Use of Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention

Judit Karacsonyi, Karen Deffenbacher, Keith H. Benzuly, James D. Flaherty, Khaldoon Alaswad, Mir Basir, Michael S. Megaly, Farouc Jaffer, Darshan Doshi, Paul Poommipanit, Jaikirshan Khatri, Mitul Patel, Robert Riley, Abdul Sheikh, Jason R. Wollmuth, Ethan Korngold, Barry F. Uretsky, Robert W. Yeh, Raj H. Chandwaney, Ahmed M. ElguindyKhalid Tammam, Nidal AbiRafeh, Christian W. Schmidt, Brynn Okeson, Spyridon Kostantinis, Bahadir Simsek, Bavana Venkata Rangan, Emmanouil S. Brilakis, Daniel R. Schimmel

Research output: Contribution to journalArticlepeer-review


The use of mechanical circulatory support (MCS) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We analyzed the clinical and angiographic characteristics, and procedural outcomes of 7,171 CTO PCIs performed between 2012 and 2021 at 35 international centers. Mean age was 64.5 ± 10 years, mean left ventricular ejection fraction was 50 ± 13%. MCS was used in 4.5%, prophylactically in 78.7%, and urgently in 21.3%. The most common type of MCS overall was Impella CP (Abiomed) (55.5%), followed by intra-aortic balloon pump (14.8%) and TandemHeart (LivaNova Inc.) (10.0%). Prophylactic MCS patients were more likely to have diabetes mellitus (55% vs 42%, p <0.001) and had more complex lesions compared with cases without prophylactic MCS (Japan-CTO score: 2.80 ± 1.22 vs 2.39 ± 1.27, p <0.001). Cases with prophylactic MCS had similar technical (86% vs 87%, p = 0.643) but lower procedural (80% vs 86%, p = 0.028) success rates and higher rates of periprocedural major cardiac adverse events compared with no prophylactic MCS use (6.55% vs 1.68%, p <0.001). Urgent MCS use was associated with lower technical (68% vs 87%, p <0.001) and procedural (39% vs 86%, p <0.001) success rates and higher major cardiac adverse events compared with no-MCS use (32.26% vs 1.68%, p <0.001). The differences persisted in multivariable analyses. In summary, in this contemporary multicenter registry, MCS was used in 4.5% of CTO PCIs, mostly prophylactically (78.7%). Elective MCS cases had similar technical success but a higher risk of complications. Urgent MCS cases had lower technical and procedural success and higher periprocedural major complication rates.

Original languageEnglish (US)
Pages (from-to)76-85
Number of pages10
JournalAmerican Journal of Cardiology
StatePublished - Feb 15 2023
Externally publishedYes


  • chronic total occlusion
  • heart failure
  • ischemic cardiomyopathy
  • mechanical circulatory support
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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