TY - JOUR
T1 - Prevalence, Presentation and Treatment of ‘Balloon Undilatable’ Chronic Total Occlusions
T2 - Insights from a Multicenter US Registry
AU - Tajti, Peter
AU - Karmpaliotis, Dimitri
AU - Alaswad, Khaldoon
AU - Toma, Catalin
AU - Choi, James W.
AU - Jaffer, Farouc A.
AU - Doing, Anthony H.
AU - Patel, Mitul
AU - Mahmud, Ehtisham
AU - Uretsky, Barry
AU - Karatasakis, Aris
AU - Karacsonyi, Judit
AU - Danek, Barbara A.
AU - Rangan, Bavana V.
AU - Banerjee, Subhash
AU - Ungi, Imre
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
Dr Karmpaliotis: Speaker honoraria: Abbott Vascular, Boston Scientific, Medtronic, Vascular Solutions. Dr Alaswad: consulting fees from Terumo and Boston Scientific; consultant, no financial, Abbott Laboratories. Dr Jaffer: Consultant: Abbott Vascular and Boston Scientific. Research grant: Canon, Siemens and National Institutes of Health. Dr Patel: speakers’ bureau for Astra Zeneca. Dr Mahmud: consulting fees from Medtronic and Corindus; speaker’s fees from Medtronic, Corindus, and Abbott Vascular; educational program fees from Abbott Vascular; and clinical events committee fees from St. Jude. Dr Rangan: Research grants from InfraReDx, Inc., and The Spectranetics Corporation. Dr Banerjee: research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCARE Global (spouse); intellectual property in HygeiaTel. Dr Brilakis: consulting/speaker honoraria from Abbott Vascular, ACIST, Amgen, Asahi, CSI, Elsevier, GE Healthcare, Medicure, Medtronic, and Nitiloop; research support from Boston Scientific and Osprey. Board of Directors: Cardiovascular Innovations Foundation. Board of Trustees: Society of Cardiovascular Angiography and Interventions
Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - 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.
AB - 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.
KW - chronic total occlusion
KW - complex coronary intervention
KW - percutaneous coronary intervention
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U2 - 10.1002/ccd.27510
DO - 10.1002/ccd.27510
M3 - Article
C2 - 29359452
AN - SCOPUS:85043587629
SN - 1522-1946
VL - 91
SP - 657
EP - 666
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 4
ER -