article · Catheterization and Cardiovascular Interventions
This study evaluated arterial healing after opening chronically blocked coronary arteries, known as chronic total occlusions, using two distinct surgical approaches: extraplaque and intraplaque recanalisation. In a single-centre study of 50 patients who underwent successful procedures across 51 blocked vessels, the choice of technique was guided by the anatomical characteristics of the blockage. Vascular healing was measured six months later using optical coherence tomography to calculate a neointimal healing score, which assesses uncovered stent struts, malapposition, and intraluminal defects. The analysis revealed that the extraplaque approach produced a healing score comparable to the intraplaque technique. Rates of target vessel failure were also statistically similar between both groups at the six-month follow-up. These observations indicate that extraplaque techniques achieve similar mid-term vascular healing and safety profiles compared to traditional intraplaque procedures.
Opening completely blocked heart arteries often requires navigating outside the plaque rather than directly through it. Demonstrating that extraplaque techniques yield comparable vascular healing and safety outcomes to conventional intraplaque methods provides interventional cardiologists with greater confidence when choosing treatment strategies for complex arterial blockages, potentially improving procedural success rates without compromising mid-term vessel recovery.
The findings inform clinical decision-making for interventional cardiologists and medical device developers evaluating coronary stents and imaging protocols for chronic total occlusions. Because this is an observational clinical study assessing established surgical procedures and approved optical coherence tomography tools, the research represents applied clinical evaluation rather than a new standalone product. Further trials could help medical device manufacturers design specialised tools tailored specifically to extraplaque recanalisation.
AI-generated from the published abstract. Always read the original work before citing.
BACKGROUND: The expanding utilization of extraplaque (EP) strategies has led to increasing success rates in coronary chronic total occlusion (CTO) recanalization. The contemporary EP techniques have shown mid-term outcomes comparable to intraplaque (IP) recanalization approaches. Differential neointimal healing after CTO recanalization by various approaches remains to be identified. AIM: This study aimed to assess the vascular healing response across different CTO recanalization techniques using optical coherence tomography (OCT)-derived Neointimal Healing Score (NIHS). METHODS: This was a prospective, observational, analytic, single-center study recruiting 50 consecutive patients who underwent successful recanalization of 51 coronary CTOs. The recanalization technique (EP vs. IP) was according to the operator's discretion based on the CTO anatomical characteristics. The study aimed to compare the impact of the EP versus IP recanalization technique on the vascular healing assessed by OCT-derived NIHS (evaluating the presence of uncovered and/or malapposed stent struts and intraluminal filling defects), 6 months after the index procedure. RESULTS: The mean age was 58 ± 8 years, and 35 (70%) were males. EP and IP techniques were used in 15 and 36 of the recanalized CTOs, respectively. At 6 months, clinical and angiographic follow-ups were completed for all patients, while interpretable OCT imaging was available for 39 patients (77%). The mean NIHS for all patients was 14.3 ± 9.7. The NIHS was comparable between EP and IP techniques (18 ± 7.4 vs. 14.1 ± 8.4; p = 0.51). Target vessel failure (TVF) occurred in 23.5% of all patients with a numerically nonsignificant higher rate in the EP compared to the IP technique (27% vs. 22%; p = 0.73). CONCLUSION: CTO recanalization using EP techniques is associated with a nonsignificant numerical increase in NIHS without leading to a significant difference in TVF compared to IP techniques at mid-term follow-up.
This page summarises published work. The authoritative version sits with the publisher.
DOI: 10.1002/ccd.70820
Is something wrong with this record? Report it or request removal.
Discussion
Have you built on this work, tried to replicate it, or seen it applied in practice? Share what you know. Verified researchers and MARATTO™ domain experts can open a discussion, and any member can reply. Contributions are reviewed before they appear.
No discussion yet. Open the first thread.
New to MARATTO™? Create a free account.
