ArticleThe British journal of radiology2025
Development of a scoring system to predict endovascular crossing of femoropopliteal artery chronic total occlusions: the Endo VAscular CROSsing Score for Chronic Total Occlusions (EVACROSS-CTO).
Article in The British journal of radiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Interventionalist Intuition to Algorithm: Can Machine Learning Predict the Uncrossable Lesion in Femoropopliteal Occlusions?Cardiovascular and interventional radiology · 2026Article
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6 authors.
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Abstract
objectivesTo develop a predictive score for the prediction of successful endovascular crossing in femoropopliteal artery chronic total occlusions (CTOs).
methodsIn this retrospective study, 84 patients were divided 70%:30% into a training and a testing cohort. Parameters such as cap morphology, side branches, bridging collaterals, flush occlusion, and length were derived from pre-procedural CT angiography. Lesions were segmented and calcification burden was assessed by thresholding. A score (EndoVAscular CROSsing Score for Chronic Total Occlusion [EVACROSS-CTO]) was built based on multivariate logistic regression. Receiver operating characteristics (ROC) curve analysis determined the optimal score threshold, with reported accuracy, sensitivity, specificity, and area under the curve (AUC).
resultsFactors including age > 50 years (P = .036, odds ratio (OR) = 53.7), calcification percentage >10% (P = .011, OR = 16.63), the presence of a flush occlusion (P = .02, OR = 15.564), the presence of a distal side branch (P = .018, OR = 9.879), and the presence of a proximal side branch (P = 0.064, OR = 23.369) were identified as suitable for inclusion in the score. Score values were assigned based on the relative odds ratio for each factor with a maximum score of 22. EVACROSS-CTO was able to predict the success of endovascular recanalization with an AUC-ROC of 79.8% (95% CI, 58.5%-100%). A score >16 yielded a sensitivity of 75% with a specificity of 70.6% for the prediction of treatment failure.
conclusionsA score was developed by incorporating variables derived from pre-procedural CT angiography, demonstrating promising predictive capacity in determining the success of endovascular recanalization of CTOs. ADVANCES IN KNOWLEDGE: EVACROSS-CTO incorporates imaging variables for the prediction of endovascular recanalization success. This score will allow improved pre-procedural planning for femoropopliteal CTO management.
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