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J Am Heart Assoc. 2016 Aug 20;5(8). pii: e003890. doi: 10.1161/JAHA.116.003890.

Use of Intravascular Imaging During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry.

Author information

1
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary.
2
Henry Ford Hospital, Detroit, MI.
3
Massachusetts General Hospital and Harvard Medical School, Boston, MA.
4
Beth Israel Deaconess Medical Center, Boston, MA.
5
VA San Diego Healthcare System and University of California San Diego, San Diego, CA.
6
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
7
Medical Center of the Rockies, Loveland, CO.
8
Mid America Heart Institute, Kansas City, MO.
9
Columbia University, New York, NY.
10
University of Washington, Seattle, WA.
11
Piedmont Heart Institute, Atlanta, GA.
12
Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, MN.
13
Torrance Memorial Medical Center, Torrance, CA.
14
Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary.
15
Boston Scientific, Natick, MA.
16
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX esbrilakis@gmail.com.

Abstract

BACKGROUND:

Intravascular imaging can facilitate chronic total occlusion (CTO) percutaneous coronary intervention.

METHODS AND RESULTS:

We examined the frequency of use and outcomes of intravascular imaging among 619 CTO percutaneous coronary interventions performed between 2012 and 2015 at 7 US centers. Mean age was 65.4±10 years and 85% of the patients were men. Intravascular imaging was used in 38%: intravascular ultrasound in 36%, optical coherence tomography in 3%, and both in 1.45%. Intravascular imaging was used for stent sizing (26.3%), stent optimization (38.0%), and CTO crossing (35.7%, antegrade in 27.9%, and retrograde in 7.8%). Intravascular imaging to facilitate crossing was used more frequently in lesions with proximal cap ambiguity (49% versus 26%, P<0.0001) and with retrograde as compared with antegrade-only cases (67% versus 31%, P<0.0001). Despite higher complexity (Japanese CTO score: 2.86±1.19 versus 2.43±1.19, P=0.001), cases in which imaging was used for crossing had similar technical and procedural success (92.8% versus 89.6%, P=0.302 and 90.1% versus 88.3%, P=0.588, respectively) and similar incidence of major cardiac adverse events (2.7% versus 3.2%, P=0.772). Use of intravascular imaging was associated with longer procedure (192 minutes [interquartile range 130, 255] versus 131 minutes [90, 192], P<0.0001) and fluoroscopy (71 minutes [44, 93] versus 39 minutes [25, 69], P<0.0001) time.

CONCLUSIONS:

Intravascular imaging is frequently performed during CTO percutaneous coronary intervention both for crossing and for stent selection/optimization. Despite its use in more complex lesion subsets, intravascular imaging was associated with similar rates of technical and procedural success for CTO percutaneous coronary intervention.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.

KEYWORDS:

chronic total occlusion; intravascular ultrasound; optical coherence tomography; percutaneous coronary intervention

PMID:
27543800
PMCID:
PMC5015304
DOI:
10.1161/JAHA.116.003890
[Indexed for MEDLINE]
Free PMC Article

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