Feasibility and long-term outcomes of recanalization for De novo small vessel chronic total occlusions.
Journal
International journal of cardiology. Heart & vasculature
Journal Volume
65
Pages
101955
ISSN
2352-9067
Date Issued
2026-08
Author(s)
Tsai, Cheng-Ting
Lee, Chien-Lin
Liu, Shih-Chi
Chang, Chi-Jen
Lin, Chia-Pin
Huang, Chi-Hung
Liou, Jun-Ting
Abstract
Background: The impact of small vessel size on chronic total occlusions (CTO) interventions remains underexplored. We compared revascularization feasibility and follow-up outcomes between patients with small- and non-small vessel de novo CTOs. Methods: In total, 493 consecutive patients (64.0 ± 11.4 years, 432 men) undergoing wiring-based de novo CTO interventions were divided into two groups: small vessels (reference vessel diameter < 2.75 mm, n = 245) and non-small vessels (n = 248). Procedural success and guidewire crossing time were compared. Among 449 patients with successful recanalization, long-term outcomes including target lesion failure [cardiac death, target vessel myocardial infarction (TVMI), and target lesion revascularization] were assessed over a median follow-up of 57.4 (30.2–87.3) months. Results: With increased J-CTO score, the procedural success rates remained comparable in the small vessel CTO group but declined significantly in non-small vessel CTO group when the score was ≥3 (82 vs. small vessel: 93%, p = 0.008). For lesions with a J-CTO score ≥ 3, multivariate analyses showed that the presence of small vessel was independently associated with procedural success (OR = 8.2, 95% CI = 3.2–21.1, p < 0.001), and a successful guidewire crossing time ≥ 30 min (OR = 3.0, 95% CI = 1.6–5.6, p = 0.001). Cox’ regression model showed that successfully recanalized small vessel CTOs was independently accompanied by a lower long-term risk of TVMI (HR = 0.10, 95% CI = 0.01–0.79, p = 0.029). Conclusion: Despite the longer guidewire crossing time for small vessel CTOs with higher complexity, we demonstrated greater procedural feasibility and better long-term TVMI-free survival for small vessel CTO interventions. However, long-term outcomes of small vessels can be clinically silent and therefore might affect the study results. © 2024
Subjects
Chronic total occlusion
Intervention
J-CTO score
Outcome
Small vessel
Type
journal article