TY - JOUR
T1 - Prevalence, indications and management of balloon uncrossable chronic total occlusions
T2 - Insights from a contemporary multicenter US registry
AU - Karacsonyi, Judit
AU - Karmpaliotis, Dimitri
AU - Alaswad, Khaldoon
AU - Jaffer, Farouc A.
AU - Yeh, Robert W.
AU - Patel, Mitul
AU - Bahadorani, John
AU - Doing, Anthony
AU - Ali, Ziad A.
AU - Karatasakis, Aris
AU - Danek, Barbara A.
AU - Rangan, Bavana V.
AU - Alame, Aya J.
AU - Banerjee, Subhash
AU - Brilakis, Emmanouil S.
N1 - Publisher Copyright:
© 2016 Wiley Periodicals, Inc.
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Background: Balloon uncrossable lesions can be challenging to treat, requiring specialized techniques and equipment. Methods: We examined the prevalence, clinical and angiographic characteristics, management and procedural outcomes of balloon uncrossable lesions in a multicenter chronic total occlusion (CTO) percutaneous coronary intervention (PCI) registry. Results: Between 2012 and 2016, 718 CTO PCIs (in which the occlusion was successfully crossed with a guidewire) were performed in 701 patients at 11 US centers. Mean age was 65.6 ± 10 years and 84% of the patients were men. Balloon uncrossable lesions represented 9% of all CTOs. Balloon uncrossable CTOs had more moderate/severe calcification (82% vs. 52%, P < 0.0001), moderate/severe tortuosity (61% vs. 35% P < 0.0001) and higher J-CTO score (2.95 ± 1.32 vs. 2.43 ± 1.23, P = 0.005) as compared with the remaining lesions. Technical and procedural success was significantly lower for balloon uncrossable lesions (90.5% vs. 98.3%, P < 0.0001 and 88.9% vs. 96.6% P = 0.004), respectively, but the incidence of major adverse events was similar (1.6% vs. 2.2%, P = 0.751). Balloon uncrossable lesions required longer procedure (208 [interquartile range: 135, 258] vs. 135 [94, 194] min, P < 0.0001) and fluoroscopy (77 [52, 100] vs. 45 min [27, 75], P < 0.0001) time. Techniques used to treat balloon uncrossable lesions included balloon-assisted microdissection (23%), excimer laser atherectomy (18%), and rotational atherectomy (16%). Excimer laser atherectomy and balloon-assisted microdissection were associated with the highest technical and procedural success rates. Conclusions: Balloon uncrossable CTOs are common, are associated with high rates of technical failure, and require specialized techniques for successful treatment.
AB - Background: Balloon uncrossable lesions can be challenging to treat, requiring specialized techniques and equipment. Methods: We examined the prevalence, clinical and angiographic characteristics, management and procedural outcomes of balloon uncrossable lesions in a multicenter chronic total occlusion (CTO) percutaneous coronary intervention (PCI) registry. Results: Between 2012 and 2016, 718 CTO PCIs (in which the occlusion was successfully crossed with a guidewire) were performed in 701 patients at 11 US centers. Mean age was 65.6 ± 10 years and 84% of the patients were men. Balloon uncrossable lesions represented 9% of all CTOs. Balloon uncrossable CTOs had more moderate/severe calcification (82% vs. 52%, P < 0.0001), moderate/severe tortuosity (61% vs. 35% P < 0.0001) and higher J-CTO score (2.95 ± 1.32 vs. 2.43 ± 1.23, P = 0.005) as compared with the remaining lesions. Technical and procedural success was significantly lower for balloon uncrossable lesions (90.5% vs. 98.3%, P < 0.0001 and 88.9% vs. 96.6% P = 0.004), respectively, but the incidence of major adverse events was similar (1.6% vs. 2.2%, P = 0.751). Balloon uncrossable lesions required longer procedure (208 [interquartile range: 135, 258] vs. 135 [94, 194] min, P < 0.0001) and fluoroscopy (77 [52, 100] vs. 45 min [27, 75], P < 0.0001) time. Techniques used to treat balloon uncrossable lesions included balloon-assisted microdissection (23%), excimer laser atherectomy (18%), and rotational atherectomy (16%). Excimer laser atherectomy and balloon-assisted microdissection were associated with the highest technical and procedural success rates. Conclusions: Balloon uncrossable CTOs are common, are associated with high rates of technical failure, and require specialized techniques for successful treatment.
KW - balloon angioplasty
KW - balloon uncrossable lesion
KW - chronic total occlusion
KW - percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=84997724775&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84997724775&partnerID=8YFLogxK
U2 - 10.1002/ccd.26780
DO - 10.1002/ccd.26780
M3 - Article
C2 - 27650935
AN - SCOPUS:84997724775
SN - 1522-1946
VL - 90
SP - 12
EP - 20
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 1
ER -