Temporal trends and outcomes of long coronary chronic total occlusion interventions: the Japanese CTO-PCI expert registry.

Data on percutaneous coronary intervention (PCI) for long chronic total occlusions (CTOs) are limited. We sought to identify temporal trends in PCI for long CTOs. We studied patients undergoing CTO-PCI between January 2015 and December 2022. Long CTO was defined as an occlusion length of ≥ 20 mm. The study population consisted of 10,302 patients, of whom 5,627 (54.6%) had a long CTO. Of these, 1,937 CTOs (34.4%) underwent primary retrograde approach and 1,486 CTOs (26.4%) underwent reverse controlled antegrade and retrograde tracking (CART). Reverse CART had a higher technical success rate than retrograde wiring and intravascular ultrasound (IVUS)-guided wiring after antegrade wiring (94.7%, 91.0%, and 81.6%, respectively), a longer guidewire crossing time (124, 92, and 85 min, respectively), and a higher incidence of coronary perforation (8.5%, 4.9%, and 6.3%, respectively) (P < 0.01 for all). For long CTOs with good distal landing without side branches, the use of primary retrograde approach and reverse CART decreased over time from 39.9% to 27.3% and from 36.3% to 20.1%, respectively, whereas the use of antegrade wiring and IVUS-guided wiring after antegrade wiring increased from 46.6% to 58.7% and from 1.0% to 8.7%, respectively (P for trend < 0.01 for all). In PCI for long CTOs, reverse CART was the most commonly used re-entry technique. For long CTOs with good distal landing without side branches, the use of primary retrograde approach and reverse CART decreased, whereas the use of antegrade wiring and IVUS-guided wiring after antegrade wiring increased.