Equipment Utilization of a Chronic Total Occlusion Percutaneous Coronary Intervention Program: An Experience from a Single Center Registry

Abstract

Background: Chronic total occlusion (CTO) is a prevalent and challenging condition for interventional cardiologists. Recent advancements in guidewires and microcatheters have played a crucial role in improving the success rate of percutaneous coronary intervention (PCI) in CTO cases. Our study aimed to assess the utilization of equipment in CTO-PCI procedures.

Methodology: We conducted a retrospective analysis of 1483 patients with CTO who underwent PCI, including both antegrade and retrograde approaches, at a single center over a 5-year period from January 2015 to December 2019.

Results: The majority of cases (n=1473) were performed using the antegrade approach, with only a small proportion (n=10) utilizing the retrograde approach. The mean age of the patients was 59 years, and there was a higher prevalence of males (84%). Radial access was used in 933 cases, while femoral access was used in 533 cases. The right coronary artery (RCA) was the most frequently involved vessel, and the left circumflex (LCX) had the highest success rate. The overall procedural success rate was 76.1%. The mean contrast volume used was 236 ± 88 ml. The average utilization of guidewires, stents, microcatheters, and balloons was 2.7 ± 2, 1.7 ± 1, 1.6 ± 1, and 3.8 ± 3, respectively. Commonly used guidewires included Pilot 50 and Pilot 200, while OTW and Corsair were frequently utilized microcatheters in the antegrade approach. In retrograde cases, RG3 and BMW 300 cm were commonly used. JR and hockey stick guides were predominantly used in RCA vessels. The utilization of double stick procedures was limited to 10.8% of cases due to cost barriers.

Conclusion: The use of polymer jacketed guidewires, torque-producing microcatheters with varying penetration forces, and the double stick approach significantly improved the success rate of CTO-PCI procedures. However, cost-effectiveness remains a significant barrier in the context of Pakistan.