Evaluating the frequency of successful guidewire crossing through a complex lesion in coronary artery disease patients having chronic total occlusion

Objectives: To determine the frequency of successful guidewire crossing through chronic total occlusion (CTO) in patients having a J-CTO Score = 2 (difficult lesion).

Methods: A prospective, cross-sectional study was conducted at the Armed Forces Institute of Cardiology (AFIC) in Rawalpindi. Patients with high calcium score on CT-angiogram were sent for elective coronary angiogram out of which patients diagnosed with chronic total occlusion (CTO) were selected and J-CTO Score was assessed. Those with a J-CTO score = 2 (difficult lesion) were enrolled for percutaneous coronary intervention (PCI). Guidewire that can cross the lesion within 30 minutes was considered successful.

Results: A total of 158(95.8%) cases had successful guidewire crossing, while in 7(4.2%) patients, the procedure was unsuccessful. No significant association between the success rate of guidewire crossing and age (p = 0.21). Furthermore, there was no statistically significant relationship between guidewire crossing and LV function (p = 0.559) i.e. 32.2% and 42.9% of those with LV function between 25-35% had successful and unsuccessful guidewire crossing, respectively. While 67.7% and 57.1% patients having 36-65% LV function were observed having successful and failed PCI, respectively.

Conclusions: The success rate of guidewire crossing through CTO in patients having a J-CTO Score =2 (difficult lesion) is acceptable so J-CTO score can be considered for difficulty grading of the lesion before intervention to prevent complications and success rate of PC