Lots of interesting abstracts and cases were submitted for TCTAP 2024. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP A-002
Exploring the Success Rate in CTO PCI: Bayesian Approach for Preprocedural Inference and Intraprocedural Revising
By Toshikazu Kashiyama, Atsunori Okamura
Presenter
Toshikazu Kashiyama
Authors
Toshikazu Kashiyama1, Atsunori Okamura2
Affiliation
Sumitomo Hospital, Japan1, Sakurabashi Watanabe Hospital, Japan2
View Study Report
TCTAP A-002
CTO
Exploring the Success Rate in CTO PCI: Bayesian Approach for Preprocedural Inference and Intraprocedural Revising
Toshikazu Kashiyama1, Atsunori Okamura2
Sumitomo Hospital, Japan1, Sakurabashi Watanabe Hospital, Japan2
Background
Various techniques and approaches have been developed to improve the success rate in CTO PCI, but whether they can be implemented into real clinical practice is determined by time and resources which can be allocated to each procedure. While several complexity scores enable preprocedural planning and estimation of the success rate, the response to selected strategies is also a crucial factor for the choice of alternative strategies, and helps making decisions about whether or not to discontinue the procedure. We aimed to develop the method to assess the likelihood of success in CTO PCI not only in the preprocedural phase but during the procedure using Bayesian model.
Methods
All variables in J-CTO, PROGRESS-CTO, and CT-RECTOR score in 204 retrospectively analyzed cases were converted into likelihood ratio (LR) to put weight on the odds for successful lesion crossing within 15 minutes with antegrade wire escalation approach (AWE) or plus within 60 minutes with more advanced techniques (determined by the median values). In addition to the preprocedural predicted success rate, intraprocedural factors such as selection of wires or strategies were also incorporated for Bayesian updating.
Results
When the pre-test odds was assumed as 1.0 (success rate = 50 %), Preprocedural predicted success rate ranged from 82.3 to 16.7 % depending on the accumulation of the factors in the complexity scores. When the intermediate wires (tip load 3 ~ 6 g) failed to cross the CTO lesion, the estimated success rate fell to 75.5 - 11.7 % with IVUS-guided (the tip-detection) strategy and 60.7 - 6.2 % with retrograde approach, respectively. Meanwhile, pursuing AWE with the stiff wires (tip load 9 g ~) substantially decreased the odds by LR of 0.39. The LR of retry lesion differed between 0.10 for AWE and 0.70 for advanced approaches.l 1
Conclusion
When CTO lesion cannot be crossed using intermediate wires, early switching to IVUS-guided (the tip-detection) strategy or the retrograde approach can maximize the success rate in the limited procedural time, which is especially true for previously failed cases.