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Catheter Cardiovasc Interv. 2019 Dec 4. doi: 10.1002/ccd.28614. [Epub ahead of print]

Outcomes of subintimal plaque modification in chronic total occlusion percutaneous coronary intervention.

Author information

1
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
2
Baylor Heart and Vascular Hospital, Dallas, Texas.
3
Henry Ford Hospital, Detroit, Michigan.
4
Cleveland Clinic, Cleveland, Ohio.
5
Medical Center of the Rockies, Loveland, Colorado.
6
Massachusetts General Hospital, Boston, Massachusetts.
7
VA Central Arkansas Healthcare System, Little Rock, Arkansas.
8
Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia.
9
VA San Diego Healthcare System and University of California San Diego, La Jolla, California.
10
The Heart Hospital Baylor Plano, Plano, Texas.
11
Red Cross Hospital of Athens, Athens, Greece.
12
Emory University Hospital Midtown, Atlanta, Georgia.
13
Tristar Centennial Medical Center, Nashville, Tennessee.
14
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.

Abstract

BACKGROUND:

When crossing into the distal true lumen fails during chronic total occlusion (CTO) percutaneous coronary intervention (PCI), subintimal plaque modification (SPM) is often performed to restore antegrade flow and facilitate subsequent lesion recanalization.

METHODS:

Between January 2012 and May 4, 2019, 4,659 CTO PCIs were included in the PROGRESS-CTO registry, of which 935 (20%) had a prior unsuccessful attempt. Of those 935 patients, 119 (13%) had prior SPM. We analyzed the outcomes of the 58 SPM procedures for which data were available, as well as the outcomes of the 60 subsequent CTO PCI attempts.

RESULTS:

Mean patient age was 67 ± 9 years and 86% were men. Patients had high prevalence of cardiovascular risk factors such as dyslipidemia (91%), hypertension (93%) diabetes (48%), prior PCI (61%), and prior coronary artery bypass graft surgery (47%). The target CTO lesions often had proximal cap ambiguity (54%), moderate/severe calcification (73%), moderate/severe tortuosity (63%), and high J-CTO score (mean 3.2 ± 1.1). The technical and procedural success of subsequent CTO PCI were high (83% for both) with an acceptable rate of in-hospital major adverse cardiovascular events (3.3%). Technical and procedural success were higher for repeat attempts that were performed ≥60 days after the index CTO PCI (94% vs. 69%, p = .015). Median (interquartile range) subsequent procedure time was 147 (100, 215) min, contrast volume was 185 (150, 260) ml, and air kerma radiation dose was 2.5 (1.4, 4.2) Gray.

CONCLUSION:

Repeat CTO PCI attempts after SPM are associated with high likelihood for successful revascularization with acceptable risks.

KEYWORDS:

STAR; chronic total occlusion; investment procedure; percutaneous coronary intervention; subintimal plaque modification

PMID:
31797507
DOI:
10.1002/ccd.28614

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