Coronary artery spatial distribution of chronic total occlusions: Insights from a large US registry

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Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions


OBJECTIVE: To assess the spatial distribution of chronic total occlusions (CTOs) within the coronary arteries and describe procedural strategies and outcomes during CTO percutaneous coronary intervention (PCI).

BACKGROUND: Acute occlusions due to plaque rupture tend to cluster within the proximal third of the coronary artery.

METHODS: We examined the clinical and procedural characteristics of 1,348 patients according to lesion location within the coronary tree.

RESULTS: A total of 1,369 lesions in 1,348 patients (mean age 66 ± 10 years, 85% male) were included. CTO PCI of proximal segments (n = 633, 46%) was more common than of mid (n = 557, 41%) and distal segments (n = 179, 13%). Patients undergoing CTO PCI of proximal segments were more likely to be smokers (P < 0.01), have prior coronary artery bypass graft surgery (P = 0.03) and lower ejection fraction (P = 0.04). CTOs occurring in proximal segments had longer length (P

CONCLUSIONS: The most common target vessel location for CTO PCI is the proximal coronary segment. PCI of proximal occlusions is associated with adverse clinical and angiographic characteristics and often requires use of the retrograde approach, but can be accomplished with high procedural and technical success and low complication rates. © 2016 Wiley Periodicals, Inc.

Medical Subject Headings

Aged; Chronic Disease; Collateral Circulation; Coronary Angiography; Coronary Circulation; Coronary Occlusion; Coronary Vessels; Female; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Plaque, Atherosclerotic; Predictive Value of Tests; Registries; Risk Factors; Rupture, Spontaneous; Time Factors; Treatment Outcome; United States

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