Research Fellow Minneapolis Heart Institute Foundation Minneapolis Heart Institute Foundation Minneapolis, Minnesota
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 5,986 CTO-PCIs performed at 30 US and international centers between 2012 and 2019.
Results: In-stent CTOs represented 16% of the total procedures. Patients with in-stent CTOs were younger (64 [57, 70] vs. 65 [58, 72] years, p=0.0033) and had a higher prevalence of diabetes mellitus (48% vs. 41%, P=0.0003). In-stent CTOs had higher J-CTO score (3 [2, 3] vs. 2 [1, 3], p=0.0051). Retrograde crossing was used les often (36% vs. 28%, p<0.0001) and intravascular ultrasound more often (51% vs. 39%, p<0.0001) in the in-stent CTO group. The in-stent CTO group had more balloon uncrossable (14% vs. 10%, p=0.0252) and balloon undilatable (20% vs. 10%, p<0.0001) lesions. Compared with de novo CTOs, in-stent CTO-PCIs had similar technical success (85% vs. 86%, p=0.32), procedural success (84% vs. 85%, p=0.43) and incidence of in-hospital major adverse cardiovascular events (2% vs. 2.2%, p=0.72).
Conclusion: In-stent CTOs represent 16% of all CTOs and have higher complexity but can be recanalized with similar success and in-hospital major adverse events as de novo CTOs.