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Prevalence, indications and management of balloon uncrossable chronic total occlusions: Insights from a contemporary multicenter US registry
Authors
Aya J Alame
Khaldoon Alaswad
+13 more
Ziad A Ali
John Bahadorani
Subhash Banerjee
Emmanouil S Brilakis
Barbara A Danek
Anthony Doing
Farouc A Jaffer
Judit Karacsonyi
Aris Karatasakis
Dimitri Karmpaliotis
Mitul Patel
Bavana V Rangan
Robert W Yeh
Publication date
1 July 2017
Publisher
Henry Ford Health System Scholarly Commons
Abstract
BACKGROUND: Balloon uncrossable lesions can be challenging to treat, requiring specialized techniques and equipment. METHODS: We examined the prevalence, clinical and angiographic characteristics, management and procedural outcomes of balloon uncrossable lesions in a multicenter chronic total occlusion (CTO) percutaneous coronary intervention (PCI) registry. RESULTS: Between 2012 and 2016, 718 CTO PCIs (in which the occlusion was successfully crossed with a guidewire) were performed in 701 patients at 11 US centers. Mean age was 65.6 ± 10 years and 84% of the patients were men. Balloon uncrossable lesions represented 9% of all CTOs. Balloon uncrossable CTOs had more moderate/severe calcification (82% vs. 52%, P \u3c 0.0001), moderate/severe tortuosity (61% vs. 35% P \u3c 0.0001) and higher J-CTO score (2.95 ± 1.32 vs. 2.43 ± 1.23, P = 0.005) as compared with the remaining lesions. Technical and procedural success was significantly lower for balloon uncrossable lesions (90.5% vs. 98.3%, P \u3c 0.0001 and 88.9% vs. 96.6% P = 0.004), respectively, but the incidence of major adverse events was similar (1.6% vs. 2.2%, P = 0.751). Balloon uncrossable lesions required longer procedure (208 [interquartile range: 135, 258] vs. 135 [94, 194] min, P \u3c 0.0001) and fluoroscopy (77 [52, 100] vs. 45 min [27, 75], P \u3c 0.0001) time. Techniques used to treat balloon uncrossable lesions included balloon-assisted microdissection (23%), excimer laser atherectomy (18%), and rotational atherectomy (16%). Excimer laser atherectomy and balloon-assisted microdissection were associated with the highest technical and procedural success rates. CONCLUSIONS: Balloon uncrossable CTOs are common, are associated with high rates of technical failure, and require specialized techniques for successful treatment. © 2016 Wiley Periodicals, Inc
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Last time updated on 30/10/2019