Author + information
- Omar Jawaid1,
- Damianos Kokkinidis2,
- Aaron Strobel2,
- T. Raymond Foley3,
- Bejan Alvandi4,
- Robert Sturm5,
- Ho-Hin Choy4,
- Gagan Singh6,
- Stephen Waldo7 and
- Ehrin Armstrong8
- 1University of Colorado Denver, Aurora, Colorado, United States
- 2VA Eastern Colorado Health Care System and University of Colorado, Denver, Colorado, United States
- 3University of Colorado Hospital, Denver, Colorado, United States
- 4University of California Davis, Davis, California, United States
- 5University of Colorado, Denver, Ohio, United States
- 6UC Davis Medical Center, Davis, California, United States
- 7University of Colorado, Aurora, Colorado, United States
- 8University of Colorado, Denver, Colorado, United States
Infrapopliteal chronic total occlusions (CTOs) are associated with a approximately 20% failure rate. A predictive score for successful antegrade crossing could help guide endovascular interventions.
We analyzed the angiographic characteristics of 213 infrapopliteal CTOs undergoing endovascular interventions and divided them in a derivation and a validation cohort and created a multivariate model predictive of successful crossing. We subsequently created a multi-variate model predictive of a successful crossing that was used to generate a point score for clinical use.
Lesion length ≥ 100 (univariate OR: 0.23; 95% CI: 0.12 - 0.45; P<0.05) and ≥200 mm (OR: 0.17; 95% CI: 0.06 - 0.51; P<0.05), severe calcification at the CTO entry portion (OR: 0.3; 95% CI: 0.1-0.8; P<0.05), diameter ≥2.5 (OR: 2.8; 95% CI: 1.04-7.5; P<0.05) and a central stump (OR:1.19, 95% CI: 0.44 - 3.3; P=0.74) were included in the multivariate model. One point was assigned to severe calcification at the entry portion, blunt stump, diameter ≤ 2.5mm and length ≥ 100mm; 2 points were assigned for length ≥200 mm. Lesions were categorized into 3 groups based on their total score: i) easy (score 0-1); ii) intermediate (score 2-3); iii) difficult (score 4-5). The rates of successful crossing in the derivation and validation cohort respectively were: 84.6% and 88.2% for the easy crossing group; 65.3% and 60.5% for the intermediate group; 27.3% and 25% for the difficult crossing group.
The infrapopliteal CTO crossing score suggests that specific angiographic characteristics can be used to predict the success of antegrade wire crossing. This score may be useful for defining an optimal antegrade vs. primary retrograde crossing approach.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention