Report From Japan’s CTO-PCI Expert Registry

Study Questions:

What are the clinical outcomes of patients undergoing chronic total occlusion (CTO)-percutaneous coronary interventions (PCIs) performed by highly experienced Japanese specialists?


The investigators included 2,846 consecutive CTO-PCI cases undertaken in Japan over the study period of January 2014 to December 2015. They compared clinical outcomes between the different PCI approaches, following the intention-to-treat principle.


The overall technical success rate of the procedures was 89.9%. The specialists frequently chose the retrograde approach as the primary CTO-PCI strategy (in 27.8% of cases). The technical success rate of the primary antegrade approach was significantly better than that of the primary retrograde approach (91.0% vs. 87.3%, p < 0.0001). The technical success rate decreased to 78.0% with the rescue retrograde approach. Parallel guide wire crossing and intravascular ultrasound-guided wire crossing were performed after guide wire escalation during antegrade CTO-PCI with a high technical success rate (75.0%-88.9%). Severe lesion calcification was a strong predictor of failed CTO-PCI.


The authors concluded that CTO-PCI performed by highly experienced specialists achieved a high technical success rate.


This cohort study reports that highly experienced Japanese specialists frequently chose the retrograde approach as the primary CTO-PCI strategy, especially for more complex CTO lesions, with a success rate of about 90%. For intermediate CTO lesions (J-CTO score <2), these specialists mainly performed CTO-PCIs using the antegrade approach alone, with a very high success rate (>95%). However, for the rescue retrograde approach, the success rate decreased to <80%. In addition, severe lesion calcification was a strong predictor of failed CTO-PCIs. While improvement of technologies for medical devices, such as guide wires and catheters, are required to further improve the success rate – it should be noted that there is a steep learning curve for complex CTO procedures and interventionalists should be cognizant of that before attempting these procedures. The success rate in this analysis reflects rates of certified CTO-PCI operators and may not be applicable to all.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Imaging, Echocardiography/Ultrasound

Keywords: Coronary Occlusion, Ischemia, Japan, Percutaneous Coronary Intervention, Specialization, Treatment Outcome, Ultrasonography, Vascular Calcification

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