Effect of Interval Time after Subintimal Plaque Modification on the Success Rate of Future Recanalization for Chronic Total Occlusion Percutaneous Coronary Interventions.

Background: Chronic total occlusion (CTO) is a complex and difficult type of coronary lesion for which elective secondary intervention after subintimal plaque modification (SPM) can improve the success rate. This study sought to determine the most appropriate timing for secondary interval interventions to maximize the benefit to the patient.

Methods: This study retrospectively included patients who failed their first CTO percutaneous coronary intervention (PCI) at Beijing Anzhen Hospital Department of Cardiology from January 2019 to December 2022. We reviewed the clinical characteristics, procedural features, and outcomes of patients who underwent SPM and returned to our institution for a second CTO-PCI.

Results: Of the 2847 patients who visited our institution between January 2019 and December 2022, 528 underwent SPM and returned to our institution on an elective basis for a secondary procedure. Of these, 236 procedures were performed within 30 days (Group I), and 292 were performed between 30 and 90 days (Group II). After the intervention, the occluded segment was successfully opened in 170 (72.0%) Group I and 248 (84.9%) Group II participants. When analyzing the factors for operational failure, we found that different intervals, diabetes mellitus, hyperlipidemia, and a history of previous PCI or percutaneous coronary angioplasty (PTCA) were the reasons for the secondary intervention failure. When analyzing the safety of the procedure, we found that pericardial effusion was the most common complication after the procedure, with an incidence of 7.4%. There was no notable variation in the incidence of pericardial effusion between the two groups, 8.9% vs. 6.2% (p = 0.232).

Conclusions: Higher success rates were observed when secondary procedures were performed between 30 and 90 days instead of within 30 days after the initial CTO-PCI SPM, with no significant difference in safety noted between the two groups.