Chronic Total Occlusion – Percutaneous Coronary Intervention (CTO-PCI) Experience in a Single, Multi-operator Australian Centre: Need for dedicated CTO-PCI programs
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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
“…The revascularization of CTO lesions has been recognized as a great challenge for the operator. This is because it is linked with complex anatomic lesions demanding scrupulous vessel preparation, followed by longer procedural time, higher radiation dose, and contrast amount used during the intervention [3,6,17,18]. Apart from this, high procedural difficulty is attributed to a higher rate of additional device exploitation (e.g., intravascular imaging, rotablation, intravascular lithotripsy) compared to regular PCI.…”
Section: Discussionmentioning
confidence: 99%
“…Apart from this, high procedural difficulty is attributed to a higher rate of additional device exploitation (e.g., intravascular imaging, rotablation, intravascular lithotripsy) compared to regular PCI. Moreover, challenging maneuvers, involving antegrade or retrograde dissection and re-entry approaches, may strain the mental and skillset capacity of the interventionalist [17,19]. Furthermore, the increasing clinical severity of patients eligible for PCI and its low predictability but high risk makes it more difficult to single-handedly manage these cases at the Cathlab [20].…”
Section: Discussionmentioning
confidence: 99%
“…Furthermore, the increasing clinical severity of patients eligible for PCI and its low predictability but high risk makes it more difficult to single-handedly manage these cases at the Cathlab [20]. Despite the aforementioned challenges, due to novel interventional therapies, the international procedural success of CTO-PCI has been steadily increasing over time, from less than 75% in the past to a current total of 90% at the leading highly experienced centers [9,17,[20][21][22]. However, this outcome not only remains significantly worse in comparison to regular PCI, but also exhibits great variability with regard to the site where CTO treatment is attempted.…”
Section: Discussionmentioning
confidence: 99%
“…However, this outcome not only remains significantly worse in comparison to regular PCI, but also exhibits great variability with regard to the site where CTO treatment is attempted. In fact, in other studies based on inexperienced institutions, it has been reported that achieved procedural success is unsatisfactory, far below 70% [10,17]. Thus, in an effort to improve the modest outcomes of such revascularizations, a renewed interest has arisen in establishing international guidelines for CTO-PCIs and adopting widely convenient training programs.…”
(1) Background: Since the treatment of chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) is associated with high procedural complexity, it has been suggested to use a multi-operator approach. This study was aimed at evaluating the procedural outcomes of single (SO) versus dual-operator (DO) CTO-PCI approaches. (2) Methods: This retrospective analysis included data from the Polish Registry of Invasive Cardiology Procedures (ORPKI), collected between January 2014 and December 2020. To compare the DO and SO approaches, propensity score matching was introduced with equalized baseline features. (3) Results: The DO approach was applied in 3604 (13%) out of 27,788 CTO-PCI cases. Patients undergoing DO CTO-PCI experienced puncture-site bleeding less often than the SO group (0.1% vs. 0.3%, p = 0.03). No differences were found in the technical success rate (successful revascularization with thrombolysis in myocardial infarction flow grade 2/3) of the SO (72.4%) versus the DO approach (71.2%). Moreover, the presence of either multi-vessel (MVD) or left main coronary artery disease (LMCA) (odds ratio (OR), 1.67 (95% confidence interval (CI), 1.20–2.32); p = 0.002), as well as lower annual and total operator volumes of PCI and CTO-PCI, could be noted as factors linked with the DO approach. (4) Conclusions: Due to the retrospective character, the findings of this study have to be considered only as hypothesis-generating. DO CTO-PCI was infrequent and was performed on patients who were more likely to have LMCA lesions or MVD. Operators collaboratively performing CTO-PCIs were more likely to have less experience. Puncture-site bleeding occurred less often in the dual-operator group; however, second-operator involvement had no impact on the technical success of the intervention.
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