Percutaneous coronary intervention of chronic total occlusion: A 5-year monocentric experience

Abstract

Background: Chronic total occlusions (CTO) occurin 15-30% of coronaryangiogram, yetthischallenginglesionsubsetrepresentslessthan 10% of percutaneouscoronary interventions (PCI). Tunisian data are lacking. This study analyses a real-life Tunisian CTO-PCI immediate and long-termresults. Methods: Single-center, observational retro-prospective study, between 2018 and 2023. Primaryendpointwas to assesstechnicalsuccess, major procedural complications, and targetlesionfailure (TLF) at 12-months. Secondaryendpointwas to identifyfactorsassociated to technicalfailure. Results: 115 patients, 122 CTOslesions, 133 CTO-PCIs. Mean age 62±14.4 years. Gender-Ratio=6. Mean J-CTO score was 1.47±1.12. Dual injection (43.6%) and microcatheters (50.4%) wereunderused. Number of guidewires per procedurewas 2.35±1.12. Anterograde, retrograde and hybridapproacheswerenotedin 85%, 9% and 6%, respectively. Technicalsuccesswas 69.2% (of 133 procedures) and proceduralsuccesswas 73.0% (of 115 patients). Major complication rate stood at 3%. At 12 months, cardiovascularmortalitywas 7.0%, withoutdifferenceaccording to proceduralsuccess. TLF was 9.4% amongsuccessful CTO-PCIs. Associated factors to technicalfailurewere bifurcation involvement (OR=5.83 [1.7–20.1]; p=0.005), use of more than 4 guidewires per-procedure (OR=6.83 [1.6–28.7]; p=0.009), de-novo CTO (HR=8.43 [1.9–36.6]; p=0.004), previousattempts (OR=8.87 [1.8–43.6]; p=0.007), and no microcatheter use (OR=11.4 [3.5–36.8]; p=0.001). Conclusion: This real-life studyfills a gap in Tunisian data on CTO-PCI outcomeswithtechnicalsuccess, complications and TLF rates comparable to thosereported in literature. 12-month survival rates weresimilarbetweensuccessful and failedprocedure groups.