Advances in research on vascular assessment of lower extremity chronic total occlusion for interventional therapy

Shuanglong Xue; Junbo Zhang; You LI; Bowen FU; Mengyang Kang; Hongyan Tian

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Advances in research on vascular assessment of lower extremity chronic total occlusion for interventional therapy

VernacularTitle:下肢动脉慢性完全闭塞病变介入治疗的血管评估方案研究进展
Author: Shuanglong XUE ¹ ; Junbo ZHANG ¹ ; You LI ¹ ; Bowen FU ¹ ; Mengyang KANG ¹ ; Hongyan TIAN ¹
Author Information

1. Department of Peripheral Vascular Diseases, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
Publication Type:Journal Article
Keywords: chronic limb-threatening ischemia; chronic total occlusion; percutaneous transluminal angioplasty; scoring system; assessment system
From: Journal of Xi'an Jiaotong University(Medical Sciences) 2023;44(1):147-152
CountryChina
Language:Chinese
Abstract: Lower extremity chronic total occlusion (CTO) is the most severe manifestation of peripheral artery disease (PAD), with high amputation and mortality rates. As a minimal invasive reconstruction therapy, endovascular therapy (EVT) plays an important role in limb salvage for CTO in current clinical practice. The complexity of CTO lesions leads to a high risk for complications and a low success rate of EVT. Therefore, establishing a grading or scoring system to predict the success rate of revascularization strategy will be helpful in developing appropriate treatment strategies and assessing benefits and risks. This paper summarizes the most popular CTO scoring systems, such as PACSS grading, PARC grading, TAC grading, CTOP classification, Infrapop-CTO scoring, and J-BTK CTO scoring. PACSS grading and PARC grading are suitable for evaluating the severity of vascular calcification including iliofemoral segment, femoral-popliteal segment, and below-the-knee artery segment. TAC grading is suitable for grading calcification below the knee lesions; with low intervention success rate in a high calcification grading. CTOP classification was developed by analyzing the effect of morphological characteristics of proximal and distal fibrous caps of lower extremity CTO lesions on the outcome of EVT. The success rate of antegrade intervention is lower in type IV. The Infrapop-CTO score and J-BTK CTO score can predict successful anterograde crossing of infrapopliteal CTO lesions, with low intervention success rate in high score. Both scoring systems use three variables, namely, shape of proximal stump, calcification, and occlusion length.