Background

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) comprises 10–20% of all coronary interventions. Recent advances in PCI materials, devices, approaches, and techniques have allowed operators to tackle successfully with more complex cases of CTO.

Methods

Evaluation of immediate- and long-term outcome of consecutive patients who underwent PCI for at least one CTO with the use of new wires/application of novel techniques. One hundred patients underwent PCI for 103 lesions, with evidence of large area of ischemia by noninvasive studies and favorable angiographic appearance. Patients were stratified into successful and failure procedures.

Methods

Evaluation of immediate- and long-term outcome of consecutive patients who underwent PCI for at least one CTO with the use of new wires/application of novel techniques. One hundred patients underwent PCI for 103 lesions, with evidence of large area of ischemia by noninvasive studies and favorable angiographic appearance. Patients were stratified into successful and failure procedures.

Results

The main angiographic and procedural characteristics were similar in the two groups. CTO-PCI was successful in 81 patients (81%) and 89 lesions (86.4%). Novel techniques used were “parallel” wire techniques (20 lesions), anchoring technique (7 lesions), subintimal tracking and reentry STAR (1 lesion), and contralateral injection (6 lesions). Thirty-two percent of patients had drug-eluting stents implanted. The predictors of success were as follows: occlusion age 3–6 months ( P =.006), occlusion length <20 mm ( P <.001), vessel diameter ≥3 mm ( P =.001), no calcification ( P =.001), tapered stump ( P <.001), absence of ostial occlusion ( P <.001), and absence of side branch from stump ( P =.04). The in-hospital major adverse cardiac event (MACE) rate was 11% in the CTO cohort. There was a distinct improvement of angina class and LVEF% for successful CTO treatment compared with failed CTO treatment ( P <.001). During a 10±2 months follow-up, among patients with successful procedures, 55 patients remained angina free (68%), 10 patients required repeat revascularization (12.3%), and 1 patient (1.2%) developed a new myocardial infarction. No death was reported.

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