Modification Procedures for Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry
Recommended Citation
Kladou E, Strepkos D, Alexandrou M, Mutlu D, Carvalho PEP, Sara JDS, Ser OS, Alaswad K, Basir MB, Khelimskii D, Jaffer FA, Rafeh NA, Chandwaney R, Cevik C, Ahmad Y, Mastrodemos O, Rangan BV, Jalli S, Voudris K, Sandoval Y, Nicholas Burke M, and Brilakis ES. Modification Procedures for Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry. Catheter Cardiovasc Interv 2025;106(7):3628-3639.
Document Type
Article
Publication Date
12-1-2025
Publication Title
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Keywords
Humans, Coronary Occlusion, Registries, Male, Female, Chronic Disease, Aged, Middle Aged, Treatment Outcome, Time Factors, Risk Factors, Coronary Angiography, Angioplasty, Balloon, Coronary, Percutaneous Coronary Intervention, Risk Assessment, Retrospective Studies
Abstract
BACKGROUND: CTO-ARC (Chronic Total Occlusion Academic Research Consortium) defines CTO modification procedures (previously called investment procedures) as intentional balloon dilatation (diameter ≥ 2.0 mm) of the entire CTO, including the proximal and distal caps and the CTO body.
AIMS: The aim of this study is to compare the outcomes of repeat CTO PCI between patients who underwent lesion modification during the initial failed procedure and those who did not.
METHODS: We analyzed the association of CTO modification with the baseline clinical and angiographic characteristics and outcomes of 2829 patients, with a total of 2869 CTOs who underwent CTO percutaneous coronary intervention (PCI) after a previously failed attempt.
RESULTS: CTO modification was performed in 600 of 2869 CTOs (20.9%) that underwent a repeat PCI attempt. CTOs that underwent modification had a higher prevalence of blunt/no stump (63.9% vs. 54.5%, p < 0.001), moderate/severe calcification (59.4% vs. 48.5%, p < 0.001), and moderate/severe proximal tortuosity (43.6% vs. 30.4%, p < 0.001). They also had longer length (38 vs. 31 mm, p < 0.001) and higher J-CTO (3.69 vs. 3.21, p < 0.001) score. There was no statistically significant difference in technical (84.1% vs. 85.4%, p = 0.478) or procedural (82.7% vs. 84.2%, p = 0.403) success or major adverse cardiac events (MACE, 1.7% vs. 1.8%, p = 1.0) between the modification and no modification groups. Similarly, among patients who underwent CTO modification, there were no significant differences in outcomes between early ( < 60 days) and late ( ≥ 60 days) reattempts after the initial failure. Technical success was significantly higher after subintimal tracking and re-entry (STAR) than subintimal plaque modification (SPM) (82.5% vs. 60.0%, p = 0.028).
CONCLUSIONS: CTO modification procedures were performed in approximately one of five CTO PCIs during the initial failed procedure. During reattempt CTO PCI, despite higher lesion complexity, CTO modification was associated with similar technical and procedural success and MACE compared to patients undergoing reattempt CTO PCI without prior CTO modification. Among modification techniques, STAR was associated with higher technical and procedural success than SPM.
Medical Subject Headings
Humans; Coronary Occlusion; Registries; Male; Female; Chronic Disease; Aged; Middle Aged; Treatment Outcome; Time Factors; Risk Factors; Coronary Angiography; Angioplasty, Balloon, Coronary; Percutaneous Coronary Intervention; Risk Assessment; Retrospective Studies
PubMed ID
41077705
ePublication
ePub ahead of print
Volume
106
Issue
7
First Page
3628
Last Page
3639
