Treatment of left anterior descending coronary artery chronic total occlusion: Insights form a contemporary multicenter registry

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Conference Proceeding

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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.



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