Hemodynamic improvement immediately following percutaneous recanalization of chronic total occlusions.

BACKGROUND

Resting distal-to-aortic coronary pressure (Pd/Pa), resting full-cycle ratio (RFR), fractional flow reserve (FFR), coronary flow reserve (CFR), and index of microvascular resistance (IMR) are established tools for assessing obstructive coronary artery disease but remain poorly characterized in chronic total occlusion (CTO). Evaluating immediate hemodynamic changes after CTO revascularization may serve as a marker of benefit from intervention.

METHODS

We retrospectively analyzed hemodynamic data from patients undergoing CTO percutaneous coronary intervention (PCI) at a Veterans Affairs hospital between January 2024 and July 2025. Measurements (Pd/Pa, RFR, FFR, CFR, IMR) were obtained after successful CTO crossing and compared pre- and post-PCI using the CoroFlow system (Abbott Vascular, Lake County, IL). Demographics, procedural characteristics, and clinical outcomes-including death, myocardial infarction (MI), target lesion revascularization (TLR), and angina improvement-were recorded.

RESULTS

Twenty patients were included. CTO locations were the left anterior descending (35%), right coronary artery (35%), and left circumflex (25%). Mean lesion length was 47.6 ± 23.1 mm, with a median J-CTO score of 2 ± 1. Pre-PCI Pd/Pa (0.60 ± 0.14), RFR (0.51 ± 0.18), and FFR (0.46 ± 0.10) improved significantly post-PCI to 0.96 ± 0.04, 0.95 ± 0.04, and 0.87 ± 0.08, respectively. Post-PCI CFR was 3.30 ± 2.74 and IMR 23.9 ± 33.5. No peri-procedural complications occurred; 5% experienced MI and 10% required TLR at 7.2 ± 3.5 months.

CONCLUSION

There was marked improvement in hemodynamic indices after PCI of the evaluated CTO lesions, and microvascular function was normalized immediately following revascularization.