Scoring systems for chronic total occlusion percutaneous coronary intervention: if you fail to prepare you are preparing to fail

Karatasakis, Aris; Danek, Barbara Anna; Brilakis, Emmanouil S.

doi:10.21037/jtd.2016.08.20

Cited by 12 publications

(10 citation statements)

References 18 publications

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“…The J-CTO, CL, CASTLE, and 20 all include lesion length of < or ≥ 20 mm as part of the score and have all been shown to predict final wiring or procedural success. [21][22][23][24] However, the performance of these scoring systems in predicting longer-term outcomes after CTO PCI is less robust and data specifically evaluating the relationship between lesion length and clinical outcomes after successful CTO PCI limited. 25 Moreover, CTO lesion length can be difficult to accurately determine and does not reflect the true extent of obstructive vessel disease proximal and distal to the occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…The impact of CTO lesion length on procedural complexity and success has been repeatedly demonstrated. The J‐CTO, CL, CASTLE, and 20 all include lesion length of < or ≥ 20 mm as part of the score and have all been shown to predict final wiring or procedural success 21–24 . However, the performance of these scoring systems in predicting longer‐term outcomes after CTO PCI is less robust and data specifically evaluating the relationship between lesion length and clinical outcomes after successful CTO PCI limited 25 .…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes of percutaneous coronary intervention for chronic total occlusion by treated segment length

Shoaib

Spratt

Curzen

et al. 2021

Cathet Cardio Intervent

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Background: Long lesions are known to have worse outcomes following percutaneous coronary intervention (PCI), but there are limited data assessing the association between lesion length and clinical outcomes in PCI procedures undertaken in chronic total occlusions (CTO). Methods and results:We formed a longitudinal cohort (2006-2018, n = 27,205) of stable angina patients who underwent PCI to CTO in the British Cardiovascular Intervention Society (BCIS) database. Clinical, demographical, procedural, and outcome data were analyzed in three groups by treated segment length, < 30 mm (n = 11,782), 30-59 mm (n = 10,415), ≥ 60 mm (n = 5008). Prevalence of previous myocardial infarction and PCI were higher in patients in 30-59 mm group or ≥ 60 mm group compared with < 30 mm group. Following multivariable analysis, no significant difference was observed in in-patient death (OR = 30-59 mm

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of percutaneous coronary intervention for chronic total occlusion by treated segment length

Shoaib

Spratt

Curzen

et al. 2021

Cathet Cardio Intervent

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“…Currently several different angiographic scoring systems assessing predictors of failure and success in CTO PCI are available, but none of them has ever included the duration of CTO in their analysis [24–26]. On the other hand, CTO duration as predictor of revascularization failure has been described in computed tomography studies [13, 14].…”

Section: Discussionmentioning

confidence: 99%

Differences in patients and lesion and procedure characteristics depending on the age of the coronary chronic total occlusion

Bryniarski¹,

Werner²,

Mashayekhi³

et al. 2019

pwki

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Introduction Whether duration of chronic total occlusion (CTO) affects lesion and procedural characteristics remains largely unknown. Aim To investigate whether CTO duration influences lesion characteristics and revascularization success. Material and methods EuroCTO Registry data on patients who had CTO percutaneous coronary intervention between January 2015 and April 2017 were analyzed. Three groups were created based on occlusion age: 3 to 6 months ( n = 1415), 7 to 12 months ( n = 973), > 12 months ( n = 1656). Results Patients with greater CTO duration were older (63.0 (56.0–70.0); 63.0 (56.0–71.0); 66.0 (59.0–73.0) years respectively; p < 0.001), had more 3-vessel disease (32.2%; 30.9%; 46.1% respectively; p < 0.001) and more frequent prior coronary artery bypass grafting (8.2%; 9.9%; 29.4% respectively; p < 0.001). In multivariate analysis, occlusion duration was associated with moderate/severe calcification (OR = 1.52; 95% CI: 1.28–1.80; p < 0.001), lesion length > 20 mm (OR 1.77; 95% CI 1.49–2.10; p < 0.001), and collateral circulation Werner type 2 (OR = 1.20; 95% CI: 1.01–1.43; p = 0.041). The CTO duration was associated with lower procedural success (OR for success 0.60; 95% CI: 0.46–0.79; p < 0.001). In multivariate analysis in-hospital adverse events did not differ according to duration of CTO. Conclusions Coronary artery CTO duration is associated with greater extent of calcification, lesion length, development of collateral circulation and, most importantly, with lower procedural success.

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“…Las escalas de puntuación se consideran de gran utilidad por varios motivos: a) cuantifican la probabilidad de éxito y de complicaciones; b) permiten optimizar la selección de casos; c) ayudan a revisar y planificar la forma de abordaje de la OTC; y d) contribuyen a estandarizar la complejidad de las lesiones y poder comparar resultados 30 .…”

Section: Escalas De Puntuación En El Intervencionismo De La Otcunclassified

Actualizaci�n del intervencionismo percut�neo en la oclusi�n total cr�nica

Cuevas¹,

Elorriaga²,

Sagredo³

2021

RECIC

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Palabras clave: Enfermedad arterial coronaria. Oclusión total crónica. Intervención coronaria percutánea. Cardiopatía isquémica estable. RESUMENEl tratamiento de la oclusión total coronaria (OTC) sigue siendo uno de los grandes retos de la cardiología. La complejidad del procedimiento de angioplastia de una OTC, unida a cierta controversia en cuanto al beneficio clínico, han generado resistencias en la comunidad de cardiólogos para desarrollar programas de intervención coronaria en los laboratorios de hemodinámica. Sin embargo, la evidencia proveniente de estudios observacionales indica que el intervencionismo con éxito puede aumentar de manera significativa la calidad de vida del paciente, mejorar la función ventricular izquierda, reducir la necesidad de una posterior cirugía y, posiblemente, prolongar la supervivencia. Deben tenerse en cuenta varios factores en la selección de los pacientes para el intervencionismo, como la extensión de la isquemia que rodea a la oclusión, la viabilidad miocárdica, la ubicación coronaria de la OTC y la probabilidad de éxito del procedimiento. Esta revisión proporciona una descripción general de la anatomía y de la histopatología de las OTC, la evidencia sobre el beneficio clínico del intervencionismo, el uso de sistemas de puntuación que pueden ser útiles para evaluar de forma más objetiva la probabilidad de éxito, y un resumen de las técnicas actuales para la realización del procedimiento. AbreviaturasEAC: enfermedad arterial coronaria. ICP: intervencionismo coronario percutáneo. IVUS: ecografía intravascular. MACE: evento adverso cardiovascular mayor. MDL: microcatéter de doble luz. OTC: oclusión total coronaria. Update on percutaneous coronary intervention in the management of chronic total occlusions ABSTRACTThe management of chronic total coronary occlusions (CTO) is still today one of the greatest challenges of cardiology. The complexity of the angioplasty procedure of a CTO added to its controversial clinical benefits has generated certain skepticism in the community of cardiologists when developing CTO intervention programs at the catheterization laboratory. However, the evidence from observational studies indicates that if the intervention is successful it can significantly increase the patient's quality of life, improve the left ventricular function, reduce the need for a subsequent coronary artery bypass graft, and possibly improve survival. Several factors must be taken into consideration in the selection of patients elective for an intervention, including the extent of ischemia surrounding the occlusion, the myocardial viability, the coronary location of the CTO, and the chances of being successful with the procedure. This review provides a general description of the anatomy and histopathology of the CTOs, the evidence surrounding the clinical benefit of these procedures, the use of useful scoring systems to assess more objectively the probability of success, and a summary of the latest techniques available today to perform this procedure.

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Scoring systems for chronic total occlusion percutaneous coronary intervention: if you fail to prepare you are preparing to fail

Cited by 12 publications

References 18 publications

Clinical outcomes of percutaneous coronary intervention for chronic total occlusion by treated segment length

Clinical outcomes of percutaneous coronary intervention for chronic total occlusion by treated segment length

Differences in patients and lesion and procedure characteristics depending on the age of the coronary chronic total occlusion

Actualizaci�n del intervencionismo percut�neo en la oclusi�n total cr�nica

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