TCT CONNECT-240 CTO PCI for In-Stent Restenosis: Insights From a Pooled Analysis of Four Multicenter Registries

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Conference Proceeding

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Journal of the American College of Cardiology


Background: The outcomes of percutaneous coronary intervention (PCI) for in-stent chronic total occlusions (CTOs) have received limited study.

Methods: We examined the clinical, angiographic characteristics and procedural outcomes of 11,966 CTO PCIs performed at 11,756 patients at 108 U.S. and international centers between 2012 and 2020, pooling patient-level data from four multicenter registries. In-hospital major adverse cardiovascular events included death, myocardial infarction, stroke, and tamponade.

Results: In-stent CTOs represented 15% of the total procedures (n = 1,753). Patients with in-stent CTOs had higher rates of diabetes mellitus (44% vs. 38%, p < 0.0001) and prior coronary artery bypass grafts (26.5% vs. 24%, p = 0.0273). In-stent CTOs had a higher Japan-CTO score (2.3 ± 1.3 vs. 2.2 ± 1.3, p = 0.009) and less proximal cap ambiguity compared with de novo lesions (27% vs. 36%, p < 0.0001). Regarding successful crossing strategies, antegrade wiring was the most used strategy in the in-stent group (70% vs. 61%) followed by antegrade dissection/re-entry (17% vs. 21%) and retrograde crossing (13% vs. 18%, p < 0.0001). Intravascular imaging was used more often (43% vs. 35%, p < 0.0001) in the in-stent CTO group. Compared with de novo CTOs, in-stent CTO PCIs required less contrast (215 [150, 300] vs. 250 [180, 341] ml, p < 0.0001).Technical (85% vs. 85%, p = 0.87) and procedural (84% vs. 84%, p = 0.82) success rates were similar between in-stent and de novo CTOs as was the incidence of in-hospital major adverse cardiovascular events (1.7% vs. 2.2%, p = 0.25).

Conclusion: In-stent CTOs represent 15% of all CTO PCIs and can be re-canalized with similar success and in-hospital complication rates as de novo CTOs.





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