Mario Iannaccone, On Behalf Of The Euro Cto Investigators, Iskander Atmowihardjo, Nicolaus Reifart, Meruzhan Saghatelyan, Andrew Ladwiniec, Nicolaus Boudou, Alexander Avran, Mohamed Ayoub, Gerald S Werner, Kambis Mashayekhi, Carlo Di Mario, Eugenio La Scala, Gabriele L Gasparini, Roberto Diletti, Sudhir Rathore, Alfredo R Galassi, Alexander Bufe, Michael Behnes, George Sianos, Sevket Gorgulu, Giuseppe Vadalà, Laura Maniscalco, Pierfrancesco Agostoni, Roberto Garbo, Omer Goktekin
Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2024;20(3):e185-e197
PMID: 38343371
BACKGROUND
Percutaneous coronary interventions (PCI) of chronic total occlusions (CTO) have reached high procedural success rates thanks to dedicated equipment, evolving techniques, and worldwide adoption of state-of-the-art crossing algorithms.
AIMS
We report the contemporary results of CTO PCIs performed by a large European community of experienced interventionalists. Furthermore, we investigated the impact of different risk factors for procedural major adverse cardiac and cerebrovascular events (MACCE) and trends of employment of specific devices like dual lumen microcatheters, guiding catheter extensions, intravascular ultrasound and calcium-modifying tools.
METHODS
We evaluated data from 8,673 CTO PCIs included in the European Registry of Chronic Total Occlusion (ERCTO) between January 2021 and October 2022.
RESULTS
The overall technical success rate was 89.1% and was higher in antegrade as compared with retrograde cases (92.8% vs 79.3%; p<0.001). Compared with antegrade procedures, retrograde procedures had a higher complexity of attempted lesions (Japanese CTO [J-CTO] score: 3.0±1.0 vs 1.9±1.2; p<0.001), a higher procedural and in-hospital MACCE rate (3.1% vs 1.2%; p<0.018) and a higher perforation rate with and without tamponade (1.5% vs 0.4% and 8.3% vs 2.1%, respectively; p<0.001). As compared with mid-volume operators, high-volume operators had a higher technical success rate in antegrade and retrograde procedures (93.4% vs 91.2% and 81.5% vs 69.0%, respectively; p<0.001), and had a lower MACCE rate (1.47% vs 2.41%; p<0.001) despite a higher mean complexity of the attempted lesions (J-CTO score: 2.42±1.28 vs 2.15±1.27; p<0.001).
CONCLUSIONS
The adoption of different recanalisation techniques, operator experience and the use of specific devices have contributed to a high procedural success rate despite the high complexity of the lesions documented in the ERCTO.
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