Author + information
- Received December 23, 2016
- Revision received June 11, 2017
- Accepted June 15, 2017
- Published online November 6, 2017.
- Yoriyasu Suzuki, MDa,
- Etsuo Tsuchikane, MD, PhDb,∗ (, )
- Osamu Katoh, MDc,
- Toshiya Muramatsu, MDd,
- Makoto Muto, MDe,
- Koichi Kishi, MDf,
- Yuji Hamazaki, MDg,
- Yuji Oikawa, MDh,
- Tomohiro Kawasaki, MDi and
- Atsunori Okamura, MDj
- aDivision of Cardiovascular Medicine, Nagoya Heart Center, Aichi, Japan
- bDepartment of Cardiology, Toyohashi Heart Center, Aichi, Japan
- cJapanese CTO-PCI Expert Foundation, Okayama, Japan
- dDepartment of Cardiology, Tokyo General Hospital, Tokyo, Japan
- eDivision of Cardiology, Saitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan
- fDepartment of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
- gDivision of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
- hDepartment of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
- iDepartment of Cardiology, Shin-Koga Hospital, Fukuoka, Japan
- jDivision of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan
- ↵∗Address for correspondence:
Dr. Etsuo Tsuchikane, Department of Cardiology, Toyohashi Heart Center, 21-1 Gobutori Oyama-cho Toyohashi, Aichi, Japan 441-8530.
Objectives This report describes the registry and presents an initial analysis of outcomes for the different PCI approaches taken by the specialists.
Background Strategies for percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) are complex. The Japanese Board of CTO Interventional Specialists has developed a prospective, nonrandomized registry of patients undergoing CTO-PCIs performed by 41 highly experienced Japanese specialists.
Methods Over the study period of January 2014 to December 2015, the registry included 2,846 consecutive CTO-PCI cases undertaken in Japan. The authors compared clinical outcomes between the different PCI approaches, following the intention-to-treat principle.
Results The overall technical success rate of the procedures was 89.9%. The specialists frequently chose a retrograde approach as the primary CTO-PCI strategy (in 27.8% of cases). The technical success rate of the primary antegrade approach was significantly better than that of the primary retrograde approach (91.0% vs. 87.3%; p < 0.0001). The technical success rate decreased to 78.0% with the rescue retrograde approach. Parallel guidewire crossing and intravascular ultrasound–guided wire crossing were performed after guidewire escalation during antegrade CTO-PCI with a high technical success rate (75.0% to 88.9%). Severe lesion calcification was a strong predictor of failed CTO-PCI.
Conclusions CTO-PCI performed by highly experienced specialists achieved a high technical success rate.
Dr. Tsuchikane is a consultant for Asahi Intecc, Boston Scientific, and NIPRO Corporation. Dr. Katoh is a consultant for Asahi Intecc and NIPRO Corp.; and is board chairman of and stock holder in RetroVascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 23, 2016.
- Revision received June 11, 2017.
- Accepted June 15, 2017.
- 2017 American College of Cardiology Foundation