A Detailed Analysis of Perforations During Chronic Total Occlusion Angioplasty

OPEN-CTO Study Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: This study sought to describe the angiographic characteristics, strategy associated with perforation, and the management of perforation during chronic total occlusion percutaneous coronary intervention (CTO PCI). Background: The incidence of perforation is higher during CTO PCI compared with non-CTO PCI and is reportedly highest among retrograde procedures. Methods: Among 1,000 consecutive patients who underwent CTO PCI in a 12-center registry, 89 (8.9%) had core lab–adjudicated angiographic perforations. Clinical perforation was defined as any perforation requiring treatment. Major adverse cardiac events (MAEs) were defined as in-hospital death, cardiac tamponade, and pericardial effusion. Results: Among the 89 perforations, 43 (48.3%) were clinically significant, and 46 (51.7%) were simply observed. MAE occurred in 25 (28.0%), and in-hospital death occurred in 9 (10.1%). Compared with nonclinical perforations, clinical perforations were larger in size, more often at a collateral location, had a high-risk shape, and less likely to cause staining or fast filling. Compared with perforations not associated with MAE, perforations associated with MAE were larger in size, more proximal or at collateral location, and had a high-risk shape. When the core lab attributed the perforation to the approach used when the perforation occurred, 61% of retrograde perforations by other classifications were actually antegrade. Conclusions: Larger size, proximal or collateral location, and high-risk shapes of a coronary perforation were associated with MAE. Six of 10 perforations occurred with antegrade approaches among patients who had both strategies attempted. These finding will help emerging CTO operators understand high-risk features of the perforation that require treatment and inform future comparisons of retrograde and antegrade complications.

Original languageEnglish (US)
Pages (from-to)1902-1912
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume12
Issue number19
DOIs
StatePublished - Oct 14 2019
Externally publishedYes

Fingerprint

Percutaneous Coronary Intervention
Angioplasty
Cardiac Tamponade
Pericardial Effusion
Registries
Staining and Labeling
Incidence
Therapeutics

Keywords

  • antegrade
  • chronic total occlusion
  • major adverse event
  • percutaneous coronary intervention
  • perforation
  • retrograde

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

A Detailed Analysis of Perforations During Chronic Total Occlusion Angioplasty. / OPEN-CTO Study Group.

In: JACC: Cardiovascular Interventions, Vol. 12, No. 19, 14.10.2019, p. 1902-1912.

Research output: Contribution to journalArticle

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title = "A Detailed Analysis of Perforations During Chronic Total Occlusion Angioplasty",
abstract = "Objectives: This study sought to describe the angiographic characteristics, strategy associated with perforation, and the management of perforation during chronic total occlusion percutaneous coronary intervention (CTO PCI). Background: The incidence of perforation is higher during CTO PCI compared with non-CTO PCI and is reportedly highest among retrograde procedures. Methods: Among 1,000 consecutive patients who underwent CTO PCI in a 12-center registry, 89 (8.9{\%}) had core lab–adjudicated angiographic perforations. Clinical perforation was defined as any perforation requiring treatment. Major adverse cardiac events (MAEs) were defined as in-hospital death, cardiac tamponade, and pericardial effusion. Results: Among the 89 perforations, 43 (48.3{\%}) were clinically significant, and 46 (51.7{\%}) were simply observed. MAE occurred in 25 (28.0{\%}), and in-hospital death occurred in 9 (10.1{\%}). Compared with nonclinical perforations, clinical perforations were larger in size, more often at a collateral location, had a high-risk shape, and less likely to cause staining or fast filling. Compared with perforations not associated with MAE, perforations associated with MAE were larger in size, more proximal or at collateral location, and had a high-risk shape. When the core lab attributed the perforation to the approach used when the perforation occurred, 61{\%} of retrograde perforations by other classifications were actually antegrade. Conclusions: Larger size, proximal or collateral location, and high-risk shapes of a coronary perforation were associated with MAE. Six of 10 perforations occurred with antegrade approaches among patients who had both strategies attempted. These finding will help emerging CTO operators understand high-risk features of the perforation that require treatment and inform future comparisons of retrograde and antegrade complications.",
keywords = "antegrade, chronic total occlusion, major adverse event, percutaneous coronary intervention, perforation, retrograde",
author = "{OPEN-CTO Study Group} and Taishi Hirai and Nicholson, {William J.} and James Sapontis and Salisbury, {Adam C.} and Marso, {Steven P.} and William Lombardi and Dimitri Karmpaliotis and Jeffrey Moses and Ashish Pershad and Wyman, {R. Michael} and Anthony Spaedy and Stephen Cook and Parag Doshi and Robert Federici and Karen Nugent and Gosch, {Kensey L.} and Spertus, {John A.} and Grantham, {J. Aaron}",
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AU - OPEN-CTO Study Group

AU - Hirai, Taishi

AU - Nicholson, William J.

AU - Sapontis, James

AU - Salisbury, Adam C.

AU - Marso, Steven P.

AU - Lombardi, William

AU - Karmpaliotis, Dimitri

AU - Moses, Jeffrey

AU - Pershad, Ashish

AU - Wyman, R. Michael

AU - Spaedy, Anthony

AU - Cook, Stephen

AU - Doshi, Parag

AU - Federici, Robert

AU - Nugent, Karen

AU - Gosch, Kensey L.

AU - Spertus, John A.

AU - Grantham, J. Aaron

PY - 2019/10/14

Y1 - 2019/10/14

N2 - Objectives: This study sought to describe the angiographic characteristics, strategy associated with perforation, and the management of perforation during chronic total occlusion percutaneous coronary intervention (CTO PCI). Background: The incidence of perforation is higher during CTO PCI compared with non-CTO PCI and is reportedly highest among retrograde procedures. Methods: Among 1,000 consecutive patients who underwent CTO PCI in a 12-center registry, 89 (8.9%) had core lab–adjudicated angiographic perforations. Clinical perforation was defined as any perforation requiring treatment. Major adverse cardiac events (MAEs) were defined as in-hospital death, cardiac tamponade, and pericardial effusion. Results: Among the 89 perforations, 43 (48.3%) were clinically significant, and 46 (51.7%) were simply observed. MAE occurred in 25 (28.0%), and in-hospital death occurred in 9 (10.1%). Compared with nonclinical perforations, clinical perforations were larger in size, more often at a collateral location, had a high-risk shape, and less likely to cause staining or fast filling. Compared with perforations not associated with MAE, perforations associated with MAE were larger in size, more proximal or at collateral location, and had a high-risk shape. When the core lab attributed the perforation to the approach used when the perforation occurred, 61% of retrograde perforations by other classifications were actually antegrade. Conclusions: Larger size, proximal or collateral location, and high-risk shapes of a coronary perforation were associated with MAE. Six of 10 perforations occurred with antegrade approaches among patients who had both strategies attempted. These finding will help emerging CTO operators understand high-risk features of the perforation that require treatment and inform future comparisons of retrograde and antegrade complications.

AB - Objectives: This study sought to describe the angiographic characteristics, strategy associated with perforation, and the management of perforation during chronic total occlusion percutaneous coronary intervention (CTO PCI). Background: The incidence of perforation is higher during CTO PCI compared with non-CTO PCI and is reportedly highest among retrograde procedures. Methods: Among 1,000 consecutive patients who underwent CTO PCI in a 12-center registry, 89 (8.9%) had core lab–adjudicated angiographic perforations. Clinical perforation was defined as any perforation requiring treatment. Major adverse cardiac events (MAEs) were defined as in-hospital death, cardiac tamponade, and pericardial effusion. Results: Among the 89 perforations, 43 (48.3%) were clinically significant, and 46 (51.7%) were simply observed. MAE occurred in 25 (28.0%), and in-hospital death occurred in 9 (10.1%). Compared with nonclinical perforations, clinical perforations were larger in size, more often at a collateral location, had a high-risk shape, and less likely to cause staining or fast filling. Compared with perforations not associated with MAE, perforations associated with MAE were larger in size, more proximal or at collateral location, and had a high-risk shape. When the core lab attributed the perforation to the approach used when the perforation occurred, 61% of retrograde perforations by other classifications were actually antegrade. Conclusions: Larger size, proximal or collateral location, and high-risk shapes of a coronary perforation were associated with MAE. Six of 10 perforations occurred with antegrade approaches among patients who had both strategies attempted. These finding will help emerging CTO operators understand high-risk features of the perforation that require treatment and inform future comparisons of retrograde and antegrade complications.

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KW - chronic total occlusion

KW - major adverse event

KW - percutaneous coronary intervention

KW - perforation

KW - retrograde

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