Treatment of left anterior descending coronary artery chronic total occlusion: Insights form a contemporary multicenter registry
Karacsonyi J, Alaswad K, Karmpaliotis D, Moses J, Kirtane A, Parikh M, Ali Z, Jaffer F, Yeh R, Kandzari D, Lembo N, Patel M, Mahmud E, Lombardi W, Choi J, Doing A, Wyman M, Toma C, Uretsky B, Martinez-Parachini JR, Karatasakis A, Danek B, Khalili H, Rangan B, Ungi I, Thompson C, Banerjee S, Brilakis E. Treatment of left anterior descending coronary artery chronic total occlusion: Insights form a contemporary multicenter registry. Catheter Cardiovasc Interv. 2017;89:S53-S54.
Catheter Cardiovasc Interv
Background: To examine the impact of calcification on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: The outcomes of 1,862 consecutive CTO PCIs performed in 1,825 patients (65.1±10 years; 86% male) between 2012 and 2016 at 11 US centers were evaluated. Results: Left anterior descendingcoronary artery target vessels (LAD) represented 27% of the cases. LAD CTOs were less complex than leftcircumflex and right coronary artery lesion, with lower Japanese CTO scores (2.02±1.18 vs. 2.53±1.27 vs. 2.74±1.20, p<.0001). LAD CTOs were also less tortuous (15% vs. 55% vs. 38%, p<.0001) and less likely required retrograde crossing attempt (24% vs. 32% vs. 50%, p<.0001). LAD CTOs were associated with shorter procedure and fluoroscopy time and lower air kerma radiation dose and contrast volume. LAD CTOs were associated with higher technical (91.6% vs. 85.4% vs. 87.7%, p=0.019) and procedural (90.9% vs. 85.2% vs. 85.2%, p=0.010) success rates but similar incidence of major adverse cardiac events (1.40% vs. 2.38% vs. 3.44%, p=0.085) compared to the other vessels (Figure 1.) Conclusion: In a contemporary, multicenter registry, LAD CTOs were present in 27% of attempted CTO lesions and were associated with higher success rates and similar complication rates.