Predicting Successful Guidewire Crossing Through Chronic Total Occlusion of Native Coronary Lesions Within 30 Minutes

Morino, Yoshihiro; Abe, Mitsuru; Morimoto, Takeshi; Hayashi, Yasuhiko; Muramatsu, Toshiya; Ochiai, Masahiko; Noguchi, Yuichi; Kato, Kenichi; Shibata, Yoshisato; Hiasa, Yoshikazu; Doi, Osamu; Yamashita, Takehiro; Hinohara, Tomoaki; Tanaka, Hiroyuki; Mitsudo, Kazuaki; Investigators, J-Cto Registry

doi:10.1016/j.jcin.2010.09.024

Cited by 718 publications

(261 citation statements)

References 19 publications

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“…To the best of our knowledge, the current study involves the largest number of hemodialysis patients treated with CTO‐PCI to date. In agreement with previous reports, our study showed that patients undergoing long‐term hemodialysis commonly carry accumulated cardiovascular risk factors25 and angiographic findings indicative of advanced atherosclerosis and difficulty in CTO‐PCI procedures 14. Further, hemodialysis independently and strikingly predicted the technical failure in overall CTO‐PCI in the present study.…”

Section: Discussionsupporting

confidence: 93%

“…Although several scoring systems to predict the difficulty or technical failure in CTO‐PCI have been developed, these studies have included few hemodialysis patients: only 14 cases in the report of the J‐CTO score14 and 10 in that of the PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) score 24. In the present study, a total of 313 hemodialysis patients undergoing contemporary CTO‐PCI with dedicated devices and specialized techniques were included.…”

Section: Discussionmentioning

confidence: 99%

“…The collateral connection grade was classified as previously reported 13. The Multicenter CTO Registry in Japan (J‐CTO) score was calculated as described by Morino et al,14 and the Clinical and Lesion‐related (CL) score as described by Alessandrino et al 15…”

Section: Methodsmentioning

confidence: 99%

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Impact of Hemodialysis on Procedural Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion: Insights From the Japanese Multicenter Registry

Nakatani

Kohsaka

Yamane³

et al. 2017

JAHA

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BackgroundAmong patients treated with percutaneous coronary intervention for chronic total occlusion (CTO‐PCI), patients on long‐term hemodialysis are at significantly high risk for cardiovascular mortality and morbidity. However, clinical or angiographic predictors that might aid in better patient selection remain unclear. We aimed to assess the acute impact of hemodialysis in patients who underwent CTO‐PCI.Methods and ResultsThe Retrograde Summit registry is a multicenter, prospective registry of patients undergoing CTO‐PCI at 65 Japanese centers. Patient characteristics and procedural outcomes of 4749 patients were analyzed, according to the presence (n=313) or absence (n=4436) of baseline hemodialysis. A prediction model for technical failure among hemodialysis patients was also developed. The technical success rate of CTO‐PCI was significantly lower in hemodialysis than in nonhemodialysis patients (78.0% versus 89.1%, P<0.001). The rates of in‐hospital major adverse cardiac and cerebrovascular events were similar between the 2 groups (1.6% versus 0.9%, P=0.24). Irrespective of clinical/angiographic characteristics or previously developed scoring systems, hemodialysis independently predicted technical failure for CTO‐PCI. Among hemodialysis patients, predictors of technical failure were blunt stump (odds ratio 2.45, 95% confidence interval, 1.15–5.21, P=0.021), severe lesion calcification (odds ratio 2.50, 95% confidence interval, 1.19–5.24, P=0.015), and absence of diabetes mellitus (odds ratio 3.15, 95% confidence interval, 1.49–6.64, P=0.003). In hemodialysis patients without these predictors, the technical success rate was 96.2%.ConclusionsHemodialysis is significantly associated with technical failure. Contemporary CTO‐PCI seems feasible and safe in selected hemodialysis patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Impact of Hemodialysis on Procedural Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion: Insights From the Japanese Multicenter Registry

Nakatani

Kohsaka

Yamane³

et al. 2017

JAHA

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“…Several scoring systems have been developed to determine the likelihood of CTO PCI technical success and the potential difficulty of the procedure (measured as time required to cross the occlusion), such as the CL Clinical and lesion‐related) score,34 Ellis score,35 Japan‐chronic total occlusion score (J‐CTO),36 Ostial, Rentrop grade, Age score (ORA),37 PROGRESS‐CTO score,38 and RECHARGE score39 (Table 3). These scores combine various clinical and angiographic characteristics and can provide a quantitative assessment of the likelihood of success and the difficulty of the case, as long as they are applied in similar settings as the ones that they were developed on.…”

Section: Success Of Cto Pcimentioning

confidence: 99%

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Tajti

Brilakis

2018

JAHA

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“…CTOs treated by the retrograde approach were excluded. CTOs were categorized according to the J-CTO criteria [8]. Four groups were created, based on the difficulty of the CTO lesion (easy (0), intermediate (1), difficult (2) and very difficult (≥3)).…”

Section: Study Populationmentioning

confidence: 99%

Chronic total occlusions for intermediate volume operators: An antegrade step-up algorithm allows high success in easy and intermediate difficult CTO lesions

Maeremans¹,

Selleslagh²,

Serafino³

et al. 2013

WJCD

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To improve the success rates of chronic total occlusion (CTO) intervention, a large range of CTO-dedicated guidewires (GWs), devices and techniques have been developed. However, such an abundant choice of materials confuses inexperienced operators. Therefore, the usefulness of a simple antegrade treatment algorithm with a limited set of GWs, for easy to intermediate lesions, was investigated. Between November 2011 and March 2013, 105 patients were included, who underwent CTO PCI following the algorithm. Lesions were classified according to the Multicenter CTO Registry of Japan score. Overall technical success was achieved in 77%. Study endpoint was successful GW crossing within 30 min and was reached in 57%. High success rates were achieved in easy (81%) and intermediate (64%) lesion types. In both types, a soft wire could successfully cross in 57% and 51% respectively, with the Fielder XT ® (Asahi Intecc Co.) capable of crossing most commonly (90%). The proposed treatment algorithm simplifies the percutaneous treatment of easy to intermediate CTO lesions. However, it merits further evaluation, especially for operators/centers who perform a low to intermediate amount of CTO PCI.

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Predicting Successful Guidewire Crossing Through Chronic Total Occlusion of Native Coronary Lesions Within 30 Minutes

Abstract: This model predicted the probability of successful guidewire crossing within 30 min very well and can be applied for difficulty grading.

Cited by 718 publications

References 19 publications

Impact of Hemodialysis on Procedural Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion: Insights From the Japanese Multicenter Registry

Impact of Hemodialysis on Procedural Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion: Insights From the Japanese Multicenter Registry

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Chronic total occlusions for intermediate volume operators: An antegrade step-up algorithm allows high success in easy and intermediate difficult CTO lesions

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