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2 . 2022

Results of recanalization of chronic total occlusions based on hybrid approach


Aim. To study the efficacy, safety and long-term results of recanalization of chronic total occlusions (CTO) based on hybrid approach.

Material and methods. During the period from 2015 to 2020 in Federal Center for Cardiovascular Surgery (Astrakhan) performed 244 endovascular interventions for the CTO’s of coronary arteries. The average age of patients was 59.8±7.9 years, 204 (83.6%) were men. Patients were divided into two groups: 215 (88.1%) patients with successful recanalization and 29 (11.9%) with an attempt to recanalization.

Results. The rate of technical and procedural success of coronary artery CTO recanalization was 88.1%, and 86.9%, respectively. When examining long-term CTO recanalization outcomes, the median follow-up period was 25.5 (15.0–36.7) months in pooled cohort as a whole, 25.7 (15.2–36.7) months for patients with successful recanalization, and 21.9 (14.1–33.7) months for patients with attempted recanalization. No statistically significant differences were found between groups with respect to risk of death, acute myocardial infarction (AMI), acute cerebral circulation disorder, restenosis or reocclusion (HR 0.82 [95% CI 0.19–3.64], p=0.1573). A higher frequency  of occurrence and a higher assessment of the functional class of stable stress angina were identified regardless of its presence or functional class before intervention in the group of patients with an attempt to recanalization compared to patients with successful recanalization (OR 20.41  [8.57; 48.58], p<0,0001).

Conclusion. CTO recanalization with usage of hybrid approach is an effective and safe procedure, the rate of technical and procedural success of CTO recanalization was 88.1 и 86.9% respectively. Recanalization of CTO’s does not impair the survival rate and freedom from adverse events such as AMI, stroke, restenosis and reocclusion. Successful recanalization of CTO is reducing the functional class of exertion angina.

Keywords:coronary artery chronic total occlusion; retrograde approach; hybrid approach

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Larionov A.A., Enginoev S.T., Demina E.V., Abugov S.A. Results of recanalization of chronic total occlusions based on hybrid approach. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (2): 70–80. DOI:  (in Russian)


1.    Sachdeva R., Agrawal M., Flynn S.E., et al. The myocardium supplied by a chronic total occlusion is a persistently ischemic zone. Catheter Cardiovasc Interv. 2014; 83 (1): 9–16.

2.    Werner G.S., Gitt A.K., Zeymer U., et al. Chronic total coronary occlusions in patients with stable angina pectoris: impact on therapy and outcome in present day clinical practice. Clin Res Cardiol. 2009; 98: 435–41.

3.    Werner G.S., Martin-Yuste V., Hildick-Smith D., et al. A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions. Eur Heart J. 2018; 39 (26): 2484–93.

4.    Warren R.J., Black A.J., Valentine P.A., et al. Coronary angioplasty for chronic total occlusion reduces the need for subsequent coronary bypass surgery. Am Heart J. 1990; 120:  270–4.

5.    Park T.K., Lee S.H., Choi K.H., et al. Late survival benefit of percutaneous coronary intervention compared with medical therapy in patients with coronary chronic total occlusion: a 10-year follow-up study. J Am Heart Assoc. 2021; 10 (6): e019022.

6.    Azzalini L., Dautov R., Ojeda S., et al. Procedural and long-term outcomes of percutaneous coronary intervention for in-stent chronic total occlusion. JACC Cardiovasc Interv. 2017; 10 (9): 892–902.

7.    de la Torre Hernandez J.M., Rumoroso J.R., Subinas A.,  et al. Percutaneous intervention in chronic total coronary occlusions caused by in-stent restenosis: procedural results and long-term clinical outcomes in the TORO (Spanish registry of chronic TOtal occlusion secondary to an occlusive in-stent RestenOsis) multicentre registry. Eurointervention. 2017; 13 (2): e219–26.

8.    Michael T.T., Karmpaliotis D., Brilakis E.S., et al. Impact of prior coronary artery bypass graft surgery on chronic total occlusion revascularisation: insights from a multicentre US registry. Heart. 2013; 99: 1515–8.

9.    Potter B.J., Matteau A., Noiseux N., Mansour S. High stakes: CTO-PCI in the post-CABG patient. Can J Cardiol. 2018; 34 (3): 310–8.

10.Morino Y., Abe M., Morimoto T., et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (multicenter CTO Registry in japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011; 4: 213–21.

11.Christopoulos G., Kandzari D.E., Yeh R.W., et al. Development and validation of a novel scoring system for predicting technical success of chronic total occlusion percutaneous coronary interventions: the PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) score. JACC Cardiovasc Interv. 2016; 9: 1–9.

12.Fefer P., Knudtson M.L., Cheema A.N., et al. Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol. 2012; 59: 991–7.

13.Sabbagh A.E., Banerjee S., Brilakis E.S. Illustration of the «hybrid» approach to chronic total occlusion crossing. Interv Cardiol. 2012; 4: 639-43.

14.Christopoulos G., Karmpaliotis D., Alaswad K., et al. The efficacy of «hybrid» percutaneous coronary intervention in chronic total occlusions caused by in-stent restenosis: insights from  a US multicenter registry. Catheter Cardiovasc Interv. 2014; 84:  646-51.

15.Tajti P., Karmpaliotis D., Alaswad K., et al. The hybrid approach to chronic total occlusion percutaneous coronary intervention: update from the PROGRESS CTO Registry. JACC Cardiovasc Interv. 2018; 11 (14): 1325–35.

16.Wilson W.M., Walsh S.J., Yan A.T., et al. Hybrid approach improves success of chronic total occlusion angioplasty. Heart. 2016; 102 (18): 1486–93.

17.Maeremans J., Walsh S., Knaapen P., et al. The hybrid algorithm for treating chronic total occlusions in Europe: the RECHARGE Registry. J Am Coll Cardiol. 2016; 68 (18): 1958–70.

18.Michael T.T., Mogabgab O., Fuh E., et al. Application  of the «hybrid approach» to chronic total occlusion interventions: a detailed procedural analysis. J Interv Cardiol. 2014; 7: 36-43.

19.Knaapen, P., Henriques J. P., Nap A., et al. Percutaneous coronary intervention for chronic total coronary occlusion. Netherlands Heart Journal. – 2020 Dec 15. – P. 1–3.

20.Larionov A.A., Enginoev S.T., Gaponov D.P., Korzh D.A.,  Gorbunov M.G. Influence of hybrid approach on success rate of chronic total occlusions recanalization. Clinical and Experimental Surgery. Petrovsky Journal. 2018; 6 (4): 29–34. DOI: (in Russian)

21.Brilakis E.S., Mashayekhi K., Babunashvili A.M., et al. Guiding principles for chronic total occlusion percutaneous coronary intervention. Circulation. 2019; 140 (5): 420–33.

22.Wu E.B., Brilakis E.S., Mashayekhi K., et al. Global chronic total occlusion crossing algorithm. J Am Coll Cardiol. 2021;  78 (8): 840–53.

Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)
Medicine today

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