{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T07:03:39Z","timestamp":1789715019369,"version":"4.0.1"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,5,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Chronic total occlusion (CTO) percutaneous coronary intervention in small vessels (&lt;3.0\u2009mm) poses distinct technical challenges that may affect procedural success and long\u2010term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We analyzed 507 consecutive CTO percutaneous coronary intervention procedures in 456 patients (January 2018\u2013December 2023), categorized as small vessel (n=178, 35.1%) or large vessel (n=329, 64.9%) by reference vessel diameter. The primary end point was a composite of target lesion revascularization, heart failure hospitalization, myocardial infarction, and stroke at median 704\u2010day follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Small vessel CTOs were more frequent in women (27.5% versus 17.3%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.007) and associated with higher rates of diabetes (57.9% versus 45.3%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.007) and chronic kidney disease (42.7% versus 31.0%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.008). Technical success (66.3% versus 88.5%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) and procedural success (65.7% versus 88.2%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) were lower in small vessels. Composite end point rates were similar at follow\u2010up (19.1% versus 12.4%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.058); large vessel size was not independently protective (hazard ratio, 0.60 [95% CI, 0.34\u20131.07]). Small vessel size strongly predicted guidewire crossing failure (odds ratio, 0.31 [95% CI, 0.18\u20130.55],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). Adding vessel size to Japan CTO score improved discrimination (area under the curve, 0.66 versus 0.60) but yielded unfavorable reclassification.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">CTO percutaneous coronary intervention in small vessels is associated with significantly lower procedural success but comparable long\u2010term outcomes. Vessel size is a strong determinant of procedural difficulty; routine incorporation into complexity scoring requires multicenter validation. Current scoring systems may underestimate the complexity of small vessel CTOs, underscoring the need for refined techniques and careful patient selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.046690","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T11:07:12Z","timestamp":1778756832000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Procedural Success and Long\u2010Term Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion in Small Versus Large Vessels"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0383-6471","authenticated-orcid":false,"given":"Gal","family":"Sella","sequence":"first","affiliation":[{"name":"Houston Methodist DeBakey Heart & Vascular Center","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2680-7047","authenticated-orcid":false,"given":"Chloe","family":"Kharsa","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart & Vascular Center","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1763-9340","authenticated-orcid":false,"given":"Yasser M.","family":"Sammour","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart & Vascular Center","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1953-5956","authenticated-orcid":false,"given":"Rody G.","family":"Bou Chaaya","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart & Vascular Center","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5508-5107","authenticated-orcid":false,"given":"Mangesh","family":"Kritya","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart & Vascular Center","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9034-7718","authenticated-orcid":false,"given":"Yueh\u2010Yun","family":"Lin","sequence":"additional","affiliation":[{"name":"Center for Health Data Science and Analytics, Houston Methodist","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3158-3723","authenticated-orcid":false,"given":"Anshuj","family":"Deva","sequence":"additional","affiliation":[{"name":"Center for Health Data Science and Analytics, Houston Methodist","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9229-0290","authenticated-orcid":false,"given":"Jerrin","family":"Philip","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart & Vascular Center","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3907-4448","authenticated-orcid":false,"given":"Muhammad Haisum","family":"Maqsood","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart & Vascular Center","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4334-8133","authenticated-orcid":false,"given":"Neal S.","family":"Kleiman","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart & Vascular Center","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8600-6352","authenticated-orcid":false,"given":"Alpesh R.","family":"Shah","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart & Vascular Center","place":["Houston, 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