The Characteristics of Primary Retrograde Approach Selection for Native Coronary Chronic Occlusion With Short Occlusion Length from the Japanese CTO-PCI Expert Registry

• Published in: The American journal of cardiology Vol. 218; pp. 113 - 120
• Main Authors: Ochiumi, Yusuke, Tsuchikane, Etsuo, Kishi, Koichi, Okada, Hisayuki, Ito, Yoshiaki, Oikawa, Yuji, Yoshikawa, Ryohei, Okamura, Atsunori, Tanaka, Hiroyuki, Katoh, Osamu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2024; Elsevier Limited
• Subjects: Algorithms; Calcification; Chronic Disease; chronic total occlusion; Coronary Angiography; Coronary artery; Coronary Occlusion - surgery; Coronary vessels; Ejection fraction; Heart attacks; Hemodialysis; Humans; Japan; Kidney diseases; Kidney transplantation; Lesions; Medical imaging; Occlusion; Patients; percutaneous coronary intervention; Percutaneous Coronary Intervention - methods; primary retrograde approach; Registries; Risk Factors; short occlusion length; Success; Time Factors; Tortuosity; Treatment Outcome; Veins & arteries; Japan; short occlusion length; percutaneous coronary intervention; chronic total occlusion; primary retrograde approach
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2024.02.040

•The selection of a preprocedural strategy in chronic total occlusion - percutaneous coronary intervention with the short occlusion length chronic total occlusion remains concern.•We find that the predicting factors for selecting strategies and prolonged guidewire manipulation time in primary antegrade approach procedures with short occlusion lengths.•Further research may enable us to stratify the preprocedural difficulty during chronic total occlusion - percutaneous coronary intervention with short occlusion length. Although the coronary chronic total occlusion (CTO) crossing algorithm has been published, the characteristics associated with the first strategy selection for short-length lesions <20 mm is still debatable. This study aimed to determine the characteristics associated with primary retrograde approach (PRA) for native CTO with short occlusion length in percutaneous coronary intervention (PCI). Between January 2014 and December 2021, we examined data on 4,088 lesions in the Japanese CTO-PCI Expert Registry with occlusion lengths <20 mm. Then, the characteristics for short-length CTO, which was performed by way of the PRA, were assessed. PRA was performed in 785 patients (19.2%). The guidewire success rate was 93.6%, and the technical success rate was 91.3%. Previous coronary artery bypass grafting, chronic kidney disease, and 6 lesion/anatomic characteristics (i.e., blunt stump, distal runoff <1 mm, CTO lesion tortuosity, reattempt procedures, ostial location, and the presence of collateral channel grade 2) were associated with PRA (p <0.05). Moreover, hemodialysis was an independent factor of unsuccessful anterograde guidewire crossing, along with distal runoff <1 mm, the existence of calcification, and CTO lesion tortuosity (all p <0.05). In clinical settings, these independent factors for PRA in short-length CTO can help in selecting the CTO-PCI strategy.