Abstract 19665: Angiographic Predictors of Successful Guide-wire Crossing Through Infrapopliteal Chronic Total Occlusions (CTOs)
Background: No current scoring system exists to predict successful guide-wire crossing of infrapopliteal CTOs.
Methods: All patients undergoing peripheral endovascular procedures from 2006 to 2014 at University of California, Davis and Denver Veterans Affairs Medical Centers were reviewed. Interventions performed on anterior tibial, peroneal, or posterior tibial artery CTOs were identified. Angiographic analysis was performed to identify stump morphology, presence of bridging collaterals and side branches near the stump, calcification at entry and within the occluded segment, and the length and the diameter of the lesion. Angiographic predictors of successful wire crossing were then identified.
Results: 215 cases of infrapopliteal CTOs were performed at the two centers during the study period. Antegrade wire crossing was successful in 151 cases (70%). Failure of antegrade wire crossing was associated with a beaded stump morphology (15% of failure cases vs. 4% of successful cases, p<0.01); presence of severe calcification at the entry point (56% of failure cases vs. 34% of successful cases, p = 0.02); presence of severe calcification in the occluded route (52% of failure cases vs. 33% of successful cases, p = 0.04); an occluded segment longer than 200 mm (51% of failure cases vs. 17% of successful cases, p<0.01); and reference vessel diameter smaller than 2.5 mm (63% of failure cases vs. 37% of successful cases, p<0.01). The presence of bridging collaterals and side branches were not significantly associated with success or failure of antegrade wire crossing (Table).
Conclusions: A beaded stump morphology at the proximal cap, presence of severe calcification at the entry site and in the occluded route, longer occluded segment length, and narrower reference vessel diameter are associated with greater failure of antegrade wire crossing for infrapopliteal CTOs. A scoring system will be developed to identify multivariable predictors of antegrade wire crossing.
Author Disclosures: T. Thiruvoipati: None. A. Strobel: None. S.D. Gagan: None. J.R. Laird: None. E.J. Armstrong: None.
- © 2015 by American Heart Association, Inc.