Prevalence, Presentation and Treatment of ‘Balloon Undilatable’ Chronic Total Occlusions: Insights from a Multicenter US Registry

Peter Tajti, Dimitri Karmpaliotis, Khaldoon Alaswad, Catalin Toma, James W. Choi, Farouc A. Jaffer, Anthony H. Doing, Mitul Patel, Ehtisham Mahmud, Barry Uretsky, Aris Karatasakis, Judit Karacsonyi, Barbara A. Danek, Bavana V. Rangan, Subhash Banerjee, Imre Ungi, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Background: The prevalence, treatment and outcomes of balloon undilatable chronic total occlusions (CTOs) have received limited study. Methods: We examined the prevalence, clinical and angiographic characteristics, and procedural outcomes of percutaneous coronary interventions (PCIs) for balloon undilatable CTOs in a contemporary multicenter US registry. Results: Between 2012 and 2017 data on balloon undilatable lesions were available for 425 consecutive CTO PCIs in 415 patients in whom guidewire crossing was successful: 52 of 425 CTOs were balloon undilatable (12%). Mean patient age was 65 ± 10 years and most patients were men (84%). Patients with balloon undilatable CTOs were more likely to be diabetic (67 vs. 41%, P < 0.001) and have heart failure (44 vs. 28%, P = 0.027). Balloon undilatable CTOs were longer (40 mm [interquartile range, IQR 20-50] vs. 30 [IQR 15-40], P = 0.016), more likely to have moderate/severe calcification (87 vs. 54%, P < 0.001), and had higher J-CTO score (3.2 ± 1.1 vs. 2.5 ± 1.3, P < 0.001) and PROGRESS-CTO complications score (3.9 ± 1.7 vs. 3.1 ± 2.0, P < 0.005). They were associated with lower technical and procedural success (92 vs. 98%, P = 0.024; and 88 vs. 96%, P = 0.034, respectively) and higher risk for in-hospital major adverse events (8 vs. 2%, P = 0.008) due to higher perforation rates. The most frequent treatments for balloon undilatable CTOs were high pressure balloon inflations (64%), rotational atherectomy (31%), laser (21%), and cutting balloons (15%). Conclusions: Balloon undilatable CTOs are common and are associated with lower success and higher complication rates.

Original languageEnglish (US)
Pages (from-to)657-666
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Issue number4
StatePublished - Mar 1 2018


  • chronic total occlusion
  • complex coronary intervention
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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