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Catheter Cardiovasc Interv. 2017 Jul;90(1):12-20. doi: 10.1002/ccd.26780. Epub 2016 Sep 21.

Prevalence, indications and management of balloon uncrossable chronic total occlusions: Insights from a contemporary multicenter US registry.

Author information

1
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
2
Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.
3
Columbia University, New York, New York.
4
Henry Ford Hospital, Cardiology Department, Detroit, Michigan.
5
Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
6
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
7
VA San Diego Healthcare System and University of California San Diego, San Diego, California.
8
Medical Center of the Rockies, Loveland, Colorado.
9
Minnepolis Heart Institute, Minneapolis, Minnesota.

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 < 0.0001), moderate/severe tortuosity (61% vs. 35% P < 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 < 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 < 0.0001) and fluoroscopy (77 [52, 100] vs. 45 min [27, 75], P < 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.

KEYWORDS:

balloon angioplasty; balloon uncrossable lesion; chronic total occlusion; percutaneous coronary intervention

PMID:
27650935
DOI:
10.1002/ccd.26780
[Indexed for MEDLINE]

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