Ahead of print Pak J Med Sci May - June 2022 Vol. 38 No. 5 www.pjms.org.pk 1 1. Waheed Akhtar, MBBS, FCPS. 2. Syed Tehseen Shah, MBBS, FCPS. 3. Shahzad Hasrat, MBBS, FCPS. 4. Waqar Mustafa, MBBS, FCPS. 1-4: Abbas Institute of Medical Sciences, Muzaffarabad Azad Jammu and Kashmir, Pakistan. Correspondence: Dr. Waheed Akhtar, MBBS, FCPS. Consultant Cardiologist, Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, Azad Jammu and Kashmir, Pakistan. E-mail: doc.waheed@hotmail.com * Received for Publication: May 27, 2021 * Revision Received: January 4, 2022 * Revision Accepted: January 28, 2022 Original Article Evaluating the frequency of successful guidewire crossing through a complex lesion in coronary artery disease patients having chronic total occlusion Waheed Akhtar 1 , Syed Tehseen Shah 2 , Shahzad Hasrat 3 , Waqar Mustafa 4 ABSTRACT Objectives: To determine the frequency of successful guidewire crossing through chronic total occlusion (CTO) in patients having a J-CTO Score = 2 (diffcult lesion). Methods: A prospective, cross-sectional study was conducted at the Armed Forces Institute of Cardiology (AFIC) in Rawalpindi. Patients with high calcium score on CT-angiogram were sent for elective coronary angiogram out of which patients diagnosed with chronic total occlusion (CTO) were selected and J-CTO Score was assessed. Those with a J-CTO score = 2 (diffcult lesion) were enrolled for percutaneous coronary intervention (PCI). Guidewire that can cross the lesion within 30 minutes was considered successful. Results: A total of 158(95.8%) cases had successful guidewire crossing, while in 7(4.2%) patients, the procedure was unsuccessful. No signifcant association between the success rate of guidewire crossing and age (p = 0.21). Furthermore, there was no statistically signifcant relationship between guidewire crossing and LV function (p = 0.559) i.e. 32.2% and 42.9% of those with LV function between 25-35% had successful and unsuccessful guidewire crossing, respectively. While 67.7% and 57.1% patients having 36-65% LV function were observed having successful and failed PCI, respectively. Conclusions: The success rate of guidewire crossing through CTO in patients having a J-CTO Score =2 (diffcult lesion) is acceptable so J-CTO score can be considered for diffculty grading of the lesion before intervention to prevent complications and success rate of PCI. KEYWORDS: Angioplasty, Chronic Total Occlusion, Coronary Artery Disease, Percutaneous Coronary Intervention, Stents and J-CTO score. doi: https://doi.org/10.12669/pjms.38.5.4770 How to cite this: Akhtar W, Shah ST, Hasrat S, Mustafa W. Evaluating the frequency of successful guidewire crossing through a complex lesion in coronary artery disease patients having chronic total occlusion. Pak J Med Sci. 2022;38(5):---------. doi: https://doi.org/10.12669/pjms.38.5.4770 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. INTRODUCTION Cardiovascular disorders, particularly coronary artery diseases, contribute to almost one-third of the world-wide mortality rate. 1 However, the exact fgure is still unknown as a subset of the patients does not go through the diagnostic process. 1 In most cases, chronic total occlusion (CTO) is a common factor in patients with coronary artery disease (CAD). 2 CTO is prevalent among CAD patients who undergo angiography, and an estimated value suggests that it is around 18 to 30%. 3