TY - JOUR
T1 - Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention
AU - Karacsonyi, Judit
AU - Kostantinis, Spyridon
AU - Simsek, Bahadir
AU - Rempakos, Athanasios
AU - Allana, Salman S.
AU - Alaswad, Khaldoon
AU - Krestyaninov, Oleg
AU - Khatri, Jaikirshan
AU - Poommipanit, Paul
AU - Jaffer, Farouc A.
AU - Choi, James
AU - Patel, Mitul
AU - Gorgulu, Sevket
AU - Koutouzis, Michalis
AU - Tsiafoutis, Ioannis
AU - Sheikh, Abdul M.
AU - ElGuindy, Ahmed
AU - Elbarouni, Basem
AU - Patel, Taral
AU - Jefferson, Brian
AU - Wollmuth, Jason R.
AU - Yeh, Robert
AU - Karmpaliotis, Dimitrios
AU - Kirtane, Ajay J.
AU - McEntegart, Margaret B.
AU - Masoumi, Amirali
AU - Davies, Rhian
AU - Rangan, Bavana V.
AU - Mastrodemos, Olga C.
AU - Doshi, Darshan
AU - Sandoval, Yader
AU - Basir, Mir B.
AU - Megaly, Michael S.
AU - Ungi, Imre
AU - Abi Rafeh, Nidal
AU - Goktekin, Omer
AU - Brilakis, Emmanouil S.
N1 - Publisher Copyright:
© 2023 by the authors.
PY - 2023/3
Y1 - 2023/3
N2 - Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions.
AB - Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions.
KW - balloon uncrossable
KW - chronic total occlusion
KW - percutaneous coronary intervention
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U2 - 10.3390/jpm13030515
DO - 10.3390/jpm13030515
M3 - Article
C2 - 36983697
AN - SCOPUS:85152710736
SN - 2075-4426
VL - 13
JO - Journal of Personalized Medicine
JF - Journal of Personalized Medicine
IS - 3
M1 - 515
ER -