The Impact of Laser Use on the Outcomes of Balloon Uncrossable and Balloon Undilatable Chronic Total Occlusion Percutaneous Coronary Intervention

Background: We sought to examine the impact of laser use on the outcomes of balloon uncrossable and balloon undilatable chronic total occlusions (CTO) undergoing percutaneous coronary intervention (PCI). Methods: The baseline clinical and angiographic characteristics and procedural outcomes of 4,845 CTO PCIs performed between 2012 and 2020 at 32 international centers were examined. Results: Of the 4,845 CTOs 752 (15.5%), there were balloon uncrossable or balloon undilatable that were included in the further analyses. Mean patient age was 66.9 ± 10 years and 83% were men, with 51% prevalence of diabetes mellitus. Laser was used in 20.3% of the lesions. Compared with cases in which laser was not used, laser use was associated with longer occlusion length (33 [21, 50] vs. 25 [15, 40] mm, p = 0.0004) and in-stent restenotic lesions (41% vs. 20%, p \u3c 0.0001). Laser use was associated with higher technical (91.5% vs. 83.1%, p = 0.010) and procedural (88.9% vs. 81.6%, p = 0.033) success rates and similar incidence of major cardiac adverse events (3.92% vs. 3.51%, p = 0.805). Laser use was also associated with longer procedural (169 [109, 231] vs. 130 [87, 199], p \u3c 0.0001) and fluoroscopy time (64 [40, 94] vs. 50 [31, 81], p = 0.003). [Formula presented] Conclusion: In a contemporary, multicenter registry balloon uncrossable and balloon undilatable lesions represented 15.5% of the CTO PCIs. Laser was used in approximately one-fifth of these cases. Use of laser was associated with higher technical and procedural success and similar major complication rates. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP