Novel proctorship effectively teaches interventionists coronary artery chronic total occlusion lesions

Masanori Yamamoto, Etsuo Tsuchikane, Ai Kagase, Tetsuro Shimura, Tomohiko Teramoto, Masashi Kimura, Hitoshi Matsuo, Yoshiaki Kawase, Yoriyasu Suzuki, Seiji Kano, Maoto Habara, Kenya Nasu, Yoshihisa Kinoshita, Mitsuyasu Terashima, Tetsuo Matsubara, Takahiko Suzuki

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: Interventionists’ experience and skills are essential factors for successful chronic total occlusion-percutaneous coronary intervention (CTO-PCI). However, the construction of theoretical strategy independent from interventionists’ procedure may also improve it. We sought to assess the feasibility of CTO-PCI using an educational system supported by a single expert proctor. Methods: A total of 160 patients underwent CTO-PCI between 2009 and 2016 at 92 Japanese centers in the Hands-on proctorship project. The CTO-PCI strategy was discussed with all participants and their specialists, before and during the procedure. We divided patients into 2 groups based on the CTO-PCI experience of their interventionist: (1) the less experienced group (CTO-PCI ≤ 50 cases, n = 65) and (2) the more experienced group (CTO-PCI > 50 cases, n = 95). Baseline characteristics, procedural complications, and clinical outcomes were compared between groups. Results: No significant differences in patient age, sex, prevalence for coronary risk factors, and lesion complexity was observed between groups. The retrograde approach was used equivalently between groups (55.4% vs. 60.0%, p = 0.56), and procedural success rates were similar (96.9% vs. 90.5%, p = 0.12). The rate of proctor's bailout for recanalization were not frequent between groups (4.6% vs. 5.3%, p = 0.85). No procedure-related mortality was noted in either group. In addition, no significant differences in procedural cardiac complications, including coronary dissection, perforation, or tamponade, were observed between groups (10.8% vs. 14.7%, p = 0.47). Conclusions: The expert-supported CTO-PCI maintained high success rates regardless of interventionists’ experience. This highlights the importance of theoretical strategy for the management patients undergoing CTO-PCI.

Original languageEnglish
Pages (from-to)407-412
Number of pages6
JournalCardiovascular Revascularization Medicine
Volume19
Issue number4
DOIs
StatePublished - Jun 2018
Externally publishedYes

Keywords

  • Chronic total occlusion
  • Educational hands-on proctorship project
  • Percutaneous coronary intervention

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