Key result
Hydrophilic guidewire recanalization achieves ~96% clinical success in subacute coronary occlusions, outperforming chronic lesions.
Why the study?
Does recanalization of chronic total coronary occlusions using a hydrophilic guidewire result in similar immediate and long-term outcomes compared to subacute total occlusions?
Cohort (n=83)
Does recanalization of chronic total coronary occlusions using a hydrophilic guidewire result in similar immediate and long-term outcomes compared to subacute total occlusions?
Absolute Event Rate: 96% vs 81%
Recanalization of chronic total coronary occlusions using a hydrophilic guidewire is feasible with an 81% success rate and yields long-term clinical outcomes comparable to those of subacute occlusions.
Supports feasibility in chronic total occlusions; leaves open whether RCTs confirm long-term equivalence to subacute cases.
Eighty-three consecutive patients with 85 coronary total occlusions undergoing coronary angioplasty were retrospectively studied. Patients were divided into two groups according to the occlusion age that was < 30 days (subacute total occlusion [STO]: 25 patients; range 1-30 days) or > 30 days (chronic total occlusion [CTO]: 58 patients; range 3-144 months). All procedures were carried out using a hydrophilic guidewire. Clinical success, consisting of crossing the lesion, balloon dilatation, stent deployment without complications, was 96% in STO and 81% in CTO. Multiple stepwise logistic regression analysis identified a family history of coronary artery disease (CAD), left anterior descending and right coronary artery occlusions as independent predictors of a successful procedure. No major events occurred during or immediately after the angioplasty. After a mean follow-up of 24 +/- 2 months, no difference was found in survival or freedom from myocardial infarction or target vessel revascularization among the STO and CTO patients. Successful recanalization by using a hydrophilic guidewire was achieved in a high percentage of chronic total occlusions with a low incidence of complications and a satisfactory late clinical outcome. Family history of CAD and occlusion of left anterior descending or right coronary arteries are independent predictors of procedural success.
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Piscione et al. (2002) conducted a cohort in Coronary total occlusions (n=83). Subacute total occlusion (< 30 days) vs. Chronic total occlusion (> 30 days) was evaluated on Clinical success (crossing the lesion, balloon dilatation, stent deployment without complications). Recanalization of coronary total occlusions using a hydrophilic guidewire achieved clinical success in 96% of subacute occlusions and 81% of chronic occlusions.
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