title: Percutaneous intervention in chronic total coronary occlusions caused by in-stent restenosis: procedural results and long-term clinical outcomes in the TORO (Spanish registry of chronic TOtal occlusion secondary to an occlusive in-stent RestenOsis) multicentre registry.
abstract: OBJECTIVE
  Limited data exist on the treatment and outcomes of patients with chronic total occlusions due to in-stent restenosis (CTO-ISR). We sought to evaluate results and clinical outcomes in percutaneous interventions over CTO-ISR.
  
  
  RESULTS
  We conducted a registry in 16 centres involving consecutive patients undergoing attempted percutaneous intervention over CTO-ISR. A total of 233 patients were included, 192 (82.4%) with a successful acute result. The success rate was significantly lower in patients with: lesion in the circumflex artery, ostial lesions, J score >3 and no femoral access. The presence of tandem lesions (OR 0.19, 95% CI: 0.06-0.68; p=0.01) was identified as an independent predictor for outcome. After a median follow-up of 20 months, cardiac death in the successful vs. failed groups was 3% and 8.3%, respectively (p=0.09). Independent predictors for mortality were previous CABG (HR 8, 95% CI: 1.3-50; p=0.02) and multivessel disease (HR 2.3, 95% CI: 1.2-4.3; p=0.01). In the successful group, TLR was 15%, re-occlusion 6% and definite/probable stent thrombosis 1.8%.
  
  
  CONCLUSIONS
  Percutaneous treatment of CTO due to ISR in contemporary practice shows a high success rate, resulting in good long-term results. The angiographic and procedural predictors identified may contribute to improving procedural outcome through better patient selection.
authors.affiliation: Hospital U. Marques de Valdecilla, Santander, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: de la Torre Hernandez
authors.forename: José R
authors.initials: JR
authors.lastname: Rumoroso
authors.forename: Asier
authors.initials: A
authors.lastname: Subinas
authors.forename: Nieves
authors.initials: N
authors.lastname: Gonzalo
authors.forename: Soledad
authors.initials: S
authors.lastname: Ojeda
authors.forename: Manuel
authors.initials: M
authors.lastname: Pan
authors.forename: Victoria
authors.initials: V
authors.lastname: Martín Yuste
authors.forename: Alfonso
authors.initials: A
authors.lastname: Suárez
authors.forename: Felipe
authors.initials: F
authors.lastname: Hernández
authors.forename: Luis
authors.initials: L
authors.lastname: Teruel
authors.forename: José
authors.initials: J
authors.lastname: Moreu
authors.forename: José M
authors.initials: JM
authors.lastname: Cubero
authors.forename: José D
authors.initials: JD
authors.lastname: Cascón
authors.forename: Hugo
authors.initials: H
authors.lastname: Vinhas
authors.forename: Íñigo
authors.initials: Í
authors.lastname: Lozano
authors.forename: Javier
authors.initials: J
authors.lastname: Martin Moreiras
authors.forename: Armando
authors.initials: A
authors.lastname: Pérez de Prado
authors.forename: Javier
authors.initials: J
authors.lastname: Goicolea
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome