OBJECTIVES: This study sought to establish a model for grading lesion difficulty in interventional chronic total occlusion (CTO) treatment. BACKGROUND: Owing to uncertainty of success of the procedure and difficulties in selecting suitable cases for treatment, performance of interventional CTO remains infrequent. METHODS: Data from 494 native CTO lesions were analyzed. To eliminate operator bias, the objective parameter of successful guidewire crossing within 30 min was set as an end point, instead of actual procedural success. All observations were randomly assigned to a derivation set and a validation set at a 2:1 ratio. The J-CTO (Multicenter CTO Registry of Japan) score was determined by assigning 1 point for each independent predictor of this end point and summing all points accrued. This value was then used to develop a model stratifying all lesions into 4 difficulty groups: easy (J-CTO score of 0), intermediate (score of 1), difficult (score of 2), and very difficult (score of ≥ 3). RESULTS: The set end point was achieved in 48.2% of lesions. Independent predictors included calcification, bending, blunt stump, occlusion length >20 mm, and previously failed lesion. Easy, intermediate, difficult, and very difficult groups, stratified by J-CTO score, demonstrated stepwise, proportioned, and highly reproducible differences in probability of successful guidewire crossing within 30 min (87.7%, 67.1%, 42.4%, and 10.0% in the derivation set and 92.3%, 58.3%, 34.8%, and 22.2% in the validation set, respectively). Areas under receiver-operator characteristic curves were comparable (derivation: 0.82 vs. validation: 0.76). CONCLUSIONS: This model predicted the probability of successful guidewire crossing within 30 min very well and can be applied for difficulty grading.
OBJECTIVES: This study sought to establish a model for grading lesion difficulty in interventional chronic total occlusion (CTO) treatment. BACKGROUND: Owing to uncertainty of success of the procedure and difficulties in selecting suitable cases for treatment, performance of interventional CTO remains infrequent. METHODS: Data from 494 native CTO lesions were analyzed. To eliminate operator bias, the objective parameter of successful guidewire crossing within 30 min was set as an end point, instead of actual procedural success. All observations were randomly assigned to a derivation set and a validation set at a 2:1 ratio. The J-CTO (Multicenter CTO Registry of Japan) score was determined by assigning 1 point for each independent predictor of this end point and summing all points accrued. This value was then used to develop a model stratifying all lesions into 4 difficulty groups: easy (J-CTO score of 0), intermediate (score of 1), difficult (score of 2), and very difficult (score of ≥ 3). RESULTS: The set end point was achieved in 48.2% of lesions. Independent predictors included calcification, bending, blunt stump, occlusion length >20 mm, and previously failed lesion. Easy, intermediate, difficult, and very difficult groups, stratified by J-CTO score, demonstrated stepwise, proportioned, and highly reproducible differences in probability of successful guidewire crossing within 30 min (87.7%, 67.1%, 42.4%, and 10.0% in the derivation set and 92.3%, 58.3%, 34.8%, and 22.2% in the validation set, respectively). Areas under receiver-operator characteristic curves were comparable (derivation: 0.82 vs. validation: 0.76). CONCLUSIONS: This model predicted the probability of successful guidewire crossing within 30 min very well and can be applied for difficulty grading.
Authors: Rosa Alba Abellas-Sequeiros; Raymundo Ocaranza-Sanchez; Ramiro Trillo-Nouche; Carlos Gonzalez-Juanatey; Jose Ramon Gonzalez-Juanatey Journal: Heart Vessels Date: 2017-04-21 Impact factor: 2.037
Authors: Nicola Ryan; Nieves Gonzalo; Philip Dingli; Oscar Vedia Cruz; Pilar Jiménez-Quevedo; Luis Nombela-Franco; Ivan Nuñez-Gil; María Del Trigo; Pablo Salinas; Carlos Macaya; Antonio Fernandez-Ortiz; Javier Escaned Journal: Int J Cardiovasc Imaging Date: 2017-02-14 Impact factor: 2.357
Authors: Mohammad Hasan Namazi; Ali Reza Serati; Hosein Vakili; Morteza Safi; Saeed Ali Pour Parsa; Habibollah Saadat; Maryam Taherkhani; Sepideh Emami; Shamseddin Pedari; Masoomeh Vatanparast; Mohammad Reza Movahed Journal: Int J Angiol Date: 2016-10-31