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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)


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

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