The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry

Peter Tajti, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, James W. Choi, M. Nicholas Burke, Anthony H. Doing, Phil Dattilo, Catalin Toma, A. J.Conrad Smith, Barry Uretsky, Elizabeth Holper, R. Michael Wyman, David E. Kandzari, Santiago Garcia, Oleg Krestyaninov, Dmitrii KhelimskiiMichalis Koutouzis, Ioannis Tsiafoutis, Jeffrey W. Moses, Nicholas J. Lembo, Manish Parikh, Ajay J. Kirtane, Ziad A. Ali, Darshan Doshi, Bavana V. Rangan, Imre Ungi, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

126 Scopus citations


Objectives: The aim of this study was to determine the techniques and outcomes of hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a diverse group of patients and operators on 2 continents. Background: CTO PCI has been evolving with constant improvement of equipment and techniques. Methods: Contemporary outcomes of CTO PCI were examined by analyzing the clinical, angiographic, and procedural characteristics of 3,122 CTO interventions performed in 3,055 patients at 20 centers in the United States, Europe, and Russia. Results: The mean age was 65 ± 10 years, and 85% of the patients were men, with high prevalence of diabetes (43%), prior myocardial infarction (46%), prior coronary artery bypass graft surgery (33%), and prior PCI (65%). The CTO target vessels were the right coronary artery (55%), left anterior descending coronary artery (24%), and left circumflex coronary artery (20%). The mean J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores were 2.4 ± 1.3 and 1.3 ± 1.0, respectively. The overall technical and procedural success rate was 87% and 85%, respectively, and the rate of in-hospital major complications was 3.0%. The final successful crossing strategy was antegrade wire escalation in 52.0%, retrograde in 27.1%, and antegrade dissection re-entry in 20.9%; >1 crossing strategy was required in 40.9%. Median contrast volume, air kerma radiation dose, and procedure and fluoroscopy time were 270 ml (interquartile range: 200 to 360 ml), 2.9 Gy (interquartile range: 1.7 to 4.7 Gy), 123 min (interquartile range: 81 to 188 min) and 47 min (interquartile range: 29 to 77 min), respectively. Conclusions: CTO PCI is currently being performed with high success and acceptable complication rates among various experienced centers in the United States, Europe, and Russia.

Original languageEnglish (US)
Pages (from-to)1325-1335
Number of pages11
JournalJACC: Cardiovascular Interventions
Issue number14
StatePublished - Jul 23 2018


  • chronic total occlusion
  • outcomes
  • percutaneous coronary intervention
  • techniques

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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