TY - JOUR
T1 - Incidence, mechanisms, treatment, and outcomes of donor vessel injury during percutaneous coronary interventions for chronic total occlusion
AU - Kostantinis, Spyridon
AU - Rempakos, Athanasios
AU - Simsek, Bahadir
AU - Karacsonyi, Judit
AU - Allana, Salman S.
AU - Alaswad, Khaldoon
AU - Basir, Mir B.
AU - Krestyaninov, Oleg
AU - Khelimskii, Dmitrii
AU - Gorgulu, Sevket
AU - Davies, Rhian E.
AU - Benton, Stewart M.
AU - Khatri, Jaikirshan J.
AU - Poommipanit, Paul
AU - Choi, James W.
AU - Jaber, Wissam A.
AU - Rinfret, Stephane
AU - Nicholson, William
AU - Al-Azizi, Karim M.
AU - Potluri, Srinivasa
AU - Aygul, Nazif
AU - Altunkeser, Bulent B.
AU - Koutouzis, Michael
AU - Tsiafoutis, Ioannis
AU - Milkas, Anastasios
AU - ElGuindy, Ahmed M.
AU - Abi Rafeh, Nidal
AU - Goktekin, Omer
AU - Mastrodemos, Olga C.
AU - Rangan, Bavana V.
AU - Sandoval, Yader
AU - Burke, M. Nicholas
AU - Brilakis, Emmanouil S.
N1 - Publisher Copyright:
© 2023 Wiley Periodicals LLC.
PY - 2023/10/1
Y1 - 2023/10/1
N2 - Background: Donor vessel injury is a potentially life-threatening complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Aims: Our goal was to examine the incidence, mechanisms, treatment, and outcomes of patients with donor vessel injury in a large multicenter CTO PCI registry. Methods: We analyzed the baseline clinical and angiographic characteristics, and procedural outcomes of 12,349 CTO PCIs performed between 2012 and 2022 at 44 centers. Results: The incidence of donor vessel injury was 0.35% (n = 43). The baseline clinical characteristics of patients with and without donor vessel injury were similar. Cases complicated by donor vessel injury were more complex with higher Japanese CTO score (2.9 ± 1.1 vs. 2.4 ± 1.3; p = 0.004) and lower procedural success rate (69.8% vs. 85.2%; p = 0.004). The retrograde approach was used more commonly in donor vessel injury cases (68.9% vs. 30.9%; p < 0.001). Most (53.5%) donor vessel injuries were guide catheter-induced, whereas 20.9% were due to donor vessel thrombosis. Of the 43 patients with donor vessel injury, 36 (83.7%) were treated with stenting and seven (16.3%) received a left ventricular assist device. The incidence of major adverse cardiovascular events (MACEs) was significantly higher in cases with donor vessel injury (23.3% vs. 2.0%; p < 0.001). Of the 43 patients with donor vessel injury, five patients (11.6%) experienced acute myocardial infarction and four patients (9.3%) died. Conclusions: Donor vessel injury, occurred in 0.35% of CTO PCIs performed by experienced operators, was mainly due to guide catheter-induced dissection or thrombosis and was associated with lower procedural success and higher MACE.
AB - Background: Donor vessel injury is a potentially life-threatening complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Aims: Our goal was to examine the incidence, mechanisms, treatment, and outcomes of patients with donor vessel injury in a large multicenter CTO PCI registry. Methods: We analyzed the baseline clinical and angiographic characteristics, and procedural outcomes of 12,349 CTO PCIs performed between 2012 and 2022 at 44 centers. Results: The incidence of donor vessel injury was 0.35% (n = 43). The baseline clinical characteristics of patients with and without donor vessel injury were similar. Cases complicated by donor vessel injury were more complex with higher Japanese CTO score (2.9 ± 1.1 vs. 2.4 ± 1.3; p = 0.004) and lower procedural success rate (69.8% vs. 85.2%; p = 0.004). The retrograde approach was used more commonly in donor vessel injury cases (68.9% vs. 30.9%; p < 0.001). Most (53.5%) donor vessel injuries were guide catheter-induced, whereas 20.9% were due to donor vessel thrombosis. Of the 43 patients with donor vessel injury, 36 (83.7%) were treated with stenting and seven (16.3%) received a left ventricular assist device. The incidence of major adverse cardiovascular events (MACEs) was significantly higher in cases with donor vessel injury (23.3% vs. 2.0%; p < 0.001). Of the 43 patients with donor vessel injury, five patients (11.6%) experienced acute myocardial infarction and four patients (9.3%) died. Conclusions: Donor vessel injury, occurred in 0.35% of CTO PCIs performed by experienced operators, was mainly due to guide catheter-induced dissection or thrombosis and was associated with lower procedural success and higher MACE.
KW - chronic total occlusion
KW - complications
KW - donor vessel injury
KW - percutaneous coronary intervention
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U2 - 10.1002/ccd.30798
DO - 10.1002/ccd.30798
M3 - Article
C2 - 37560823
AN - SCOPUS:85167710739
SN - 1522-1946
VL - 102
SP - 585
EP - 593
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 4
ER -