Contemporary Strategies and Outcomes of Dedicated Chronic Total Occlusion Percutaneous Coronary Intervention Programs: A Prospective Multicentre Registry

Figure 1

Temporal trends in the success rates and approaches of CTO PCI. (a) Significant improvement in technical success up to 85.6% and procedural success up to 84.1% in year 9 (p value for trend both <0.001). (b) Significant increase in the lesion complexity (increase in J-CTO score) (p value for trend <0.001), with an increase in retrograde and dissection/reentry techniques. (c) There was evolution from the use of the CrossBoss catheter to contemporary ADR techniques using dual or triple lumen microcatheters. (d) Temporal increase in the number of guidewires, microcatheters, and guide extensions (all p value for trend <0.001) and balloons (). (e) Increase in the average stent length (p value for trend <0.001). (f) More comprehensive approaches with an increase in the use of dual injections and intracoronary imaging but contemporary with an increase in at least one radial access and a decrease in sheaths larger than 7F (all p for trend <0.001). (g) Temporal increase in fluoroscopy time () but decrease in the skin dose (). (h) Regression model adjusted for age, LV EF, vessel, J-CTO score, the use of microcatheters, dual injections, and intracoronary imaging showing a significant increase in technical success starting from year 3 and year 4, compared to year 1 as reference. ADR, antegrade dissection/reentry; AWE, antegrade wire escalation; IVUS, intravascular ultrasound; J-CTO, Multicentre CTO Registry of Japan score; LV EF, left ventricular ejection fraction; OCT, optical coherence tomography; OR, odds ratio; RDR, retrograde dissection/reentry; RWE, retrograde wire escalation.

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