Percutaneous coronary intervention of chronic total occlusion: A 5-year monocentric experience

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Published Apr 1, 2026
https://doi.org/10.62438/tunismed.v104i02.6457
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Vol. 104 No. 02 (2026): Tunis Med Fev 2026

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Selim Boudiche
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Mouna Bader
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Manel Abbassi
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Zeynab Jebbari
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Nadim Khader
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Bassem Rekik
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Fourat Zouari
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Amal Ben Salem
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Khaled Ezzaouia
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Boutheina Besbes
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Mohamed Chedly
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Foued Daly
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Rim Ben Rejeb
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Faten El Ayech
Cardiology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Dhekra Sebki
Anesthesiology Department, , La Rabta Hospital , Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Ines Bounaoues
Anesthesiology Department, , La Rabta Hospital , Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Mehrez Gouader
Anesthesiology Department, , La Rabta Hospital , Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Fathia Mghaieth
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Sana Ouali
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Noureddine Larbi
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Manel Ben Halima
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Mohamed Sami Mourali1
Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.

Abstract

Background: Chronic total occlusions (CTO) occurin 15-30% of coronaryangiogram, yetthischallenginglesionsubsetrepresentslessthan 10% of percutaneouscoronary interventions (PCI). Tunisian data are lacking. This study analyses a real-life Tunisian CTO-PCI immediate and long-termresults.


Methods: Single-center, observational retro-prospective study, between 2018 and 2023. Primaryendpointwas to assesstechnicalsuccess, major procedural complications, and targetlesionfailure (TLF) at 12-months. Secondaryendpointwas to identifyfactorsassociated to technicalfailure.


Results: 115 patients, 122 CTOslesions, 133 CTO-PCIs. Mean age 62±14.4 years. Gender-Ratio=6. Mean J-CTO score was 1.47±1.12. Dual injection (43.6%) and microcatheters (50.4%) wereunderused. Number of guidewires per procedurewas 2.35±1.12. Anterograde, retrograde and hybridapproacheswerenotedin 85%, 9% and 6%, respectively. Technicalsuccesswas 69.2% (of 133 procedures) and proceduralsuccesswas 73.0% (of 115 patients). Major complication rate stood at 3%. At 12 months, cardiovascularmortalitywas 7.0%, withoutdifferenceaccording to proceduralsuccess. TLF was 9.4% amongsuccessful CTO-PCIs. Associated factors to technicalfailurewere bifurcation involvement (OR=5.83 [1.7–20.1]; p=0.005), use of more than 4 guidewires per-procedure (OR=6.83 [1.6–28.7]; p=0.009), de-novo CTO (HR=8.43 [1.9–36.6]; p=0.004), previousattempts (OR=8.87 [1.8–43.6]; p=0.007), and no microcatheter use (OR=11.4 [3.5–36.8]; p=0.001).


Conclusion: This real-life studyfills a gap in Tunisian data on CTO-PCI outcomeswithtechnicalsuccess, complications and TLF rates comparable to thosereported in literature. 12-month survival rates weresimilarbetweensuccessful and failedprocedure groups.

Keywords:

Chronic total occlusion, Prognosis, Percutaneous coronary intervention, Technical success.

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