In-stent versus de novo chronic total occlusion PCI: Similar acute success but distinct procedural and treatment patterns
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The question whether in-stent chronic total occlusion (ISR-CTO) reflects lower CTOpercutaneous coronary intervention (PCI) efficacy or a distinct procedural profile remains uncertain. AIMS: Our aim was to compare acute outcomes, strategy, and treatment pattern between ISR-CTOand de novo CTO. METHODS: We performed a retrospective procedure-level analysis of a prospectively maintainedthree-center CTO PCI registry from Türkiye, including consecutive procedures performed betweenJanuary 2019 and February 2026. The primary endpoint was procedural success, defined as technicalsuccess without in-hospital major procedural complications. Technical success was final Thrombolysisin Myocardial Infarction (TIMI) 3 flow with residual stenosis <30%. Major procedural complicationswere death, stroke, emergency repeat PCI or coronary artery bypass grafting, donor-vessel complication,and coronary or collateral perforation requiring active treatment. Multivariable logisticregression and prespecified sensitivity analyses were performed. RESULTS: Among 2375 CTO PCI procedures, 296 (12.5%) involved ISR-CTO. Technical success was92.9% in ISR-CTO and 91.7% in de novo CTO (P = 0.49). Procedural success was at 90.2% and 89.0%,respectively (P = 0.55), and the ratio of major procedural complications was similar (3.4% vs.3.9%, respectively, P = 0.66). After adjustment, ISR-CTO was not associated with lower technical success(odds ratio [OR], 1.26; 95% confidence interval [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 associatedwith less actual retrograde approach (adjusted OR, 0.63; 95% CI, 0.45-0.88; P = 0.007), greater use ofintravascular ultrasound (OR, 2.03; 95% CI, 1.42-2.90; P <0.001), greater use of drug-coated balloontherapy (OR, 2.31; 95% CI, 1.71-3.12; P <0.001), and less frequent drug-eluting stent implantation(OR, 0.65; 95% CI, 0.48-0.88; P = 0.006). CONCLUSIONS: ISR-CTO had acute procedural results comparable to de novo CTO in this selectedmulticenter cohort. Its main differences were procedural and treatment-related, including less actualretrograde approach and a different use of intravascular ultrasound/drug-coated balloon/drug-eluting stent.
Source: Kardiologia Polska
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7202276291