Division of Cardiology, University Hospital "P. Giaccone", Palermo, Italy.
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
EuroIntervention. 2024 Feb 5;20(3):e185-e197. doi: 10.4244/EIJ-D-23-00490.
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.
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.
We evaluated data from 8,673 CTO PCIs included in the European Registry of Chronic Total Occlusion (ERCTO) between January 2021 and October 2022.
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).
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.
由于专用设备、不断发展的技术以及全球采用最先进的交叉算法，经皮冠状动脉介入治疗（PCI）治疗慢性完全闭塞（CTO）已达到高程序成功率。
我们报告了由经验丰富的介入专家组成的大型欧洲社区进行的 CTO PCI 的最新结果。此外，我们还研究了不同的风险因素对程序主要不良心脏和脑血管事件（MACCE）的影响，以及双腔微导管、导引导管延长、血管内超声和钙修饰工具等特定设备的使用趋势。
我们评估了 2021 年 1 月至 2022 年 10 月期间欧洲慢性完全闭塞登记处（ERCTO）纳入的 8673 例 CTO PCI 的数据。
总的技术成功率为 89.1%，正向介入明显高于逆向介入（92.8%比 79.3%；p<0.001）。与正向程序相比，逆向程序的尝试病变的复杂性更高（日本 CTO [J-CTO]评分：3.0±1.0 比 1.9±1.2；p<0.001），程序和住院 MACCE 发生率更高（3.1%比 1.2%；p<0.018），穿孔率更高，伴有或不伴有填塞（1.5%比 0.4%和 8.3%比 2.1%，分别；p<0.001）。与中容量操作者相比，高容量操作者在正向和逆向程序中具有更高的技术成功率（93.4%比 91.2%和 81.5%比 69.0%，分别；p<0.001），MACCE 发生率更低（1.47%比 2.41%；p<0.001），尽管尝试病变的平均复杂性更高（J-CTO 评分：2.42±1.28 比 2.15±1.27；p<0.001）。
尽管 ERCTO 中记录的病变复杂性很高，但采用不同的再通技术、术者经验和使用特定设备有助于提高程序成功率。
