Success Rate of Drilling and Knuckle Wire Crossing Technique in Chronic total Occlusion of the Femoro-Popliteal Artery and Predicting Factors Related to it in Real-World Data

Sorracha Rookkapan; Thanakorn Phothong; Keerati Hongsakul; Jitpreedee Sungsiri; Surasit Akkakrisee; Phurich Janjindamai; Boonprasit Kritpracha; Wittawat Tantarattanapong; Pong Juntarapatin; Supong Worathanmanon

doi:10.31584/jhsmr.20241103

Success Rate of Drilling and Knuckle Wire Crossing Technique in Chronic total Occlusion of the Femoro-Popliteal Artery and Predicting Factors Related to it in Real-World Data

Sorracha Rookkapan, Thanakorn Phothong, Keerati Hongsakul, Jitpreedee Sungsiri, Surasit Akkakrisee, Phurich Janjindamai, Boonprasit Kritpracha, Wittawat Tantarattanapong, Pong Juntarapatin, Supong Worathanmanon

Abstract

Objective: Crossing chronic total occlusion (CTO) in femoro-popliteal (FP) arteries is challenging. Hence, this study aimed to describe real-world data on the technical success rate of crossing FP CTO lesions, and analyze predicting factors for crossing failure.
Material and Methods: This retrospective study, conducted at a single center, involved patients with peripheral arterial disease (PAD) and FP CTOs, categorized as Rutherford categories 3-6, having undergone endovascular recanalization from 2017 to 2022. Baseline characteristics and crossing success rates were described using frequencies, percentages, means, medians, standard deviations, and interquartile ranges. Factors associated with crossing failure were analyzed through logistic regression analysis, with statistical significance set at a p-value<0.05.
Results: Among the 181 patients analyzed, the majority exhibited minor tissue loss (63%) and severe disease (TASC II category D, GLASS grade 4). The predominant CTO crossing approach was based on plaque cap morphology (CTOP) classification type B (66.9%), with severe CTO calcification (PACSS type 4) in 23.8%. Median occlusion length was 16.1 cm; 85.6% successfully crossed the CTO and antegrade success was 57.5%. Factors associated with crossing failure included: CTOP types C or D, CTO at the P3-popliteal artery, severe CTO calcification, and dyslipidemia. Retrograde recanalization showed higher success rates in CTOP type D and longer occlusions.
Conclusion: This study highlights the safety and effectiveness of the catheter-wire crossing technique for FP CTOs. CTOP classification, CTO location, severe calcification, and dyslipidemia predicted crossing failure. The retrograde approach works well in CTOP type D and longer CTOs, providing insights for improving success in clinical practice.

Keywords

chronic limb-threatening ischemia; chronic total occlusion; crossing the lesion; femoro-popliteal arteries; predictive factor

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DOI: http://dx.doi.org/10.31584/jhsmr.20241103

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