An observational study in Chronic Total Occlusion, sponsored by Mersin Medicalpark Hastanesi. Completed at 1 site in Turkey (Türkiye). Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-01-28.
Sponsored by Mersin Medicalpark Hastanesi · Observational
The aim of this study is to compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in the treatment of isolated chronic total occlusion (CTO) of the left anterior descending (LAD) artery in terms of short- and mid-term clinical outcomes, myocardial revascularization success, and complication rates.
Chronic total occlusion (CTO) represents one of the most challenging subgroups of coronary artery disease and is closely associated with adverse cardiovascular outcomes. Previous studies have demonstrated that patients with CTO experience a higher incidence of major adverse cardiovascular events compared with patients without CTO but with significant coronary artery disease (CAD), even after adjustment for demographic characteristics, clinical parameters, and disease severity. Among these patients, those with unrevascularized CTO constitute the highest-risk group, whereas successful revascularization has been shown to reduce the risk to a level comparable to that of patients without CTO but with significant CAD.
Among CTOs, isolated total occlusion of the left anterior descending (LAD) artery has particular clinical importance due to its critical role in myocardial perfusion. Two main revascularization strategies are currently used in the treatment of isolated LAD CTO: percutaneous coronary intervention (PCI) and single-vessel coronary artery bypass grafting (CABG). In surgical revascularization, the left internal mammary artery (LIMA) is most commonly used, although saphenous vein grafts may be preferred in selected cases.
However, direct comparative data between these two treatment strategies in this specific patient population remain extremely limited. In particular, differences between CTO-PCI and single-vessel CABG with respect to revascularization success, in-hospital events, and early post-discharge outcomes have not been systematically evaluated. In the present study, within the framework of the RITUAL study, the outcomes of CTO-PCI and CABG surgery were compared in patients with isolated LAD CTO.
Mersin Medicalpark Hastanesi is the lead sponsor of 4 studies on the registry; 1 is open to participants now.
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The study population consists of adult patients aged 18 years or older with isolated chronic total occlusion (CTO) of the left anterior descending (LAD) coronary artery who underwent coronary revascularization with either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) as part of routine clinical care. Isolated LAD CTO was defined as a de novo or in-stent total occlusion confined to the LAD artery, without significant coronary artery disease (≥50% stenosis) in other major epicardial coronary arteries. Patients with prior coronary revascularization, multiple CTOs, severe left ventricular dysfunction, or incomplete follow-up data were excluded.
Exclusion Criteria:
Patients with isolated chronic total occlusion of the left anterior descending artery who underwent coronary artery bypass graft surgery.
Procedure: Coronary Artery Bypass Grafting
Patients with isolated chronic total occlusion of the left anterior descending artery who underwent percutaneous coronary intervention.
Procedure: Percutaneous Coronary Intervention
Coronary artery bypass graft surgery performed as part of routine clinical care prior to study inclusion.
Percutaneous coronary intervention performed as part of routine clinical care prior to study inclusion.
Procedural success
Successful completion of coronary revascularization of the left anterior descending artery without in-hospital major adverse cardiac events.
Time frame: perioperatively / periprocedurally
Major adverse cardiac events (MACCE) at 3 years
Composite endpoint including all-cause mortality, non-fatal myocardial infarction, cerebrovascular events, and target vessel revascularization within 3 years after the index procedure.
Time frame: 3 years
Plan to share: No — Individual participant data will not be shared due to the retrospective design of the study and institutional data privacy policies.
No publications or documents are linked to this record.
This study is completed, as verified in Jan 2026. You cannot join it, but the record below documents what was studied.
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