Clinical Impact of Location on the Outcomes of Left Anterior Descending Artery Chronic Total Occlusion Percutaneous Coronary Intervention
Sefa Sural, Ahmet Seyfeddin Gurbuz, Abdullah Yildirim, Vedat Aslan, Baris Duzel, Gokhan Avci, Emre Pacacı, Omer Bedir, Serafettin Demir, Sevket Gorgulu, Emmanouil S. BrilakisABSTRACT
Background
The anatomical location of left anterior descending artery (LAD) chronic total occlusion (CTO) may influence procedural complexity and technical success beyond conventional CTO scores.
Aims
We evaluated the association between LAD CTO location and procedural characteristics and outcomes.
Methods
Consecutive patients undergoing LAD CTO percutaneous coronary intervention at three centers between 2019 and 2026 were classified as having ostial, proximal, or mid/distal CTOs. Lesion complexity, crossing strategy, resource utilization, and in‐hospital outcomes were compared. Multivariable logistic regression was adjusted for clinical characteristics and either the J‐CTO or EuroCTO score.
Results
Among 2157 CTO procedures, 644 involved the LAD: 81 ostial, 144 proximal, and 419 mid/distal lesions. Ostial CTOs had greater anatomical complexity and required a retrograde approach more frequently than proximal and mid/distal lesions (43.2% vs. 20.1% vs. 14.1%; p < 0.001). They were also associated with longer procedures, greater guidewire use, and higher contrast volume. Technical success was lower in ostial lesions (77.8% vs. 89.6% vs. 92.6%; p < 0.001), whereas in‐hospital major adverse cardiovascular events were similar. Ostial location remained independently associated with lower technical success after adjustment for the J‐CTO score (OR, 0.43; 95% CI, 0.21–0.87; p = 0.019) or EuroCTO score (OR, 0.41; 95% CI, 0.20–0.84; p = 0.015).
Conclusions
Ostial LAD CTOs require retrograde strategies more often and have lower technical success despite adjustment for established CTO scores.