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Catheter Cardiovasc Interv. 2018 Mar 1;91(4):657-666. doi: 10.1002/ccd.27510. Epub 2018 Jan 23.

Prevalence, Presentation and Treatment of 'Balloon Undilatable' Chronic Total Occlusions: Insights from a Multicenter US Registry.

Author information

1
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
2
Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.
3
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
4
Columbia University, New York, New York.
5
Henry Ford Hospital, Detroit, Michigan.
6
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
7
Baylor Heart and Vascular Hospital, Dallas, Texas.
8
Massachusetts General Hospital, Boston, Massachusetts.
9
Medical Center of the Rockies, Loveland, Colorado.
10
VA San Diego Healthcare System and University of California San Diego, La Jolla, California.
11
VA Central Arkansas Healthcare System, Little Rock, Arkansas.

Abstract

BACKGROUND:

The prevalence, treatment and outcomes of balloon undilatable chronic total occlusions (CTOs) have received limited study.

METHODS:

We examined the prevalence, clinical and angiographic characteristics, and procedural outcomes of percutaneous coronary interventions (PCIs) for balloon undilatable CTOs in a contemporary multicenter US registry.

RESULTS:

Between 2012 and 2017 data on balloon undilatable lesions were available for 425 consecutive CTO PCIs in 415 patients in whom guidewire crossing was successful: 52 of 425 CTOs were balloon undilatable (12%). Mean patient age was 65 ± 10 years and most patients were men (84%). Patients with balloon undilatable CTOs were more likely to be diabetic (67 vs. 41%, P < 0.001) and have heart failure (44 vs. 28%, P = 0.027). Balloon undilatable CTOs were longer (40 mm [interquartile range, IQR 20-50] vs. 30 [IQR 15-40], P = 0.016), more likely to have moderate/severe calcification (87 vs. 54%, P < 0.001), and had higher J-CTO score (3.2 ± 1.1 vs. 2.5 ± 1.3, P < 0.001) and PROGRESS-CTO complications score (3.9 ± 1.7 vs. 3.1 ± 2.0, P < 0.005). They were associated with lower technical and procedural success (92 vs. 98%, P = 0.024; and 88 vs. 96%, P = 0.034, respectively) and higher risk for in-hospital major adverse events (8 vs. 2%, P = 0.008) due to higher perforation rates. The most frequent treatments for balloon undilatable CTOs were high pressure balloon inflations (64%), rotational atherectomy (31%), laser (21%), and cutting balloons (15%).

CONCLUSIONS:

Balloon undilatable CTOs are common and are associated with lower success and higher complication rates.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02061436.

KEYWORDS:

chronic total occlusion; complex coronary intervention; percutaneous coronary intervention

Comment in

PMID:
29359452
PMCID:
PMC5849516
DOI:
10.1002/ccd.27510
[Indexed for MEDLINE]
Free PMC Article

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