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June 12, 2026Journal of the Society for Cardiovascular Angiography & InterventionsOpen Access

The Morphological and Mechanistic Impact of an Investment Procedure on Coronary Chronic Total Occlusions

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Why the study?

Does a planned investment procedure reduce occlusion complexity and improve morphology in high-risk coronary chronic total occlusions?

Population

80 consecutive patients with high-risk coronary chronic total occlusions returning for completion of CTO PCI

Comparison

Planned 2-stage CTO PCI with upfront… vs Baseline angiographic characteristics prior to…

Design

Cohort

Authors

AØAnja ØksnesAMAkiko MaeharaBEBritt Engan

Discussion

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Overview

May simplify high-risk CTO anatomy for staged PCI; leaves open need for randomized trials on success.

Key Points

  • This study aims to examine the anatomical and mechanistic effects of an upfront investment procedure on chronic total occlusions during PCI.
  • 80 consecutive patients were included for completion of CTO PCI after an investment procedure.
  • Angiographic characteristics were compared at baseline and during completion procedures.
  • Intravascular ultrasound was used to analyze morphological changes post-wire crossing.
  • The median J-CTO score reduced from 4 to 2 (P < .001).
  • The vessel was successfully open in 28.8% of cases (n = 23).
  • Median lesion length decreased significantly from 28.2 mm to 15 mm (P < .001).

Structured PICO

Does a planned investment procedure reduce occlusion complexity and improve morphology in high-risk coronary chronic total occlusions?

P
Population
80 consecutive patients with high-risk coronary chronic total occlusions (CTO) returning for completion of CTO PCI
I
Intervention
Planned 2-stage CTO PCI with upfront "investment" procedure
C
Comparator
Baseline angiographic characteristics prior to the investment procedure
O
Outcome
Changes in angiographic characteristics (J-CTO score, proximal cap ambiguity, vessel course ambiguity, lesion length) and intravascular ultrasound morphologysurrogate

A planned investment procedure in high-risk CTO PCI significantly reduces angiographic occlusion complexity and facilitates subsequent wire crossing.

Cite This Study

Øksnes et al. (2026) studied this question.

synapsesocial.com/papers/6a2bd11d6550ea4541ffe8bdhttps://doi.org/10.1016/j.jscai.2026.105447
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Long‐Term Follow‐up After Percutaneous Coronary Interventions for Chronic Total Occlusions2026
  2. 2The Role of Intravascular Imaging in Coronary Chronic Total Occlusion PCIs: Enhancing Procedural Success Through Real-Time Visualization2025
  3. 3Comparative Impact of Coronary Imaging Strategies in CTO-PCI: A Retrospective Single-Center Analysis2025
  4. 4Predictive factors and clinical outcomes following successful contemporary percutaneous coronary interventions for chronic total occlusions2025
  5. 5A Review of Indications and Guidelines of Chronic Total Occlusion Revascularization2025