The Impact of Proximal Vessel Tortuosity on the Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry

J Invasive Cardiol. 2017 Aug;29(8):264-270. Epub 2017 May 15.


Introduction: We examined the impact of proximal vessel tortuosity on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Methods: The baseline clinical and angiographic characteristics and procedural outcomes of 1618 consecutive CTO-PCIs performed between 2012 and 2016 at 14 United States centers in 1589 patients were reviewed.

Results: Mean patient age was 65.3 ± 10.0 years and 85% were men. Moderate/severe proximal vessel tortuosity was present in 35.7% of target lesions. Compared with non-tortuous lesions, tortuous lesions had longer length (30 mm [interquartile range, 20-50 mm] vs 28 mm [interquartile range, 16-40 mm]; P<.001), more proximal cap ambiguity (36% vs 28%; P<.01), and more frequent utilization of the retrograde approach (52% vs 37%; P<.001). Moderate/severe proximal vessel tortuosity was associated with lower technical success rates (84.1% vs 91.3%; P<.001) and procedural success rates (82.3% vs 89.9%; P<.001), but similar incidence of major cardiac adverse events (3.0% vs 2.5%; P=.59). Moderate/severe tortuosity was associated with longer procedure time and fluoroscopy time, higher air kerma radiation dose, and larger contrast volume.

Conclusion: In a contemporary multicenter registry, moderate/severe proximal vessel tortuosity was present in approximately one-third of target CTO lesions and was associated with more frequent use of the retrograde approach and lower success rates, but similar complication rates.

MeSH terms

  • Aged
  • Contrast Media
  • Coronary Angiography / methods*
  • Coronary Occlusion* / diagnosis
  • Coronary Occlusion* / surgery
  • Coronary Vessel Anomalies* / complications
  • Coronary Vessel Anomalies* / diagnosis
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Intraoperative Complications* / diagnosis
  • Intraoperative Complications* / etiology
  • Male
  • Middle Aged
  • Operative Time
  • Outcome and Process Assessment, Health Care
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / methods
  • Radiation Monitoring
  • Risk Factors
  • United States


  • Contrast Media