Key result
In-stent CTO shows procedural success comparable to de novo occlusion despite requiring more complex adjunctive therapies.
Why the study?
Whether in-stent chronic total occlusion (ISR-CTO) reflects lower CTO PCI efficacy or a distinct procedural profile remained uncertain.
Does in-stent CTO PCI compared to de novo CTO PCI affect acute procedural success and complication rates in patients undergoing CTO recanalization?
Cohort (n=2,375)
Yes
Does in-stent CTO PCI compared to de novo CTO PCI affect acute procedural success and complication rates in patients undergoing CTO recanalization?
ISR-CTO percutaneous coronary intervention has comparable acute procedural success and safety to de novo CTO procedures but involves distinct procedural strategies, such as less actual retrograde involvement and greater use of IVUS and drug-coated balloons.
Comparable ISR-CTO success supports PCI feasibility; leaves open whether routine IVUS or DCB improves outcomes.
BACKGROUND: Whether in-stent chronic total occlusion (ISR-CTO) reflects lower CTO percutaneous coronary intervention (PCI) efficacy or a distinct procedural profile remains uncertain. AIMS: To compare acute outcomes, strategy, and treatment pattern between ISR-CTO and de novo CTO. METHODS: We performed a retrospective procedure-level analysis of a prospectively maintained three-center CTO PCI registry from Türkiye, including consecutive procedures between January 2019 and February 2026. The primary endpoint was procedural success, defined as technical success without in-hospital major procedural complications. Technical success was final TIMI 3 flow with residual stenosis < 30%. Major procedural complications included death, stroke, emergency repeat PCI or coronary artery bypass grafting (CABG), donor-vessel complication, and coronary or collateral perforation requiring active treatment. Multivariable logistic regression and prespecified sensitivity analyses were performed. RESULTS: Among 2375 CTO PCI procedures, 296 (12.5%) involved ISR-CTO. Technical success was 92.9% in ISR-CTO and 91.7% in de novo CTO (P = 0.49). Procedural success was 90.2% and 89.0% (P = 0.55), and major procedural complications were similar (3.4% vs. 3.9%, P = 0.66). After adjustment, ISR-CTO was not associated with lower technical success (OR, 1.26; 95% CI, 0.77-2.05), lower procedural success (OR, 1.20; 95% CI, 0.79-1.83), or higher complication risk (OR, 0.84; 95% CI, 0.43-1.66). ISR-CTO was associated with less actual retrograde involvement, greater IVUS/DCB use, and a lower observed DES implantation rate. CONCLUSIONS: ISR-CTO showed acute procedural results comparable to de novo CTO in this selected multicenter cohort. Its main differences were procedural and treatment-related, including less actual retrograde involvement and different IVUS/DCB/DES use.
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Öztürk et al. (2026) conducted a cohort in Chronic total occlusion (CTO) (n=2,375). In-stent chronic total occlusion (ISR-CTO) vs. De novo chronic total occlusion was evaluated on Procedural success (technical success without in-hospital major procedural complications) (OR 1.20, 95% CI 0.79-1.83, p=0.55). In-stent chronic total occlusion was not associated with lower procedural success compared to de novo occlusion (90.2% vs 89.0%, adjusted OR 1.20), but was treated with more frequent use of intravascular ultrasound and drug-coated balloons.
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