Chronic total occlusion interventions in patients with coronary artery disease. When to stop and when to start again?

S.M. Furkalo

O.O. Shalimov National Institute of Surgery and Transplantology of NAMS of Ukraine, Kyiv, Ukraine

In the present observation, we included 52 patients, where repeated CTO recanalization attempts to recanalize were performed. Most of the patients were males, 77 % had a history of myocardial infarction, 70 % had multivessel CAD, 30.7 % underwent CABG. In 32 patients 2 attempts were made, in 14 patients – 3 attempts, in 5 patients 4 attempts were made and in 1 patient 6 repeated attempts were made to achieve CTO recanalization. More often, the intervention was carried out on the right coronary artery – 65.4 % of cases, the need for retrograde access was noted in 46.2 % of cases, and the length of the stented segment was more than 60 mm on average. The efficiency of CTO interventions in recent years was 86–91 %, then the efficiency of the repeated attempt of recanalization in our series of patients was 74 %, the efficiency of the third attempt was 77 % and the efficiency of the fourth attempt was 60 %. The main factors of the unsuccessful attempt were the previous CABG, long and calcified lesions, as well as ostial occlusions.

Conclusions. Failure of CTO recanalization may have many reasons. Discontinuation of the intervention should be considered in case of exceeding the threshold values of radiation exposure, exceeding the amount contrast agent, loss of visualization of the artery due to the formation of subintimal hematoma, the presence of significant complications, in view of the absence of further clinical «scenarios», fatigue of the physician and the patient. The main factors associated with the CTO recanalization failure were previous CABG surgery, calcified CTO, and ostial occlusion.

Key words: chronic coronary occlusion, failed revascularization, CTO hybrid algorithm, repeated CTO recanalization.

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