

PDV:

Poor distal vessel quality

ADR:

Antegrade dissection reentry

CART:

Controlled antegrade and retrograde subintimal tracking

CTO:

Chronic total occlusion

IVUS:

Intravascular ultrasound

J-CTO:

Japan-CTO

PCI:

Percutaneous coronary intervention

RCART:

Reverse CART

TIMI:

Thrombolysis in myocardial infarction

CC:

Interventional collateral channel

PAA:

Primary antegrade approach

RRA:

Rescue retrograde approach

References

  1. Grantham JA, Jones PG, Cannon L, Spertus JA. Quantifying the early health status benefits of successful chronic total occlusion recanalization: results from the Flow Cardia's Approach to Chronic Total Occlusion Recanalization (FACTOR) Trial. Circ Cardiovasc Qual Outcomes. 2010;3:284–90.

    Article  Google Scholar 

  2. Mehran R, Claessen BE, Godino C, Dangas GD, Obunai K, Kanwal S, et al. Long-term outcome of percutaneous coronary intervention for chronic total occlusions. JACC Cardiovasc Interv. 2011;4:952–61.

    Article  Google Scholar 

  3. George S, Cockburn J, Clayton TC, Ludman P, Cotton J, Spratt J, et al. Long-term follow-up of elective chronic total coronary occlusion angioplasty: analysis from the UK Central Cardiac Audit Database. J Am Coll Cardiol. 2014;64:235–43.

    Article  Google Scholar 

  4. Teramoto T, Tsuchikane E, Yamamoto M, Matsuo H, Kawase Y, Suzuki Y, et al. Successful revascularization improves long-term clinical outcome in patients with chronic coronary total occlusion. Int J Cardiol Heart Vasc. 2016;14:28–322.

    PubMed  PubMed Central  Google Scholar 

  5. Mitsudo K, Yamashita T, Asakura Y, Muramatsu T, Doi O, Shibata Y, et al. 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;20:571–7.

    PubMed  Google Scholar 

  6. Kimura M, Katoh O, Tsuchikane E, Nasu K, Kinoshita Y, Ehara M, et al. The efficacy of a bilateral approach for treating lesions with chronic total occlusions the CART (controlled antegrade and retrograde subintimal tracking) registry. JACC Cardiovasc Interv. 2009;2:1135–41.

    Article  Google Scholar 

  7. Tsuchikane E, Katoh O, Kimura M, Nasu K, Kinoshita Y, Suzuki T. The first clinical experience with a novel catheter for collateral channel tracking in retrograde approach for chronic coronary total occlusions. JACC Cardiovasc Interv. 2010;3:165–71.

    Article  Google Scholar 

  8. Morino Y, Abe M, Morimoto T, Kimura T, Hayashi Y, Muramatsu T, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 min: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011;4:213–21.

    Article  Google Scholar 

  9. Christopoulos G, Kandzari DE, Yeh RW, Jaffer FA, Karmpaliotis D, Wyman MR, et al. Development and validation of a novel scoring system for predicting technical success of chronic total occlusion percutaneous coronary interventions: the PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) score. JACC Cardiovasc Interv. 2016;9:1–9.

    Article  Google Scholar 

  10. Szijgyarto Z, Rampat R, Werner GS, Ho C, Reifart N, Lefevre T, et al. Derivation and validation of a chronic total coronary occlusion intervention procedural success score from the 20,000-patient EuroCTO Registry: the EuroCTO (CASTLE) Score. JACC Cardiovasc Interv. 2019;12:335–42.

    Article  Google Scholar 

  11. Harding SA, Wu EB, Lo S, Lim ST, Ge L, Chen JY, et al. New algorithm for crossing chronic total occlusions from the Asia Pacific Chronic Total Occlusion Club. JACC Cardiovasc Interv. 2017;10:2135–43.

    Article  Google Scholar 

  12. Maeremans J, Walsh S, Knaapen P, Spratt JC, Avran A, Hanratty CG, et al. The hybrid algorithm for treating chronic total occlusions in Europe: the RECHARGE Registry. J Am Coll Cardiol. 2016;68:1958–70.

    Article  Google Scholar 

  13. Suzuki Y, Tsuchikane E, Katoh O, Muramatsu T, Muto M, Kishi K, et al. Outcomes of percutaneous coronary interventions for chronic total occlusion performed by highly experienced Japanese Specialists: the first report from the Japanese CTO-PCI expert registry. JACC Cardiovasc Interv. 2017;10:2144–54.

    Article  Google Scholar 

  14. Di Mario C, Werner GS, Sianos G, Galassi AR, Büttner J, Dudek D, et al. European perspective in the recanalisation of Chronic Total Occlusions (CTO): consensus document from the EuroCTO Club. EuroIntervention. 2007;3:30–433.

    Article  Google Scholar 

  15. Werner GS, Ferrari M, Heinke S, Kuethe F, Surber R, Richartz BM, et al. Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions. Circulation. 2003;107:1972–7.

    Article  Google Scholar 

  16. Huang CC, Lee CK, Meng SW, Hung CS, Chen YH, Lin MS, et al. Collateral channel size and tortuosity predict retrograde percutaneous coronary intervention success for chronic total occlusion. Circ Cardiovasc Interv. 2018;11:e005124.

    PubMed  Google Scholar 

  17. Suzuki Y, Muto M, Yamane M, Muramatsu T, Okamura A, Igarashi Y, et al. Independent predictors of retrograde failure in CTO-PCI after successful collateral channel crossing. Catheter Cardiovasc Interv. 2017;90:E11–E18.

    Article  Google Scholar 

  18. Suzuki T, Hosokawa H, Yokoya K, Kojima A, Kinoshita Y, Miyata S, et al. Time-dependent morphologic characteristics in angiographic chronic total coronary occlusions. Am J Cardiol. 2001;88(167–169):A5–6.

    Google Scholar 

Download references

Acknowledgements

We thank all participants and coauthors in this study.

Author information

Authors and Affiliations

  1. Department of Cardiology, Nagoya Heart Center, 1-1-14, Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan

    Yusuke Ochiumi, Yoriyasu Suzuki, Akira Murata & Tatsuya Ito

Authors
  1. Yusuke Ochiumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoriyasu Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akira Murata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tatsuya Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yusuke Ochiumi.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ochiumi, Y., Suzuki, Y., Murata, A. et al. The evaluation of technical outcome and wire manipulation time within 30 min in patients with poor distal vessel quality on percutaneous coronary intervention for chronic total occlusion. Cardiovasc Interv and Ther 36, 67–73 (2021). https://doi.org/10.1007/s12928-020-00647-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12928-020-00647-5

Keywords

Search

Navigation