Angiographical coronary artery calcification predicts antegrade guidewire crossing during percutaneous coronary intervention of chronic total occlusion

Kiwamu Sudo, Tomotaka Dohi, Iwao Okai, Shinya Okazaki, Hiroaki Nishida, Yusuke Miura, Kenichiro Shimoji, Koji Ueno, Tohru Minamino, Shigetaka Noma

Background: Coronary artery calcification (CAC) is a predictor of failed revascularization in Chronic Total Occlusion (CTO) Percutaneous Coronary Intervention (PCI). However, CTO PCI operators believe that angiographical CAC shows promise as a landmark in the manipulation of antegrade guidewire crossing. We aimed to identify the relationship between angiographical CAC and successful antegrade guidewire crossing in CTO PCI.

Methods and Findings: This single-center, retrospective, observational study enrolled 48 consecutive patients who underwent Coronary Computed Tomography Angiography (CCTA) before PCI for CTO. They were divided, according to the level of antegrade guidewire crossing success, into the success (≤ 30 min; n=25, 50%) and unsuccess (>30 min; n=25, 50%) groups. All the CCTA and coronary angiographic findings obtained before PCI were analyzed. We assessed the relationship between angiographical CAC and successful antegrade guidewire crossing and other factors associated with it. The baseline characteristics were similar between the groups. Angiographical CAC was more frequently observed in the success group than in the unsuccess group (68% vs. 24%, p=0.080). There were no statistically significant differences in the CTO entry morphology, bridging collateral, vessel bending, distal reference diameter, occlusion length, and calcification severity between the groups. In the multivariable analysis, angiographical CAC in the CTO lesion predicted successful antegrade guidewire crossing within 30 min (odds ratio=0.043, 95% confidence interval=0.003–0.614, p=0.006).

Conclusion: Angiographical CAC may be a promising landmark for antegrade wire manipulation in patients with CTO.

Abbreviations: CAC: Coronary Artery Calcification; CAG: Coronary Angiography; CART: Controlled Antegrade and Retrograde Subintimal Tracking; CCTA: Coronary Computed Tomography Angiography; CTO: Chronic Total Occlusion; IVUS: Intravascular Ultrasound; J-CTO: Multicenter CTO Registry of Japan; LAD: Left Descending Artery; LCX: Left Circumflex Artery; PCI: Percutaneous Coronary Intervention; RCA: Right Coronary Artery; TIMI: Thrombolysis in Myocardial Infarction