Author + information
- Received April 29, 2019
- Revision received August 20, 2019
- Accepted August 21, 2019
- Published online November 4, 2019.
- Hiroyuki Tanaka, MDa,∗ (, )
- Etsuo Tsuchikane, MD, PhDb,
- Toshiya Muramatsu, MDc,
- Koichi Kishi, MDd,
- Makoto Muto, MDe,
- Yuji Oikawa, MDf,
- Tomohiro Kawasaki, MDg,
- Yuji Hamazaki, MDh,
- Tsutomu Fujita, MDi and
- Osamu Katoh, MDj
- aKurashiki Central Hospital, Okayama, Japan
- bToyohashi Heart Center, Aichi, Japan
- cTokyo General Hospital, Tokyo, Japan
- dTokushima Red Cross Hospital, Tokushima, Japan
- eSaitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan
- fCardiovascular Institute, Tokyo, Japan
- gShin-Koga Hospital, Fukuoka, Japan
- hOotakanomori Hospital, Kashiwa, Japan
- iSapporo Cardio Vascular Clinic, Sapporo, Japan
- jJapanese CTO-PCI Expert Foundation, Okayama, Japan
- ↵∗Address for correspondence:
Dr. Hiroyuki Tanaka, Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
Background Guidewire manipulation time is rarely used in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) strategies.
Objectives This study sought to develop an algorithm based on angiographic characteristics and guidewire manipulation time.
Methods This study assessed 5,843 patients undergoing CTO PCI between January 2014 and December 2017 and enrolled in the Japanese CTO-PCI expert registry and analyzed their CTO-PCI strategies, procedural outcomes, and guidewire manipulation time.
Results Primary retrograde approach was performed on 1,562 patients. The average Japanese CTO score of primary antegrade approach and primary retrograde approach were 1.7 ± 1.1 and 2.3 ± 1.1, respectively (p < 0.001). The overall guidewire and technical success rates were 92.8% and 90.6%, respectively. Median guidewire manipulation time of guidewire success and failure were 56 min (interquartile range [IQR]: 22 to 111 min) and 176 min (IQR: 130 to 229 min), respectively. Median successful guidewire crossing time of single wiring and parallel wiring in the antegrade alone were 23 min (IQR: 11 to 44 min) and 60 min (IQR: 36 to 97 min), and rescue retrograde approach and primary retrograde approach were 126 min (IQR: 87 to 174 min) and 107 min (IQR: 70 to 161 min), respectively (p < 0.001). Significant predictors for antegrade guidewire failure in primary antegrade approach, which were reattempt, CTO length of ≥20 mm, and no stump, did not predict guidewire failure after collateral channel crossing in primary retrograde approach.
Conclusions Results from a large registry with information on guidewire manipulation time as well as CTO characteristics suggest a redefinition of the current strategy algorithms.
This study was funded by the Japanese board of Chronic Total Occlusion Interventional Specialist that is funded by Asahi Intecc, Abbott Vascular Japan, Biosensors Japan, Boston Scientific, Daiichi-Sankyo, Kaneka Medix, Medtronic Japan, NIPRO, and Terumo. Dr. Tsuchikane has served as a consultant for Asahi Intecc, Boston Scientific, Kaneka, and NIPRO Corporation. Dr. Fujita has served as a consultant for Terumo Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 29, 2019.
- Revision received August 20, 2019.
- Accepted August 21, 2019.
- 2019 American College of Cardiology Foundation
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