Abstract 1783: Which Factors Should Influence Patient Selection For Percutaneous Revascularisation Of Chronic Total Occlusions In The Modern Era? An Analysis Of 477 Consecutive Chronic Total Occlusion Revascularisation Attempts.
Objective: Factors predicting failure in percutaneous revascularisation of chronic total occlusions (CTO) are likely to have evolved with the advent of new Japanese CTO specific guide wires, adjunctive technology and novel techniques. We sought to determine which clinical or angiographic factors predict failure of percutaneous revascularisation of CTO in the modern era.
Methods: Clinical and angiogaphic data relating to 477 consecutive revascularisation attempts of CTO were prospectively collected and analysed in our 2 centres between January 2004 and April 2007. Chronic total occlusions were defined as vessel occlusion greater than or equal to 3 months duration with TIMI 0 or 1 flow. Success was defined as a patent vessel with <50% residual stenosis and TIMI 3 flow. 21 separate patient or angiographic characteristics were investigated for their relationship to procedural failure. Use of specific CTO technology and novel techniques were guided by angiographic characteristics and technical need.
Results: Patient and angiographic data are described in the table⇓ as well as the techniques employed and specialised equipment used. The procedure was successful in 67.4% of lesions attempted. Univariate predictors of failure of revascularisation were lesion length (p<0.001) and moderate to severe calcification (p<0.001) and a history of hypertension (p=0.043). Using logistic regression the only independent predictors of failure of percutaneous revascularisation were moderate to severe calcification (p<0.001, odds ratio 2.4, CI: 1.6–3.7) and occlusion length (p<0.001). Previously identified adverse anatomical features such as bridging collaterals, tortuous anatomy and blunted stump or the presence of multivessel disease did not predict failure of revascularisation.
Conclusion: With novel techniques and CTO specific equipment, occlusion length and moderate-severe lesion calcification are the only factors that predict failure of revascularisation.