Impact of negative lesion characteristics of chronic total occlusions on procedural outcome and strategy.

Abstract

Objective In the past, certain lesion characteristics of chronic total occlusions (CTOs) have been shown to have an influence on guidewire (GW) crossing and thus percutaneous coronary interventional (PCI) outcome. However, a clear description of the individual impact of these characteristics on procedural outcome, procedural characteristics and treatment strategy is lacking. The purpose of this study was to give a “weight” to these individual characteristics and evaluate their influence on interventional strategy. Methods Between November 2011 and May 2013, a non-randomized, prospective study was conducted in the hospitals of Genk and Aalst, leading to the inclusion of 132 consecutive patients. Lesions were classified according to the J-CTO (Multicenter CTO Registry of Japan) score (Morino et al., 2011). Both antegrade and retrograde procedures were performed. For antegrade procedures, a step-up strategy was applied. Univariate and multivariate analyses were performed and compared with the results of Morino et al. Study endpoint was general procedural success, defined as successful stenting with Thrombosis in Myocardial Infarction (TIMI) 3 flow. Results Overall procedural success was achieved in 74% and according to J-CTO criteria, in 92% (easy), 82% (intermediate), 77% (difficult) and 40% (very difficult) respectively. Independent predictors included bending, blunt stump, multivessel PCI and a retrograde approach with corresponding odds ratios for failure of 5.3, 2.7, 2.8 and 4.0 respectively. Conclusion Lesion characteristics of CTOs remain important in the prediction of success. In this study, bending and a blunt stump at the entry site come forth as the most important independent predictors of failure.