In-stent versus de novo chronic total occlusion PCI: Similar acute success but distinct procedural and treatment patterns.

Authors

Semi Ozturk, Ahmet Seyfeddin Gurbuz, Sefa Sural, Vedat Aslan, Busra Ozyesil, Sevket Gorgulu

Published in

Kardiologia polska. Aug 12, 2026. Epub Aug 12, 2026.

Abstract

Whether in-stent chronic total occlusion (ISR-CTO) reflects lower CTO percutaneous coronary intervention (PCI) efficacy or a distinct procedural profile remains uncertain.
To compare acute outcomes, strategy, and treatment pattern between ISR-CTO and de novo CTO.
We performed a retrospective procedure-level analysis of a prospectively maintained three-center CTO PCI registry from Türkiye, including consecutive procedures between January 2019 and February 2026. The primary endpoint was procedural success, defined as technical success without in-hospital major procedural complications. Technical success was final TIMI 3 flow with residual stenosis < 30%. Major procedural complications included death, stroke, emergency repeat PCI or coronary artery bypass grafting (CABG), donor-vessel complication, and coronary or collateral perforation requiring active treatment. Multivariable logistic regression and prespecified sensitivity analyses were performed.
Among 2375 CTO PCI procedures, 296 (12.5%) involved ISR-CTO. Technical success was 92.9% in ISR-CTO and 91.7% in de novo CTO (P = 0.49). Procedural success was 90.2% and 89.0% (P = 0.55), and major procedural complications were similar (3.4% vs. 3.9%, P = 0.66). After adjustment, ISR-CTO was not associated with lower technical success (OR, 1.26; 95% CI, 0.77-2.05), lower procedural success (OR, 1.20; 95% CI, 0.79-1.83), or higher complication risk (OR, 0.84; 95% CI, 0.43-1.66). ISR-CTO was associated with less actual retrograde involvement, greater IVUS/DCB use, and a lower observed DES implantation rate.
ISR-CTO showed acute procedural results comparable to de novo CTO in this selected multicenter cohort. Its main differences were procedural and treatment-related, including less actual retrograde involvement and different IVUS/DCB/DES use.

PMID:
42581751
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

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