Percutaneous Coronary Intervention for Aorto-Ostial Chronic Total Occlusion

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2024-10-14 DOI:10.1016/j.jcin.2024.08.028

Takeshi Niizeki MD, PhD , Etsuo Tsuchikane MD, PhD , Tsuneo Konta MD, PhD , Koichi Kishi MD , Hisayuki Okada MD, PhD , Yoshiaki Ito MD, PhD , Yuji Oikawa MD , Ryohei Yoshikawa MD , Hiroyuki Tanaka MD

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引用次数: 0

Abstract

Background

PCI for aorto-ostial CTO remains challenging. The techniques for guidewire in aorto-ostial CTO may differ from those used in non–aorto-ostial CTOs, influenced by clinical and angiographic characteristics.

Objectives

This study aimed to assess the technical aspects and outcomes of percutaneous coronary intervention (PCI) in patients with aorto-ostial chronic total occlusion (CTO).

Methods

This analysis included 420 patients with ostial CTO from the Japanese CTO-PCI Expert Registry, spanning January 2014 to December 2022. It examined the strategies and procedural outcomes of CTO PCI.

Results

Ostial CTO represented 420 of 10,814 (3.9%) of all CTO PCI cases. Within this subset, aorto-ostial CTO accounted for 218 of 420 (52%) cases. The technical success rate for aorto-ostial CTO was 88% (191/218). Aorto-ostial CTOs exhibited longer lesion lengths and were more likely to present with challenges such as distal target lumen ambiguity, calcification, and tortuosity compared with non–aorto-ostial CTOs. The retrograde approach was more commonly used in aorto-ostial CTO, with retrograde direct crossing being the most successful technique, especially in cases of flush CTO. A multivariate logistic analysis identified several factors significantly associated with unsuccessful aorto-ostial CTO PCI, including difficulties in engaging a guiding catheter, estimating the collateral channel (as assessed by the J-Channel score), and tortuosity.

Conclusions

Aorto-ostial CTOs are more complex and frequently require a retrograde approach. The availability of suitable interventional collateral channels is crucial for the success of these procedures.

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经皮冠状动脉介入治疗主动脉口慢性全闭塞

背景PCI治疗主动脉直肠CTO仍然具有挑战性。本研究旨在评估经皮冠状动脉介入治疗（PCI）在主动脉-骨干慢性全闭塞（CTO）患者中的技术方面和结果。方法本分析纳入了日本 CTO-PCI 专家登记处的 420 例骨干 CTO 患者，时间跨度为 2014 年 1 月至 2022 年 12 月。结果在 10,814 例 CTO PCI 病例中，有 420 例（3.9%）为梗阻性 CTO。在这一子集中，主动脉肋间 CTO 占 420 例中的 218 例（52%）。主动脉肋间 CTO 的技术成功率为 88%（191/218）。与非主干道 CTO 相比，主干道 CTO 的病变长度更长，更容易出现远端靶腔不清晰、钙化和迂曲等问题。逆行方法更常用于主动脉-直管 CTO，其中逆行直接穿越是最成功的技术，尤其是在齐平的 CTO 病例中。多变量逻辑分析确定了与不成功的主动脉-骨干 CTO PCI 明显相关的几个因素，包括难以接合导引导管、难以估计侧支通道（通过 J 通道评分评估）以及迂曲。有合适的介入侧支通道对这些手术的成功至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.