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. 2024 Feb 5;20(3):e185-e197.
doi: 10.4244/EIJ-D-23-00490.

Contemporary outcomes of chronic total occlusion percutaneous coronary intervention in Europe: the ERCTO registry

Giuseppe Vadalà  1 , Alfredo R Galassi  2 , Gerald S Werner  3 , George Sianos  4 , Nicolaus Boudou  5 , Roberto Garbo  6 , Laura Maniscalco  1 , Alexander Bufe  7 , Alexander Avran  8 , Gabriele L Gasparini  9 , Eugenio La Scala  10 , Andrew Ladwiniec  11 , Meruzhan Saghatelyan  12 , Omer Goktekin  13 , Sevket Gorgulu  14 , Nicolaus Reifart  15 , Pierfrancesco Agostoni  16 , Sudhir Rathore  17 , Mohamed Ayoub  18 , Michael Behnes  19 , Iskander Atmowihardjo  20 , Mario Iannaccone  21 , Roberto Diletti  22 , Carlo Di Mario  23 , Kambis Mashayekhi  24   25 , On Behalf Of The Euro Cto Investigators
Affiliations

Contemporary outcomes of chronic total occlusion percutaneous coronary intervention in Europe: the ERCTO registry

Giuseppe Vadalà et al. EuroIntervention. .

Abstract

Background: Percutaneous coronary interventions (PCI) of chronic total occlusions (CTO) have reached high procedural success rates thanks to dedicated equipment, evolving techniques, and worldwide adoption of state-of-the-art crossing algorithms.

Aims: We report the contemporary results of CTO PCIs performed by a large European community of experienced interventionalists. Furthermore, we investigated the impact of different risk factors for procedural major adverse cardiac and cerebrovascular events (MACCE) and trends of employment of specific devices like dual lumen microcatheters, guiding catheter extensions, intravascular ultrasound and calcium-modifying tools.

Methods: We evaluated data from 8,673 CTO PCIs included in the European Registry of Chronic Total Occlusion (ERCTO) between January 2021 and October 2022.

Results: The overall technical success rate was 89.1% and was higher in antegrade as compared with retrograde cases (92.8% vs 79.3%; p<0.001). Compared with antegrade procedures, retrograde procedures had a higher complexity of attempted lesions (Japanese CTO [J-CTO] score: 3.0±1.0 vs 1.9±1.2; p<0.001), a higher procedural and in-hospital MACCE rate (3.1% vs 1.2%; p<0.018) and a higher perforation rate with and without tamponade (1.5% vs 0.4% and 8.3% vs 2.1%, respectively; p<0.001). As compared with mid-volume operators, high-volume operators had a higher technical success rate in antegrade and retrograde procedures (93.4% vs 91.2% and 81.5% vs 69.0%, respectively; p<0.001), and had a lower MACCE rate (1.47% vs 2.41%; p<0.001) despite a higher mean complexity of the attempted lesions (J-CTO score: 2.42±1.28 vs 2.15±1.27; p<0.001).

Conclusions: The adoption of different recanalisation techniques, operator experience and the use of specific devices have contributed to a high procedural success rate despite the high complexity of the lesions documented in the ERCTO.

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Conflict of interest statement

A. Bufe reports speaker honoraria from Biotronik and Shockwave Medical. A. Ladwiniec reports consulting/speaker/proctoring honoraria from Boston Scientific and Abbott. G. Werner reports speaker honoraria from Abbott, Asahi Intecc, OrbusNeich, Philips, Siemens, and Terumo. K. Mashayekhi reports consulting/speaker/proctoring honoraria from Abbott, Abiomed, Asahi Intecc, AstraZeneca, Biotronik, Boston Scientific, Cardinal Health, Daiichi Sankyo, Medtronic, OrbusNeich, Shockwave Medical, Teleflex, and Terumo. M. Ayoub reports consultant/proctor honoraria from Boston Scientific, Teleflex, Asahi Intecc, Cordis, Terumo, and SIS Medical. P. Agostoni reports consulting honoraria from Abbott, Boston Scientific, Cordis, iVascular, Medtronic, Neovasc, Seven Sons, Teleflex, and Terumo. R.D. Diletti reports consultant/proctoring honoraria from Asahi Intecc, Terumo, IMDS, Boston Scientific, Teleflex, and Philips. The other authors have no conflicts of interest to declare relevant to the contents of this paper.

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