Tratamiento percutáneo de oclusiones coronarias crónicas aorto-ostiales: resultados y consideraciones técnicas de un registro multicéntrico

Translated title of the contribution: Percutaneous coronary intervention in aorto-ostial coronary chronic total occlusion: outcomes and technical considerations in a multicenter registry

Soledad Ojeda, Aurora Luque, Manuel Pan, Barbara Bellini, Iosif Xenogiannis, Adrián Lostalo, Matteo Montorfano, Francisco Hidalgo, Giuseppe Venuti, Alessio La Manna, Mauro Carlino, Emmanouil S. Brilakis, Lorenzo Azzalini

Research output: Contribution to journalArticle

Abstract

Introduction and objectives: Percutaneous coronary intervention (PCI) for aorto-ostial chronic total coronary occlusion (CTO) can be a particularly challenging lesion subset. The aim of this study was to analyze the technical aspects and outcomes of aorto-ostial CTO PCI in a multicenter registry. Methods: Patients undergoing aorto-ostial CTO PCI at 4 centers between February 2013 and December 2018 were included. Success rates, as well as procedural aspects and outcomes, were analyzed. Results: A total of 103 patients were included. Mean age was 64 ± 10 years and the mean J-CTO score was 3.1 ± 1.1. Thirty-one lesions (30.4%) were flush ostial CTOs. Technical and procedural success were achieved in 79 (76.7%) and 78 (75.7%) of the patients, respectively. The retrograde approach was the most frequent successful crossing technique (n = 49; 62.0%), especially in flush vs nonflush aorto-ostial CTOs (82.6% vs 53.5%; P = .02). The only variable independently associated with technical failure was the absence of interventional collaterals (OR, 12.38; 95%CI, 4.02-38.15; P < .001). Coronary perforation occurred in 4 patients (3.9%) requiring covered stent implantation (without subsequent cardiac tamponade) and 2 patients (1.9%) had a stroke (one of which was a transient ischemic attack). During a median follow-up of 31 months, 3 (2.9%) patients died from cardiovascular causes and 13 (12.6%) required repeat target vessel revascularization. Conclusions: Aorto-ostial occlusions represent a challenging subset for PCI. However, an acceptable success rate with favorable outcomes during follow-up can be achieved by experienced operators. The presence of interventional collaterals allowing the use of the retrograde approach is key for achieving procedural success.

Translated title of the contributionPercutaneous coronary intervention in aorto-ostial coronary chronic total occlusion: outcomes and technical considerations in a multicenter registry
Original languageSpanish
JournalRevista Espanola de Cardiologia
DOIs
StateAccepted/In press - Jan 1 2020
Externally publishedYes

Keywords

  • Chronic total coronary occlusion
  • Percutaneous coronary intervention
  • Retrograde approach

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Ojeda, S., Luque, A., Pan, M., Bellini, B., Xenogiannis, I., Lostalo, A., Montorfano, M., Hidalgo, F., Venuti, G., La Manna, A., Carlino, M., Brilakis, E. S., & Azzalini, L. (Accepted/In press). Tratamiento percutáneo de oclusiones coronarias crónicas aorto-ostiales: resultados y consideraciones técnicas de un registro multicéntrico. Revista Espanola de Cardiologia. https://doi.org/10.1016/j.recesp.2020.01.018