Objective. The initial recanalization rate of coronary chronic total occlusions (CTOs) is >85% when performed by experienced operators, but only 10% of prior failed CTO patients receive reattempted recanalization. This retrospective study analyzed the success rate and strategies used in reattempt percutaneous coronary intervention (PCI) of CTOs after prior failures. Methods. Overall, 206 patients with 212 CTOs were enrolled. All patients with prior recanalization failures received reattempt PCIs from January 2015 to March 2019 at Zhongshan Hospital, Fudan University. Data on clinical factors (age, sex, comorbidities, left ventricular ejection fraction, history of cigarette usage, and revascularization), angiographic characteristics of CTOs (target lesion, Japanese Chronic Total Occlusion (J-CTO) score, the morphology of CTO lesions, and collateral channel scale), strategies (procedural approach and use of devices), and major adverse events were obtained and analyzed. Results. The mean age of enrolled patients was 60.96 ± 12.36 years, with a male predominance of 90.3%. Of the patients, 47.1% had a prior myocardial infarction and 70.4% underwent stent implantation previously, while the in-stent occlusion rate was 6.6%. CTOs were primarily localized in the left anterior descending artery (43.9%) and the right coronary artery (43.9%). 80.7% of lesions were classified as very difficult (J-CTO score ≥3), and the overall success rate was 81.1%. In multivariable regression analysis, J-CTO score, collateral channel scale, application of coronary multispiral computed tomography angiography, dual injection, intravascular ultrasound, active greeting technique, parallel wiring, and CTO morphology were predictors of recanalization success. There were no significant differences in rates of procedural complications between the final recanalization success and failure groups. Conclusions. Recanalization of complex CTOs is associated with high success rate and low complication rates when performed by high-volume CTO operators and after multiple reattempts.

中文翻译：

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先前失败后重新尝试经皮冠状动脉介入治疗慢性完全闭塞：策略和结果的单中心分析


客观的。当由经验丰富的操作者执行时，冠状动脉慢性完全闭塞 (CTO) 的初始再通率为 >85%，但之前失败的 CTO 患者中只有 10% 接受重新尝试再通。这项回顾性研究分析了 CTO 在先前失败后再次尝试经皮冠状动脉介入治疗 (PCI) 的成功率和策略。方法。总体而言，共有 206 名患者和 212 名 CTO 入组。 2015年1月至2019年3月，所有既往血管再通失败的患者均在复旦大学附属中山医院再次尝试PCI。临床因素（年龄、性别、合并症、左心室射血分数、吸烟史和血运重建）、CTO 的血管造影特征（目标病变、日本慢性完全闭塞 (J-CTO) 评分、CTO 病变的形态、获得并分析了主要不良事件。结果。入组患者的平均年龄为 60.96 ± 12.36 岁，其中男性占 90.3%。其中47.1%的患者既往有心肌梗死史，70.4%的患者曾接受过支架植入，支架内闭塞率为6.6%。 CTO 主要位于左前降支 (43.9%) 和右冠状动脉 (43.9%)。 80.7%的病灶被归类为非常困难（J-CTO评分≥3），总体成功率为81.1%。在多变量回归分析中，J-CTO评分、侧支通道量表、冠状动脉多螺旋计算机断层扫描血管造影的应用、双注射、血管内超声、主动问候技术、平行布线和CTO形态是再通成功的预测因素。 最终再通成功组和失败组之间的手术并发症发生率没有显着差异。结论。当由大量 CTO 操作者进行且经过多次重新尝试后，复杂 CTO 的再通与高成功率和低并发症率相关。