Impacts of Lesion Characteristics on Procedures and Outcomes of Chronic Total Occlusion Recanalization With Antegrade Guidewire True Lumen Tracking Techniques: A Substudy of Taiwan True Lumen Tracking Registry

Chi-Jen Chang; Shih-Chi Liu; Cheng-Ting Tsai; Jen-Fang Cheng; Chien-Lin Lee; Chia-Pin Lin; Chi-Hung Huang; Jun-Ting Liou; Yi-Chih Wang; Juey-Jen Hwang

doi:10.3389/fcvm.2022.769073

Impacts of Lesion Characteristics on Procedures and Outcomes of Chronic Total Occlusion Recanalization With Antegrade Guidewire True Lumen Tracking Techniques: A Substudy of Taiwan True Lumen Tracking Registry

Front Cardiovasc Med. 2022 Mar 1:9:769073. doi: 10.3389/fcvm.2022.769073. eCollection 2022.

Authors

Affiliations

¹ Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
² Cardiovascular Division, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.
³ Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
⁴ Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Cardiovascular Division, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
⁶ Cardiovascular Division, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan.
⁷ Cardiovascular Division, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan.

Abstract

Background: Lesion characteristics were shown to predict procedural success and outcomes in chronic total occlusion (CTO) recanalization. However, diverse techniques involved in these studies might cause potential heterogeneity.

Objective: The study aimed to test the impacts of lesion characteristics on CTO intervention with a pure antegrade wiring-based technique.

Methods and results: We studied consecutive 325 patients (64.5 ± 11.1 years, 285 men) with native CTO lesions intervened by a single operator with an antegrade-based technique between August 2014 and July 2020. Forty-seven patients with antegrade procedural failure (20 with pure antegrade wiring failure and 27 with back-up retrograde techniques) were compared to 278 patients with antegrade-only procedural success. With a median follow-up of 30.8 (16.1-48.6) months, 278 patients with procedural success were further assessed for target vessel failure (TVF: cardiac death, target vessel myocardial infarction [MI], and target lesion revascularization [TLR]). Patients with antegrade procedural success had a lower percentage of history with bypass graft (4 vs. 15%, p = 0.004) and lower Multicenter Chronic Total Occlusion Registry of Japan (J-CTO) score (2.1±1.3 vs. 3.4 ± 1.0, p < 0.001), when compared to those with antegrade failure. The J-CTO score was independently associated with procedural failure (odds ratio = 2.5, 95% CI = 1.8-3.4) in multivariate analysis. However, only clinical features, such as female gender (hazard ratio [HR] = 4.3, 95% CI = 1.4-13.1), estimated glomerular filtration rate <60 ml/min/1.73 m² (HR = 3.2, 95% CI = 1.0-9.9), and old MI (HR = 4.5, 95% CI = 1.5-12.8), but not J-CTO score, could predict long-term TVF in multivariate Cox regression model.

Conclusion: The feasibility of the antegrade guidewire-crossing technique for native CTO intervention was highly determined by lesion characteristics. With such a simpler technique, the prognostic impact of lesion complexity shown in studies with multiple recanalization techniques was negligible. This suggested antegrade true lumen tracking techniques deserved to be tried better even for CTO lesions with higher complexity.

Keywords: J-CTO score; antegrade approach; chronic total occlusion; long-term outcome; true lumen tracking.