Abstract 2521: Safety of Modern Chronic Total Occlusion Percutaneous Coronary Interventional Approach in Europe. A Real World Registry
Background: Considerable progress has been made in percutaneous revascularisation of chronic total occlusions (CTO) in recent years with an improvement in procedural success rates but this maybe at the cost of a higher rate of acute complications. We sought to define rates of acute and in hospital complications in a real world registry.
Methods: Data on 501 consecutive CTO revascularisation attempts in 453 patients were prospectively collected from January 2004 to June 2007. Creatinine Kinase (CK) was measured routinely 24 hours post procedure.
Results: Patients were 63±12 years old, 84% male, 28% diabetic, 28% 3 vessel disease, 21% prior MI, 6% prior CABG and 32% prior PCI. All patients had ischaemia and 18% were unstable. Occlusion duration was 17.6±12.2 months and occlusion length 19±15 mm. Lesion calcification was moderate to severe in 33% of cases, moderate to severe tortuosity in 17%. Transradial approach was used in 72% of cases. Screening time was 40±28 min. and contrast use 306±191 ml. Controlateral injection was used in 23% of cases, parallel wire technique 21%, micro catheter or coaxial balloon 29%, anchoring balloon technique 6%, retrograde approach 5% and CTO wire ≥ 3gr. in 73%. Angiographic success was obtained in 68% of cases. During the in-hospital phase, tamponade necessitating pericardiocentesis occurred in 0.4% of cases, access site complication requiring vascular surgery or transfusion 0.2%, non-Q-wave (>3x ULN CK) in 0.9% and Q wave MI 0.2%. There were 2 urgent re-interventions due to acute stent thrombosis in one case (non CTO artery) and 1 due to guide catheter induced aortic dissection. There was no incidence of acute renal failure requiring dialysis. In-hospital death occurred in 1.5% of cases (5 unstable patients with triple vessel disease, 1 haemorrhagic stroke and 1 pulmonary embolism.
Conclusion: CTO revascularisation in the modern era is associated with a relatively high rate of success with a low rate of complications.