Full stent expansion of chronic total occlusion lesions requires prolonged inflation

摘要

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been associated in some studies with higher target vessel revascularization (TVR) rates than non-CTO PCI. Optimal stent inflation time and its effect on TVR in CTO PCI is unknown. We investigated the time required for stent deployment using the previously described pressure optimized protocol (POP), which uses stent balloon pressure stability rather than an arbitrary inflation time as an end point for balloon deflation. We also compared TVR with CTO PCI vs non-CTO using the POP protocol in both groups. MethodsPatients with successful CTO PCI using POP between 2012 and 2015 were included. Patients having non-CTO PCI using POP and matched for stent diameter and length and temporal proximity constituted the control group to compare inflation time (n=83 each). TVR at 1year was compared between PCI during the time period using POP (CTO=83, non-CTO=263). ResultsStent inflation time to achieve optimal stent inflation using POP was longer in CTO vs non-CTO lesions (136±60 vs 108±51s,p=0.001). TVR at 365days was similar in CTO and non-CTO cohorts (2.4% vs 2.6%,p=0.9). ConclusionStent expansion using POP in CTO lesions requires longer inflation duration but leads to similar TVR rates at 1year in CTO PCI compared with non-CTO PCI.