Technical failure patterns during chronic total occlusion percutaneous coronary intervention: a multicenter registry analysis
5 affiliations
- 1Department of Cardiology, Necmettin Erbakan University, Konya, Turkey
- 2Toros University, Mersin, Turkey
- 3Department of Cardiology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
- 4Istinye University, Istanbul, Turkey
- 5Cardiology Department, School of Medicine, Biruni University, Istanbul, Turkey
Abstract
Introduction: Technical failure during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is usually reported as a binary outcome, although failed procedures may follow different procedural courses.
Aim: To describe procedural patterns of technical failure during CTO PCI and assess their association with conventional CTO complexity scores.
Material and methods: We analyzed 2,375 CTO PCI procedures from a multicenter registry. Technical failure was classified as Pattern A (crossing- or device-delivery failure) or Pattern B (dissection- or flow-related failure). Multivariable logistic regression was used to examine correlates of overall and pattern-specific failure.
Results: Technical failure occurred in 192 (8.1%) procedures: 148 (77.1%) were Pattern A and 44 (22.9%) were Pattern B. J-CTO and CASTLE/EuroCTO scores were higher in Pattern A than in Pattern B. Overall technical failure was associated with blunt/absent proximal cap, CTO length ≥ 30 mm, moderate/severe calcification, previous coronary artery bypass grafting, and proximal tortuosity. In the exploratory Pattern B model, CTO length ≥ 30 mm, moderate/severe calcification, and left anterior descending versus right coronary artery target vessel were associated with Pattern B versus technical success. However, target vessel did not differentiate Pattern B from Pattern A after adjustment for J-CTO or CASTLE/EuroCTO score. Pattern B consisted mainly of persistent dissection and no/slow flow.
Conclusions: Technical failure during CTO PCI is heterogeneous. Conventional CTO complexity scores appeared to align more closely with crossing- or device-delivery failure, while dissection- or flow-related failure remained a smaller exploratory subgroup requiring external validation.
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BibTeX
@article{gurbuz2026technical,
title = {{Technical failure patterns during chronic total occlusion percutaneous coronary intervention: a multicenter registry analysis}},
author = {Ahmet S. Gurbuz and Sefa Sural and Semi Ozturk and Vedat Aslan and Yakup Alsancak and Sevket Gorgulu},
journal = {Postepy w kardiologii interwencyjnej = Advances in interventional cardiology},
year = {2026},
month = sep,
doi = {10.5114/aic.2026.164691},
url = {https://europepmc.org/article/PMC/PMC13721054},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Technical failure patterns during chronic total occlusion percutaneous coronary intervention: a multicenter registry analysis
AU - Ahmet S. Gurbuz
AU - Sefa Sural
AU - Semi Ozturk
AU - Vedat Aslan
AU - Yakup Alsancak
AU - Sevket Gorgulu
PY - 2026
DA - 2026/09/01
JO - Postepy w kardiologii interwencyjnej = Advances in interventional cardiology
DO - 10.5114/aic.2026.164691
UR - https://europepmc.org/article/PMC/PMC13721054
AB - Introduction: Technical failure during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is usually reported as a binary outcome, although failed procedures may follow different procedural courses. Aim: To describe procedural patterns of technical failure during CTO PCI and assess their association with conventional CTO complexity scores. Material and methods: We analyzed 2,375 CTO PCI procedures from a multicenter registry. Technical failure was classified as Pattern A (crossing- or device-delivery failure) or Pattern B (dissection- or flow-related failure). Multivariable logistic regression was used to examine correlates of overall and pattern-specific failure. Results: Technical failure occurred in 192 (8.1%) procedures: 148 (77.1%) were Pattern A and 44 (22.9%) were Pattern B. J-CTO and CASTLE/EuroCTO scores were higher in Pattern A than in Pattern B. Overall technical failure was associated with blunt/absent proximal cap, CTO length ≥ 30 mm, moderate/severe calcification, previous coronary artery bypass grafting, and proximal tortuosity. In the exploratory Pattern B model, CTO length ≥ 30 mm, moderate/severe calcification, and left anterior descending versus right coronary artery target vessel were associated with Pattern B versus technical success. However, target vessel did not differentiate Pattern B from Pattern A after adjustment for J-CTO or CASTLE/EuroCTO score. Pattern B consisted mainly of persistent dissection and no/slow flow. Conclusions: Technical failure during CTO PCI is heterogeneous. Conventional CTO complexity scores appeared to align more closely with crossing- or device-delivery failure, while dissection- or flow-related failure remained a smaller exploratory subgroup requiring external validation.
SN - 1734-9338
SN - 1897-4295
ER -