Chronic total occlusions for intermediate volume operators: An antegrade step-up algorithm allows high success in easy and intermediate difficult CTO lesions

Joren Maeremans, Philippe Selleslagh, Luigi Di Serafino, Emanuele Barbato, Joseph Dens

Department of Cardiology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.

DOI: 10.4236/wjcd.2013.39085                

Abstract

To improve the success rates of chronic total occlusion (CTO) intervention, a large range of CTO-dedicated guidewires (GWs), devices and techniques have been developed. However, such an abundant choice of materials confuses inexperienced operators. Therefore, the usefulness of a simple antegrade treatment algorithm with a limited set of GWs, for easy to intermediate lesions, was investigated. Between November 2011 and March 2013, 105 patients were included, who underwent CTO PCI following the algorithm. Lesions were classified according to the Multicenter CTO Registry of Japan score. Overall technical success was achieved in 77%. Study endpoint was successful GW crossing within 30 min and was reached in 57%. High success rates were achieved in easy (81%) and intermediate (64%) lesion types. In both types, a soft wire could successfully cross in 57% and 51% respectively, with the Fielder XT^® (Asahi Intecc Co.) capable of crossing most commonly (90%). The proposed treatment algorithm simplifies the percutaneous treatment of easy to intermediate CTO lesions. However, it merits further evaluation, especially for operators/centers who perform a low to intermediate amount of CTO PCI.

Keywords

Percutaneous Coronary Intervention; Chronic Total Occlusion; Interventional Cardiology; Coronary Angioplasty; Guidewires

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Arslan, U., Balcioglu, A.S., Timurkaynak, T. and Cengel, A. (2006) The clinical outcomes of percutaneous coronary intervention in chronic total coronary occlusion. International Heart Journal, 47, 811-819.
[2]	Godino, C., Bassanelli, G., Economou, F.I., Takagi, K., Ancona, M., Galaverna, S., et al. (2013) Predictors of cardiac death in patients with coronary chronic total occlusion not revascularized by PCI. International Journal of Cardiology, 168, 1402-1409. http://dx.doi.org/10.1016/j.ijcard.2012.12.044
[3]	Fefer, P., Knudtson, M.L., Cheema, A.N., Galbraith, P.D., Osherov, A.B., Yalonetsky, S., et al. (2012) Current perspectives on coronary chronic total occlusions: The Canadian Multicenter Chronic Total Occlusions Registry. Journal of the American College of Cardiology, 59, 991-997. http://dx.doi.org/10.1016/j.jacc.2011.12.007
[4]	Rathore, S., Katoh, O., Matsuo, H., Terashima, M., Tanaka, N., Kinoshita, Y., et al. (2009) Retrograde percutaneous recanalization of chronic total occlusion of the coronary arteries: Procedural outcomes and predictors of success in contemporary practice. Circulation: Cardiovascular Interventions, 2, 124-132. http://dx.doi.org/10.1161/CIRCINTERVENTIONS.108.838862
[5]	Borgia, F., Viceconte, N., Ali, O., Stuart-Buttle, C., Saraswathyamma, A., Parisi, R., et al. (2012) Improved cardiac survival, freedom from MACE and angina-related quality of life after successful percutaneous recanalization of coronary artery chronic total occlusions. International Journal of Cardiology, 161, 31-38. http://dx.doi.org/10.1016/j.ijcard.2011.04.023
[6]	Suero, J.A., Marso, S.P., Jones, P.G., Laster, S.B., Huber, K.C., Giorgi, L.V., et al. (2001) Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: A 20-year experience. Journal of the American College of Cardiology, 38, 409-414.
[7]	Khan, M.F., Wendel, C.S., Thai, H.M. and Movahed, M.R. (2013) Effects of percutaneous revascularization of chronic total occlusions on clinical outcomes: A metaanalysis comparing successful versus failed percutaneous intervention for chronic total occlusion. Catheterization and Cardiovascular Interventions, 82, 95-107. http://dx.doi.org/10.1002/ccd.24863
[8]	Morino, Y., Abe, M., Morimoto, T., Kimura, T., Hayashi, Y., Muramatsu, T., et al. (2011) Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: The J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC: Cardiovascular interventions, 4, 213-221. http://dx.doi.org/10.1016/j.jcin.2010.09.024
[9]	Galassi, A., Tomasello, S., Reifart, N., Werner, G., Sianos, G., Bonnier, H., et al. (2011) In-hospital outcomes of percutaneous coronary intervention in patients with chronic total occlusion: insights from the ERCTO (European Registry of Chronic Total Occlusion) registry. Eurointervention, 7, 472-479. http://dx.doi.org/10.4244/EIJV7I4A77
[10]	Fujino, A., Sakamoto, H., Fujino, M., Yamane, T., Adachi, T., Jinnai, T., et al. (2012) The procedural benefit of soft and tapered tip guidewire use as a first choice for chronic total occlusion revascularisation. Journal of the American College of Cardiology, 59, E106. http://dx.doi.org/10.1016/S0735-1097(12)60107-7
[11]	Di Mario, C., Werner, G.S., Sianos, G., Galassi, A.R., Buttner, J., Dudek, D., et al. (2007) European perspective in the recanalisation of Chronic Total Occlusions (CTO): Consensus document from the EuroCTO Club. EuroIntervention, 3, 30-43.
[12]	Brilakis, E.S., Grantham, J.A., Rinfret, S., Wyman, R.M., Burke, M.N., Karmpaliotis, D., et al. (2012) A percutaneous treatment algorithm for crossing coronary chronic total occlusions. JACC: Cardiovascular Interventions, 5, 367-379. http://dx.doi.org/10.1016/j.jcin.2012.02.006
[13]	Brilakis, E.S., Grantham, J.A., Thompson, C.A., DeMartini, T.J., Prasad, A., Sandhu, G.S., et al. (2012) The retrograde approach to coronary artery chronic total occlusions. Catheterization and Cardiovascular Interventions, 79, 3-19. http://dx.doi.org/10.1002/ccd.23004