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Am J Cardiol. 2019 May 1;123(9):1422-1428. doi: 10.1016/j.amjcard.2019.01.054. Epub 2019 Feb 11.

Usefulness of Atherectomy in Chronic Total Occlusion Interventions (from the PROGRESS-CTO Registry).

Author information

1
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
2
Columbia University, New York, New York.
3
Henry Ford Hospital, Detroit, Michigan.
4
Massachusetts General Hospital, Boston, Massachusetts.
5
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
6
VA San Diego Healthcare System and University of California San Diego, La Jolla, California.
7
Baylor Heart and Vascular Hospital, Dallas, Texas.
8
Medical Center of the Rockies, Loveland, Colorado.
9
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
10
VA Central Arkansas Healthcare System, Little Rock, Arkansas.
11
Meshalkin Novosibrisk Research Institute, Novosibirsk, Russia.
12
The Heart Hospital Baylor Plano, Plano, Texas.
13
Torrance Memorial Medical Center, Torrance, California.
14
Piedmont Heart Institute, Atlanta, Georgia.
15
VA Minneapolis Healthcare System and University of Minnesota, Minneapolis, Minnesota.
16
Red Cross Hospital of Athens, Athens, Greece.
17
Cleveland Clinic, Cleveland, Ohio.
18
Emory University Hospital Midtown, Atlanta, Georgia.
19
Tristar Centennial Medical Center, Nashville, Tennesse.
20
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.
21
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
22
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota. Electronic address: esbrilakis@gmail.com.

Abstract

There is limited data on the use of atherectomy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared the clinical and procedural characteristics and outcomes of CTO PCIs performed with or without atherectomy in a contemporary multicenter CTO PCI registry. Between 2012 and 2018, 3,607 CTO PCIs were performed at 21 participating centers. Atherectomy was used in 117 (3.2%) cases: rotational atherectomy in 105 cases, orbital atherectomy in 8, and both in 4 cases. Patients in whom atherectomy was used, were older (68 ± 8 vs 64 ± 10 years, p <0.0001) and had higher Japan-chronic total occlusion score (3.0 ± 1.2 vs 2.4 ± 1.3, p <0.0001). CTO PCI cases in which atherectomy was used had similar technical (91% vs 87%, p = 0.240) and procedural (90% vs 85%, p = 0.159) success and in-hospital major adverse cardiac event (4% vs 3%, p = 0.382) rates. However, atherectomy cases were associated with higher rates of donor vessel injury (4% vs 1%, p = 0.031), tamponade requiring pericardiocentesis (2.6% vs 0.4%, p = 0.012) and more often required use of a left ventricular assist device (9% vs 5%, p = 0.031). Atherectomy cases were associated with longer procedural duration (196 [141, 247] vs 119 [76, 180] minutes, p <0.0001), and higher patient air kerma radiation dose (3.6 [2.5, 5.6] vs 2.8 [1.6, 4.7] Gray, p = 0.001). In conclusion, atherectomy is currently performed in approximately 3% of CTO PCI cases and is associated with similar technical and procedural success and overall major adverse cardiac event rates, but higher risk for donor vessel injury and tamponade.

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