The angiographic predictors of successful chronic total occlusion percutaneous coronary intervention: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIANG Shichu ¹ , BAI Yanlin ² , ZHANG Jing ¹ , DIAO Kaiyue ³ , LI Jing ⁴ , MA Min ¹ , HUANG He ¹ ,  HE Yong ¹

1. Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
4. Research Center of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

HE Yong, Email: heyong_huaxi@163.com

Keywords：

Chronic total occlusion; Percutaneous coronary intervention; Angiographic predictors; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.202301071

Video：

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Objective To systematically review the angiographic predictors of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods The PubMed, EMbase, Cochrane Library, Web of Science, CBM, WanFang Data, and CNKI databases were electronically searched to collect observational studies on the angiographic predictors of CTO-PCI from inception to December 18, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.4 software. Results A total of 36 studies were included. The results of meta-analysis showed that the angiographic predictors of CTO-PCI included calcification (OR=1.92, 95%CI 1.49 to 2.47, P<0.01), occlusion length≥20mm (OR=1.80, 95%CI 1.26 to 2.57, P<0.01), bending>45° (OR=2.19, 95%CI 1.56 to 3.08, P<0.01), blunt stump (OR=1.53, 95%CI 1.08 to 2.16, P<0.01), ostial lesions (OR=2.27, 95%CI 1.34 to 3.85, P<0.01), proximal cap ambiguity (OR=2.27, 95%CI 1.40 to 3.68, P<0.01), side branch at proximal cap (OR=1.65, 95%CI 1.27 to 2.16, P<0.01), and J-CTO score≥3 (OR=2.53, 95%CI 1.53 to 4.16, P<0.01). Conclusion Current evidence indicates that calcification, occlusion length ≥20mm, bending>45°, blunt stump, ostial lesions, proximal cap ambiguity, side branch at proximal cap, and J-CTO score≥3 are the angiographic predictors of CTO-PCI. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： LIANG Shichu, BAI Yanlin, ZHANG Jing, DIAO Kaiyue, LI Jing, MA Min, HUANG He, HE Yong. The angiographic predictors of successful chronic total occlusion percutaneous coronary intervention: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(8): 908-915. doi: 10.7507/1672-2531.202301071 Copy

1.	Brilakis ES, Mashayekhi K, Tsuchikane E, et al. Guiding principles for chronic total occlusion percutaneous coronary intervention. Circulation, 2019, 140(5): 420-433.
2.	Tomasello SD, Boukhris M, Giubilato S, et al. Management strategies in patients affected by chronic total occlusions: results from the Italian Registry of Chronic Total Occlusions. Eur Heart J, 2015, 36(45): 3189-3198.
3.	Lee SW, Lee PH, Ahn JM, et al. Randomized trial evaluating percutaneous coronary intervention for the treatment of chronic total occlusion. Circulation, 2019, 139(14): 1674-1683.
4.	王智琪, 李佩钊, 郑金刚. CTO患者PCI与口服药物治疗疗效比较的荟萃分析. 中华心血管病杂志, 2022, 50(6): 591-599.
5.	Zaman S, Berry C. Chronic total occlusions with multivessel disease; does bypass grafting beat percutaneous coronary intervention. Circ Cardiovasc Interv, 2022, 15(2): e011786.
6.	Stone GW. Percutaneous coronary intervention of chronic total occlusions: conquering the final frontier. JACC Cardiovasc Interv, 2018, 11(14): 1336-1339.
7.	陆浩, 葛雷. 冠状动脉慢性闭塞病变介入治疗的原则及进展. 中华心血管病杂志(网络版), 2022, 5(1): 1-7.
8.	Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA, 2000, 283(15): 2008-2012.
9.	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(2): 213-221.
10.	Alessandrino G, Chevalier B, Lefèvre T, et al. A clinical and angiographic scoring system to predict the probability of successful first-attempt percutaneous coronary intervention in patients with total chronic coronary occlusion. JACC Cardiovasc Interv, 2015, 8(12): 1540-1548.
11.	Opolski MP, Achenbach S, Schuhbäck A, et al. Coronary computed tomographic prediction rule for time-efficient guidewire crossing through chronic total occlusion: insights from the CT-RECTOR multicenter registry (Computed Tomography Registry of Chronic Total Occlusion Revascularization). JACC Cardiovasc Interv, 2015, 8(2): 257-267.
12.	韩雅玲, 张剑, 荆全民, 等. 慢性完全闭塞冠状动脉病变1148例患者的介入治疗. 中华心血管病杂志, 2005, 33(4): 299-302.
13.	Mollet NR, Hoye A, Lemos PA, et al. Value of preprocedure multislice computed tomographic coronary angiography to predict the outcome of percutaneous recanalization of chronic total occlusions. Am J Cardiol, 2005, 95(2): 240-243.
14.	Soon KH, Cox N, Wong A, et al. CT coronary angiography predicts the outcome of percutaneous coronary intervention of chronic total occlusion. J Interv Cardiol, 2007, 20(5): 359-366.
15.	García-García HM, van Mieghem CA, Gonzalo N, et al. Computed tomography in total coronary occlusions (CTTO registry): radiation exposure and predictors of successful percutaneous intervention. EuroIntervention, 2009, 4(5): 607-616.
16.	伊宪华, 韩雅玲, 李毅, 等. 介入治疗开通慢性完全闭塞病变的长期临床疗效. 中华心血管病杂志, 2009, 37(9): 773-776.
17.	Cho JR, Kim YJ, Ahn CM, et al. Quantification of regional calcium burden in chronic total occlusion by 64-slice multi-detector computed tomography and procedural outcomes of percutaneous coronary intervention. Int J Cardiol, 2010, 145(1): 9-14.
18.	Hsu JT, Kyo E, Chu CM, et al. Impact of calcification length ratio on the intervention for chronic total occlusions. Int J Cardiol, 2011, 150(2): 135-141.
19.	Choi JH, Song YB, Hahn JY, et al. Three-dimensional quantitative volumetry of chronic total occlusion plaque using coronary multidetector computed tomography. Circ J, 2011, 75(2): 366-375.
20.	Martín-Yuste V, Barros A, Leta R, et al. Factors determining success in percutaneous revascularization of chronic total coronary occlusion: multidetector computed tomography analysis. Rev Esp Cardiol (Engl Ed), 2012, 65(4): 334-340.
21.	Nombela-Franco L, Urena M, Jerez-Valero M, et al. Validation of the J-chronic total occlusion score for chronic total occlusion percutaneous coronary intervention in an independent contemporary cohort. Circ Cardiovasc Interv, 2013, 6(6): 635-643.
22.	Luo C, Huang M, Li J, et al. Predictors of interventional success of antegrade PCI for CTO. JACC Cardiovasc Imaging, 2015, 8(7): 804-813.
23.	Christopoulos G, Wyman RM, Alaswad K, et al. Clinical utility of the Japan-chronic total occlusion score in coronary chronic total occlusion interventions: results from a multicenter registry. Circ Cardiovasc Interv, 2015, 8(7): e002171.
24.	Christopoulos G, Kandzari DE, Yeh RW, 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): 1-9.
25.	Chai WL, Agyekum F, Zhang B, et al. Clinical prediction score for successful retrograde procedure in chronic total occlusion percutaneous coronary intervention. Cardiology, 2016, 134(3): 331-339.
26.	Danek BA, Karatasakis A, Karmpaliotis D, et al. Development and validation of a scoring system for predicting periprocedural complications during percutaneous coronary interventions of chronic total occlusions: the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) complications score. J Am Heart Assoc, 2016, 5(10): e004272.
27.	de Castro-Filho A, Lamas ES, Meneguz-Moreno RA, et al. Impact of the occlusion duration on the performance of J-CTO score in predicting failure of percutaneous coronary intervention for chronic total occlusion. J Invasive Cardiol, 2017, 29(6): 195-201.
28.	Yu CW, Lee HJ, Suh J, et al. Coronary computed tomography angiography predicts guidewire crossing and success of percutaneous intervention for chronic total occlusion: Korean multicenter CTO CT registry score as a tool for assessing difficulty in chronic total occlusion percutaneous coronary intervention. Circ Cardiovasc Imaging, 2017, 10(4): e005800.
29.	Tan Y, Zhou J, Zhang W, et al. Comparison of CT-RECTOR and J-CTO scores to predict chronic total occlusion difficulty for percutaneous coronary intervention. Int J Cardiol, 2017, 235: 169-175.
30.	Namazi MH, Serati AR, Vakili H, et al. A novel risk score in predicting failure or success for antegrade approach to percutaneous coronary intervention of chronic total occlusion: antegrade CTO score. Int J Angiol, 2017, 26(2): 89-94.
31.	Jin C, Kim MH, Kim SJ, et al. Predicting successful recanalization in patients with native coronary chronic total occlusion: the Busan CTO Score. Cardiology, 2017, 137(2): 83-91.
32.	Ellis SG, Burke MN, Murad MB, et al. Predictors of successful hybrid-approach chronic total coronary artery occlusion stenting: an improved model with novel correlates. JACC Cardiovasc Interv, 2017, 10(11): 1089-1098.
33.	Fujino A, Otsuji S, Hasegawa K, et al. Accuracy of J-CTO score derived from computed tomography versus angiography to predict successful percutaneous coronary intervention. JACC Cardiovasc Imaging, 2018, 11(2 Pt 1): 209-217.
34.	Maeremans J, Spratt JC, Knaapen P, et al. Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: the RECHARGE score. Catheter Cardiovasc Interv, 2018, 91(2): 192-202.
35.	Kalnins A, Strele I, Lejnieks A. Comparison among different scoring systems in predicting procedural success and long-term outcomes after percutaneous coronary intervention in patients with chronic total coronary artery occlusions. Medicina (Kaunas), 2019, 55(8): 494.
36.	Szijgyarto Z, Rampat R, Werner GS, et al. Derivation and validation of a chronic total coronary occlusion intervention procedural success score from the 20, 000-patient EuroCTO registry: the EuroCTO (CASTLE) score. JACC Cardiovasc Interv, 2019, 12(4): 335-342.
37.	李文铮, 吴铮, 彭红玉, 等. 既往失败慢性完全闭塞病变经皮冠状动脉介入治疗再次尝试成功的预测因素及短期预后. 中国介入心脏病学杂志, 2020, 28(12): 695-699.
38.	Gong M, Peng H, Wu Z, et al. Angiographic scoring system for predicting successful percutaneous coronary intervention of in-stent chronic total occlusion. J Cardiovasc Transl Res, 2021, 14(4): 598-609.
39.	Kalogeropoulos AS, Alsanjari O, Keeble TR, et al. CASTLE score versus J-CTO score for the prediction of technical success in chronic total occlusion percutaneous revascularisation. EuroIntervention, 2020, 15(18): e1615-e1623.
40.	Ochiumi Y, Yamamoto M, Tsuchikane E, et al. Predictors of prolonged guidewire manipulation time for native coronary chronic total occlusion percutaneous coronary intervention via primary antegrade approach. Catheter Cardiovasc Interv, 2021, 98(4): E571-E580.
41.	邢浩然, 王锐, 张东凤, 等. 慢性完全闭塞病变行经皮冠状动脉介入治疗结局影响因素分析及对临床-病变相关评分预测价值的评价. 中国介入心脏病学杂志, 2021, 29(4): 189-193.
42.	Ochiumi Y, Suzuki Y, Murata A, et al. The evaluation of technical outcome and wire manipulation time within 30 min in patients with poor distal vessel quality on percutaneous coronary intervention for chronic total occlusion. Cardiovasc Interv Ther, 2021, 36(1): 67-73.
43.	Kolk MZH, van Veelen A, Agostoni P, et al. Predictors and outcomes of procedural failure of percutaneous coronary intervention of a chronic total occlusion-a subanalysis of the EXPLORE trial. Catheter Cardiovasc Interv, 2021, 97(6): 1176-1183.
44.	Li W, Wu Z, Peng H, et al. Predicting the success rate of elective percutaneous coronary intervention for prior failed chronic total occlusion: a novel scoring system. J Cardiovasc Transl Res, 2022, 15(4): 797-804.
45.	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 冠状动脉CTO病变PCI前向开通技术中国专家共识. 中华心血管病杂志, 2023, 51(1): 3-18.
46.	Zein R, Seth M, Othman H, et al. Association of operator and hospital experience with procedural success rates and outcomes in patients undergoing percutaneous coronary interventions for chronic total occlusions: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Circ Cardiovasc Interv, 2020, 13(8): e008863.
47.	Tajti P, Karmpaliotis D, Alaswad K, et al. Prevalence, presentation and treatment of 'balloon undilatable' chronic total occlusions: insights from a multicenter US registry. Catheter Cardiovasc Interv, 2018, 91(4): 657-666.
48.	殷磊, 滕彬彬, 马明平, 等. 基于冠状动脉CT血管成像的慢性完全闭塞病变评分在介入治疗中的预测价值. 中华放射学杂志, 2020, 54(1): 17-22.
49.	Wang R, He Y, Xing H, et al. Inclusion of quantitative high-density plaque in coronary computed tomographic score system to predict the time of guidewire crossing chronic total occlusion. Eur Radiol, 2022, 32(7): 4565-4573.
50.	Tian T, Guan C, Gao L, et al. Prognostic significance of occlusion length in recanalized chronic total occlusion lesion: a retrospective cohort study with 5-year follow-up. BMJ Open, 2020, 10(7): e038302.
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1. Brilakis ES, Mashayekhi K, Tsuchikane E, et al. Guiding principles for chronic total occlusion percutaneous coronary intervention. Circulation, 2019, 140(5): 420-433.
2. Tomasello SD, Boukhris M, Giubilato S, et al. Management strategies in patients affected by chronic total occlusions: results from the Italian Registry of Chronic Total Occlusions. Eur Heart J, 2015, 36(45): 3189-3198.
3. Lee SW, Lee PH, Ahn JM, et al. Randomized trial evaluating percutaneous coronary intervention for the treatment of chronic total occlusion. Circulation, 2019, 139(14): 1674-1683.
4. 王智琪, 李佩钊, 郑金刚. CTO患者PCI与口服药物治疗疗效比较的荟萃分析. 中华心血管病杂志, 2022, 50(6): 591-599.
5. Zaman S, Berry C. Chronic total occlusions with multivessel disease; does bypass grafting beat percutaneous coronary intervention. Circ Cardiovasc Interv, 2022, 15(2): e011786.
6. Stone GW. Percutaneous coronary intervention of chronic total occlusions: conquering the final frontier. JACC Cardiovasc Interv, 2018, 11(14): 1336-1339.
7. 陆浩, 葛雷. 冠状动脉慢性闭塞病变介入治疗的原则及进展. 中华心血管病杂志(网络版), 2022, 5(1): 1-7.
8. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA, 2000, 283(15): 2008-2012.
9. 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(2): 213-221.
10. Alessandrino G, Chevalier B, Lefèvre T, et al. A clinical and angiographic scoring system to predict the probability of successful first-attempt percutaneous coronary intervention in patients with total chronic coronary occlusion. JACC Cardiovasc Interv, 2015, 8(12): 1540-1548.
11. Opolski MP, Achenbach S, Schuhbäck A, et al. Coronary computed tomographic prediction rule for time-efficient guidewire crossing through chronic total occlusion: insights from the CT-RECTOR multicenter registry (Computed Tomography Registry of Chronic Total Occlusion Revascularization). JACC Cardiovasc Interv, 2015, 8(2): 257-267.
12. 韩雅玲, 张剑, 荆全民, 等. 慢性完全闭塞冠状动脉病变1148例患者的介入治疗. 中华心血管病杂志, 2005, 33(4): 299-302.
13. Mollet NR, Hoye A, Lemos PA, et al. Value of preprocedure multislice computed tomographic coronary angiography to predict the outcome of percutaneous recanalization of chronic total occlusions. Am J Cardiol, 2005, 95(2): 240-243.
14. Soon KH, Cox N, Wong A, et al. CT coronary angiography predicts the outcome of percutaneous coronary intervention of chronic total occlusion. J Interv Cardiol, 2007, 20(5): 359-366.
15. García-García HM, van Mieghem CA, Gonzalo N, et al. Computed tomography in total coronary occlusions (CTTO registry): radiation exposure and predictors of successful percutaneous intervention. EuroIntervention, 2009, 4(5): 607-616.
16. 伊宪华, 韩雅玲, 李毅, 等. 介入治疗开通慢性完全闭塞病变的长期临床疗效. 中华心血管病杂志, 2009, 37(9): 773-776.
17. Cho JR, Kim YJ, Ahn CM, et al. Quantification of regional calcium burden in chronic total occlusion by 64-slice multi-detector computed tomography and procedural outcomes of percutaneous coronary intervention. Int J Cardiol, 2010, 145(1): 9-14.
18. Hsu JT, Kyo E, Chu CM, et al. Impact of calcification length ratio on the intervention for chronic total occlusions. Int J Cardiol, 2011, 150(2): 135-141.
19. Choi JH, Song YB, Hahn JY, et al. Three-dimensional quantitative volumetry of chronic total occlusion plaque using coronary multidetector computed tomography. Circ J, 2011, 75(2): 366-375.
20. Martín-Yuste V, Barros A, Leta R, et al. Factors determining success in percutaneous revascularization of chronic total coronary occlusion: multidetector computed tomography analysis. Rev Esp Cardiol (Engl Ed), 2012, 65(4): 334-340.
21. Nombela-Franco L, Urena M, Jerez-Valero M, et al. Validation of the J-chronic total occlusion score for chronic total occlusion percutaneous coronary intervention in an independent contemporary cohort. Circ Cardiovasc Interv, 2013, 6(6): 635-643.
22. Luo C, Huang M, Li J, et al. Predictors of interventional success of antegrade PCI for CTO. JACC Cardiovasc Imaging, 2015, 8(7): 804-813.
23. Christopoulos G, Wyman RM, Alaswad K, et al. Clinical utility of the Japan-chronic total occlusion score in coronary chronic total occlusion interventions: results from a multicenter registry. Circ Cardiovasc Interv, 2015, 8(7): e002171.
24. Christopoulos G, Kandzari DE, Yeh RW, 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): 1-9.
25. Chai WL, Agyekum F, Zhang B, et al. Clinical prediction score for successful retrograde procedure in chronic total occlusion percutaneous coronary intervention. Cardiology, 2016, 134(3): 331-339.
26. Danek BA, Karatasakis A, Karmpaliotis D, et al. Development and validation of a scoring system for predicting periprocedural complications during percutaneous coronary interventions of chronic total occlusions: the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) complications score. J Am Heart Assoc, 2016, 5(10): e004272.
27. de Castro-Filho A, Lamas ES, Meneguz-Moreno RA, et al. Impact of the occlusion duration on the performance of J-CTO score in predicting failure of percutaneous coronary intervention for chronic total occlusion. J Invasive Cardiol, 2017, 29(6): 195-201.
28. Yu CW, Lee HJ, Suh J, et al. Coronary computed tomography angiography predicts guidewire crossing and success of percutaneous intervention for chronic total occlusion: Korean multicenter CTO CT registry score as a tool for assessing difficulty in chronic total occlusion percutaneous coronary intervention. Circ Cardiovasc Imaging, 2017, 10(4): e005800.
29. Tan Y, Zhou J, Zhang W, et al. Comparison of CT-RECTOR and J-CTO scores to predict chronic total occlusion difficulty for percutaneous coronary intervention. Int J Cardiol, 2017, 235: 169-175.
30. Namazi MH, Serati AR, Vakili H, et al. A novel risk score in predicting failure or success for antegrade approach to percutaneous coronary intervention of chronic total occlusion: antegrade CTO score. Int J Angiol, 2017, 26(2): 89-94.
31. Jin C, Kim MH, Kim SJ, et al. Predicting successful recanalization in patients with native coronary chronic total occlusion: the Busan CTO Score. Cardiology, 2017, 137(2): 83-91.
32. Ellis SG, Burke MN, Murad MB, et al. Predictors of successful hybrid-approach chronic total coronary artery occlusion stenting: an improved model with novel correlates. JACC Cardiovasc Interv, 2017, 10(11): 1089-1098.
33. Fujino A, Otsuji S, Hasegawa K, et al. Accuracy of J-CTO score derived from computed tomography versus angiography to predict successful percutaneous coronary intervention. JACC Cardiovasc Imaging, 2018, 11(2 Pt 1): 209-217.
34. Maeremans J, Spratt JC, Knaapen P, et al. Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: the RECHARGE score. Catheter Cardiovasc Interv, 2018, 91(2): 192-202.
35. Kalnins A, Strele I, Lejnieks A. Comparison among different scoring systems in predicting procedural success and long-term outcomes after percutaneous coronary intervention in patients with chronic total coronary artery occlusions. Medicina (Kaunas), 2019, 55(8): 494.
36. Szijgyarto Z, Rampat R, Werner GS, et al. Derivation and validation of a chronic total coronary occlusion intervention procedural success score from the 20, 000-patient EuroCTO registry: the EuroCTO (CASTLE) score. JACC Cardiovasc Interv, 2019, 12(4): 335-342.
37. 李文铮, 吴铮, 彭红玉, 等. 既往失败慢性完全闭塞病变经皮冠状动脉介入治疗再次尝试成功的预测因素及短期预后. 中国介入心脏病学杂志, 2020, 28(12): 695-699.
38. Gong M, Peng H, Wu Z, et al. Angiographic scoring system for predicting successful percutaneous coronary intervention of in-stent chronic total occlusion. J Cardiovasc Transl Res, 2021, 14(4): 598-609.
39. Kalogeropoulos AS, Alsanjari O, Keeble TR, et al. CASTLE score versus J-CTO score for the prediction of technical success in chronic total occlusion percutaneous revascularisation. EuroIntervention, 2020, 15(18): e1615-e1623.
40. Ochiumi Y, Yamamoto M, Tsuchikane E, et al. Predictors of prolonged guidewire manipulation time for native coronary chronic total occlusion percutaneous coronary intervention via primary antegrade approach. Catheter Cardiovasc Interv, 2021, 98(4): E571-E580.
41. 邢浩然, 王锐, 张东凤, 等. 慢性完全闭塞病变行经皮冠状动脉介入治疗结局影响因素分析及对临床-病变相关评分预测价值的评价. 中国介入心脏病学杂志, 2021, 29(4): 189-193.
42. Ochiumi Y, Suzuki Y, Murata A, et al. The evaluation of technical outcome and wire manipulation time within 30 min in patients with poor distal vessel quality on percutaneous coronary intervention for chronic total occlusion. Cardiovasc Interv Ther, 2021, 36(1): 67-73.
43. Kolk MZH, van Veelen A, Agostoni P, et al. Predictors and outcomes of procedural failure of percutaneous coronary intervention of a chronic total occlusion-a subanalysis of the EXPLORE trial. Catheter Cardiovasc Interv, 2021, 97(6): 1176-1183.
44. Li W, Wu Z, Peng H, et al. Predicting the success rate of elective percutaneous coronary intervention for prior failed chronic total occlusion: a novel scoring system. J Cardiovasc Transl Res, 2022, 15(4): 797-804.
45. 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 冠状动脉CTO病变PCI前向开通技术中国专家共识. 中华心血管病杂志, 2023, 51(1): 3-18.
46. Zein R, Seth M, Othman H, et al. Association of operator and hospital experience with procedural success rates and outcomes in patients undergoing percutaneous coronary interventions for chronic total occlusions: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Circ Cardiovasc Interv, 2020, 13(8): e008863.
47. Tajti P, Karmpaliotis D, Alaswad K, et al. Prevalence, presentation and treatment of 'balloon undilatable' chronic total occlusions: insights from a multicenter US registry. Catheter Cardiovasc Interv, 2018, 91(4): 657-666.
48. 殷磊, 滕彬彬, 马明平, 等. 基于冠状动脉CT血管成像的慢性完全闭塞病变评分在介入治疗中的预测价值. 中华放射学杂志, 2020, 54(1): 17-22.
49. Wang R, He Y, Xing H, et al. Inclusion of quantitative high-density plaque in coronary computed tomographic score system to predict the time of guidewire crossing chronic total occlusion. Eur Radiol, 2022, 32(7): 4565-4573.
50. Tian T, Guan C, Gao L, et al. Prognostic significance of occlusion length in recanalized chronic total occlusion lesion: a retrospective cohort study with 5-year follow-up. BMJ Open, 2020, 10(7): e038302.
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The angiographic predictors of successful chronic total occlusion percutaneous coronary intervention: a meta-analysis

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