Castle Score Versus J-CTO Score for The Prediction of Technical Success in Chronic Total Occlusion Percutaneous Revascularization

Main Article Content

Asfandyar Ashraf
Husnain Yousaf
Iftikhar Ahmed
Azmat Ullah
Zeeshan Ahmad
Muhammad Fasih Ullah Khan
Syed Tahseen Shehzad
Zahid Hussain
Muhammad Masoom
Muhammad Saad Mukhtar

Abstract

Background: Chronic total occlusions (CTOs) present a significant challenge in percutaneous coronary intervention (PCI). Accurate preprocedural assessment and planning are crucial for the success of these interventions. The J-CTO score has been widely used to predict the success of PCI in CTO cases, but recent developments have introduced the EuroCTO (CASTLE) score, which may offer advantages in complex cases.


Objective: This study aimed to compare the predictive accuracy of the EuroCTO (CASTLE) score with the J-CTO score in determining the success of PCI in CTO cases, with a focus on their utility in preprocedural planning and risk assessment.


Methods: Conducted at a tertiary cardiac care center in Rawalpindi, Pakistan, this analytical cross-sectional study involved 120 patients undergoing PCI for CTO from January 2023 to November 2023. Inclusion criteria were patients aged 18-80 years requiring PCI for CTO, while patients with acute coronary syndromes, pregnant women, or those refusing consent were excluded. Data on clinical, angiographic, and procedural characteristics were systematically recorded. The EuroCTO (CASTLE) and J-CTO scores were calculated based on established algorithms. Technical success was defined as effective revascularization of the CTO lesion with less than 30% residual stenosis and TIMI grade 3 antegrade flow restoration. Statistical analysis was conducted using SPSS 25.


Results: The mean age of the participants was 58.85 ± 11.1 years, with a male predominance (62.5%). Hypertension (67.5%) and hyperlipidemia (78.3%) were common comorbidities. The mean procedural time was 132.42 ± 5.11 minutes, and the mean fluoroscopy time was 41.19 ± 2.41 minutes. The J-CTO and EuroCTO (CASTLE) scores were 2.09 ± 0.70 and 1.91 ± 0.69, respectively. Multivariate logistic regression analysis showed comparable predictive performance between the two scores, with slightly better discriminative ability in complex cases for the EuroCTO (CASTLE) score.


Conclusion: Both the EuroCTO (CASTLE) and J-CTO scores effectively predict the success of PCI in CTO cases, with the EuroCTO (CASTLE) score showing potential advantages in more complex scenarios. These scoring systems are valuable tools for clinicians in preprocedural planning and risk assessment, enhancing the decision-making process in CTO interventions.

Article Details

How to Cite
Ashraf, A., Yousaf, H., Ahmed , I., Ullah, A., Ahmad, Z., Khan, M. F. U., Shehzad, S. T., Hussain, Z., Masoom, M., & Mukhtar, M. S. (2024). Castle Score Versus J-CTO Score for The Prediction of Technical Success in Chronic Total Occlusion Percutaneous Revascularization. Journal of Health and Rehabilitation Research, 4(1), 279–284. https://doi.org/10.61919/jhrr.v4i1.398
Section
Articles
Author Biographies

Asfandyar Ashraf, Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan

Fellow Intervention Cardiology, Department of Cardiology.

Husnain Yousaf, Rawalpindi Institute of Cardiology Rawalpindi.

Senior Registrar, Department of Cardiology.

Iftikhar Ahmed , Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan

Resident Cardiology, Department of Cardiology.

Azmat Ullah, Sheikh Mohamed Bin Zayed Al Nahyan Institute of Cardiology Quetta Pakistan.

Senior Registrar Interventional Cardiology, Department of Cardiology.

Zeeshan Ahmad, Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan

Fellow Intervention Cardiology, Department of Cardiology.

Muhammad Fasih Ullah Khan, Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan

Fellow Intervention Cardiology, Department of Cardiology.

Syed Tahseen Shehzad, Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan

Fellow Intervention Cardiology, Department of Cardiology.

Zahid Hussain, Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan

Resident Cardiology, Department of Cardiology.

Muhammad Masoom, Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan

Resident Cardiology, Department of Cardiology.

Muhammad Saad Mukhtar, Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan.

Medical Officer.

References

Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Osherov AB, Yalonetsky S, et al. Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. Journal of the American College of Cardiology. 2012;59(11):991-7.

Karatasakis A, Danek BA, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, et al. Comparison of various scores for predicting success of chronic total occlusion percutaneous coronary intervention. International journal of cardiology. 2016;224:50-6.

Yamamoto K, Ito H, Iwakura K, Kawano S, Ikushima M, Masuyama T, et al. Two different coronary blood flow velocity patterns in thrombolysis in myocardial infarction flow grade 2 in acute myocardial infarction: insight into mechanisms of microvascular dysfunction. Journal of the American College of Cardiology. 2002;40(10):1755-60.

Christofferson RD, Lehmann KG, Martin GV, Every N, Caldwell JH, Kapadia SR. Effect of chronic total coronary occlusion on treatment strategy. The American journal of cardiology. 2005;95(9):1088-91.

Koelbl CO, Nedeljkovic ZS, Jacobs AK. Coronary chronic total occlusion (CTO): a review. Reviews in cardiovascular medicine. 2018;19(1):38-44.

Vo MN, Brilakis ES, Kass M, Ravandi A. Physiologic significance of coronary collaterals in chronic total occlusions. Canadian Journal of Physiology and Pharmacology. 2015;93(10):867-71.

Azzalini L, Jolicoeur EM, Pighi M, Millán X, Picard F, Tadros V-X, et al. Epidemiology, management strategies, and outcomes of patients with chronic total coronary occlusion. The American journal of cardiology. 2016;118(8):1128-35.

Claessen BE, van der Schaaf RJ, Verouden NJ, Stegenga NK, Engstrom AE, Sjauw KD, et al. Evaluation of the effect of a concurrent chronic total occlusion on long-term mortality and left ventricular function in patients after primary percutaneous coronary intervention. JACC: Cardiovascular Interventions. 2009;2(11):1128-34.

Konstantinidis NV, Werner GS, Deftereos S, Di Mario C, Galassi AR, Buettner JH, et al. Temporal trends in chronic Total occlusion interventions in Europe: 17 626 procedures from the European registry of chronic Total occlusion. Circulation: Cardiovascular Interventions. 2018;11(10):e006229.

Suzuki Y, Tsuchikane E, Katoh O, Muramatsu T, Muto M, Kishi K, et al. Outcomes of percutaneous coronary interventions for chronic total occlusion performed by highly experienced Japanese specialists: the first report from the Japanese CTO-PCI Expert Registry. JACC: Cardiovascular Interventions. 2017;10(21):2144-54.

Galassi A, Werner G, Boukhris M, Azzalini L, Mashayekhi K, Carlino M, et al. Percutaneous recanalization of chronic total occlusions: 2019 Consensus. EIJ-D-18-00826, 2014.

Sachdeva R, Agrawal M, Flynn SE, Werner GS, Uretsky BF. The myocardium supplied by a chronic total occlusion is a persistently ischemic zone. Catheterization and Cardiovascular Interventions. 2014;83(1):9-16.

Galassi AR, Brilakis ES, Boukhris M, Tomasello SD, Sianos G, Karmpaliotis D, et al. Appropriateness of percutaneous revascularization of coronary chronic total occlusions: an overview. European Heart Journal. 2016;37(35):2692-700.

Morino Y, Abe M, Morimoto T, Kimura T, Hayashi Y, Muramatsu T, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC: Cardiovascular Interventions. 2011;4(2):213-21.

Galassi AR, Boukhris M, Azzarelli S, Castaing M, Marzà F, Tomasello SD. Percutaneous coronary revascularization for chronic total occlusions: a novel predictive score of technical failure using advanced technologies. JACC: Cardiovascular Interventions. 2016;9(9):911-22.

Christopoulos G, Kandzari DE, Yeh RW, Jaffer FA, Karmpaliotis D, Wyman MR, et al. Development and validation of a novel scoring system for predicting technical success of chronic total occlusion percutaneous coronary interventions: the PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) score. JACC: Cardiovascular Interventions. 2016;9(1):1-9.

Alessandrino G, Chevalier B, Lefèvre T, Sanguineti F, Garot P, Unterseeh T, et al. A clinical and angiographic scoring system to predict the probability of successful first-attempt percutaneous coronary intervention in patients with total chronic coronary occlusion. JACC: Cardiovascular Interventions. 2015;8(12):1540-8.

Maeremans J, Spratt JC, Knaapen P, Walsh S, Agostoni P, Wilson W, et al. Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: the RECHARGE score. Catheterization and Cardiovascular Interventions. 2018;91(2):192-202.

Ronnov-Jessen L, Petersen OW, Bissell MJ. Cellular changes involved in conversion of normal to malignant breast: importance of the stromal reaction. Physiological reviews. 1996;76(1):69-125.

Guelker J-E, Kinoshita Y, Weber-Albers J, Bufe A, Blockhaus C, Mashayekhi K. Validation of the newly introduced CASTLE Score for predicting successful CTO recanalization. IJC Heart & Vasculature. 2022;38:100942.

Michael TT, Karmpaliotis D, Brilakis ES, Abdullah SM, Kirkland BL, Mishoe KL, et al. Impact of prior coronary artery bypass graft surgery on chronic total occlusion revascularisation: insights from a multicentre US registry. Heart. 2013.

Teramoto T, Tsuchikane E, Matsuo H, Suzuki Y, Ito T, Ito T, et al. Initial success rate of percutaneous coronary intervention for chronic total occlusion in a native coronary artery is decreased in patients who underwent previous coronary artery bypass graft surgery. JACC: Cardiovascular Interventions. 2014;7(1):39-46.

Most read articles by the same author(s)