STUDY OF SUCCESS RATE AND COMPLICATIONS OF PERCUTANEOUS CORONARY INTERVENTION IN CTO INTERVENTION

Authors

  • AS KHAN Department Of Cardiology, Hayatabad Medical Complex Peshawar, Pakistan
  • F ULLAH Department Of Cardiology, Hayatabad Medical Complex Peshawar, Pakistan
  • TI KHAN Department Of Cardiology, Hayatabad Medical Complex Peshawar, Pakistan
  • MQU MURSALIN Naseer Teaching Hospital, Pakistan
  • S AKBER Department Of Cardiology, MTI Lady reading hospital Peshawar, Pakistan
  • Y HAYAT Department Of Cardiology, Hayatabad Medical Complex Peshawar, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1201

Keywords:

Percutaneous Coronary Intervention (PCI), Chronic Total Occlusion (CTO), Success Rate, Complications, Stent Thrombosis

Abstract

Chronic total occlusion (CTO) is one of the most complex and challenging forms of coronary artery disease, characterized by the complete obstruction of a coronary artery for more than three months. Objective: The primary aim of this study is to assess the success rate of PCI in patients with CTO and to evaluate the frequency and types of complications associated with the procedure. Methods: Patients included in the study were diagnosed with CTO using coronary angiography. The PCI procedures were carried out using standard techniques, and the primary endpoints were technical success and clinical success. Technical success was achieved by less than 30% residual stenosis with a TIMI grade 3 flow in the target vessel. In contrast, clinical success was defined as procedural success without the occurrence of major adverse cardiovascular events (MACE) such as death, myocardial infarction, or stroke within 30 days post-procedure and target vessel revascularization. Results: Among the 200 patients who underwent PCI for CTO, technical success was achieved in 165 patients, reflecting an overall success rate of 82.5%. Clinical success, defined as the absence of MACE, was achieved in 150 patients (75%). The major complications observed included coronary perforation in 10 patients (5%) and contrast-induced nephropathy in 8 patients (4%). Stent thrombosis occurred in 5 patients (2.5%), while 4 patients (2%) succumbed to procedural complications, leading to mortality within 30 days. Other minor complications such as arrhythmias and vascular access-related complications were seen in 20 patients (10%). Despite these complications, the success rates are consistent with current literature on CTO interventions, highlighting the effectiveness of PCI in these challenging cases. Conclusion: The study concluded that PCI for CTO can be performed with a high technical and clinical success rate with an acceptable complication profile. While major complications such as coronary perforation and contrast-induced nephropathy remain a concern, the overall outcomes suggest that PCI is an effective treatment option for CTO patients.

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References

Hong S-J, Kim B-K, Cho I, Kim H-Y, Rha S-W, Lee S-H, et al. Effect of coronary CTA on chronic total occlusion percutaneous coronary intervention: a randomized trial. Cardiovascular Imaging. 2021;14(10):1993-2004.

Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, Krestyaninov O, Khelimskii D, et al. Predicting periprocedural complications in chronic total occlusion percutaneous coronary intervention: the PROGRESS-CTO complication scores. Cardiovascular Interventions. 2022;15(14):1413-22.

Mehta AB, Mehta N, Chhabria R, Mandurke V, Tawade N, Jain N, et al. Predictors of success in percutaneous Coronary intervention for chronic total occlusion. Indian Heart Journal. 2018;70:S269-S74.

Megaly M, Khalil M, Basir MB, McEntegart MB, Spratt JC, Yamane M, et al. Outcomes of successful vs. failed contemporary chronic total occlusion percutaneous coronary intervention. Cardiovascular Intervention and Therapeutics. 2021:1-7.

Gong X, Zhou L, Ding X, Chen H, Li H. The impact of successful chronic total occlusion percutaneous coronary intervention on long-term clinical outcomes in real world. BMC Cardiovascular Disorders. 2021;21:1-9.

Choo EH, Koh Y-S, Seo SM, Lee JM, Kim HY, Park H-J, et al. Comparison of successful percutaneous coronary intervention versus optimal medical therapy in patients with coronary chronic total occlusion. Journal of Cardiology. 2019;73(2):156-62.

van Veelen A, Claessen B, Houterman S, Hoebers L, Elias J, Henriques J, et al. Incidence and outcomes of chronic total occlusion percutaneous coronary intervention in the Netherlands: data from a nationwide registry. Netherlands Heart Journal. 2021;29:4-13.

de Oliveira PP, Abelin AP, Machado GP, Evandro Filho M, Araujo GN, Côrtes LA, et al. Evaluation of Success and Complications Scores for Chronic Total Occlusion Percutaneous Coronary Interventions: Insights from the Latin American Registry. The American Journal of Cardiology. 2024;227:1-10.

Nathan A, Hashemzadeh M, Movahed MR. Percutaneous coronary intervention of chronic total occlusion associated with higher inpatient mortality and complications compared with non-CTO lesions. The American journal of medicine. 2023;136(10):994-9.

Stojkovic S, Juricic S, Dobric M, Nedeljkovic MA, Vukcevic V, Orlic D, et al. Improved propensity-score matched long-term clinical outcomes in patients with successful percutaneous coronary interventions of coronary chronic total occlusion. International Heart Journal. 2018;59(4):719-26.

Assali M, Buda KG, Megaly M, Hall AB, Burke MN, Brilakis ES. Update on chronic total occlusion percutaneous coronary intervention. Progress in cardiovascular diseases. 2021;69:27-34.

Forouzandeh F, Suh J, Stahl E, Ko Y-A, Lee S, Joshi U, et al. Performance of J-CTO and PROGRESS CTO scores in predicting angiographic success and long-term outcomes of percutaneous coronary interventions for chronic total occlusions. The American journal of cardiology. 2018;121(1):14-20.

Kandan SR, Johnson TW. Management of percutaneous coronary intervention complications. Heart. 2019;105(1):75-86.

Sutton NR, Bates ER. Balancing the benefits, risks, and costs of chronic total occlusion percutaneous coronary intervention. Am Heart Assoc; 2019. p. e007809.

Suleman M, Arif N, Khan MI, Jibran MS, Jamil M, Khan SU, et al. The outcomes and complications of percutaneous interventions in chronic total coronary occlusion. The Egyptian Heart Journal. 2024;76(1):62.

Wang N, Fulcher J, Abeysuriya N, Adams M, Lal S. Predictors of successful chronic total occlusion percutaneous coronary interventions: a systematic review and meta-analysis. Heart. 2018;104(6):517-24.

Azzalini L, Carlino M, Bellini B, Marini C, Pazzanese V, Toscano E, et al. Long-term outcomes of chronic total occlusion recanalization versus percutaneous coronary intervention for complex non-occlusive coronary artery disease. The American journal of cardiology. 2020;125(2):182-8.

Schumacher SP, Stuijfzand WJ, Opolski MP, van Rossum AC, Nap A, Knaapen P. Percutaneous coronary intervention of chronic total occlusions: when and how to treat. Cardiovascular Revascularization Medicine. 2019;20(6):513-22.

Holck EN, Winther NS, Mogensen LJH, Christiansen EH. Chronic Total Occlusion is Not a Risk Factor for Mortality in Patients With Successful Percutaneous Coronary Intervention: A Cohort Study. Journal of the American Heart Association. 2023;12(20):e030989.

Khan AA, Khalid MF, Ayub MT, Murtaza G, Sardar R, White CJ, et al. Outcomes of percutaneous coronary intervention versus optimal medical treatment for chronic total occlusion: a comprehensive meta-analysis. Current Problems in Cardiology. 2021;46(3):100695.

Moroni F, Brilakis ES, Azzalini L. Chronic total occlusion percutaneous coronary intervention: managing perforation complications. Expert Review of Cardiovascular Therapy. 2021;19(1):71-87.

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Published

2024-10-18

How to Cite

KHAN, A., ULLAH, F., KHAN, T., MURSALIN, M., AKBER, S., & HAYAT, Y. (2024). STUDY OF SUCCESS RATE AND COMPLICATIONS OF PERCUTANEOUS CORONARY INTERVENTION IN CTO INTERVENTION. Biological and Clinical Sciences Research Journal, 2024(1), 1201. https://doi.org/10.54112/bcsrj.v2024i1.1201

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