Chronic Total Occlusion Intervention: Outcomes and clinical course of patients who experienced failure in their first attempt at revascularization of the chronic total occlusion.

Dr. Mathew Iype; Dr Gopakumar K S; Prof. Sunitha Viswanathan; Prof. A. George Koshy

Volume : VI, Issue : VI, June - 2017

Chronic Total Occlusion Intervention: Outcomes and clinical course of patients who experienced failure in their first attempt at revascularization of the chronic total occlusion.

Dr. Mathew Iype, Dr Gopakumar K S, Prof. Sunitha Viswanathan, Prof. A. George Koshy

Abstract :

Background: Chronic Total Occlusion (CTO) intervention reattempts by percutaneous coronary intervention(PCI) after failed CTO interventions are now an established practice. What is the clinical course, reattempt rate and success in reattempts after a failed first CTO attempt? We documented the present real–world scenario. Materials and methods: This was a single center, prospective, observational cohort study. It was conducted from August 1st 2014 to June 30th 2015 and followed up for a period of 6 months. Results: Out of the 67 failed PCI CTO (total 210 PCI CTO patients) 14 (20.9%) patients had a second attempt PCI and 16 patients underwent CABG (25%) and the rest of the patients were on medical management. The success rate during CTO reattempt was 21.4% . In 57% (8 /14 patients), PCI attempt failed due to inability to cross the lesion with a wire. In 14.2 % (2/ 14 patients), a wire was passed across the lesion in the false lumen. Immediate complications of reattempt PCI were one case each of renal failure requiring medical management and heart failure requiring mechanical ventilation and two cases of sustained ventricular tachycardia. Conclusions: Nearly a quarter of the patients with failed PCI in the first attempt had a repeat PCI attempt, another quarter of the patients underwent CABG. Nearly fifty percent of the patients with failed PCI were put on medical management .Success rate of repeat PCI using antegrade techniques for CTO intervention was low at 21% with low immediate complications. Retrograde and hyid CTO techniques have to be utilized for better results.