Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry

Georgios Christopoulos, Dimitri Karmpaliotis, Khaldoon Alaswad, Robert W. Yeh, Farouc A. Jaffer, R. Michael Wyman, William L. Lombardi, Rohan V. Menon, J. Aaron Grantham, David E. Kandzari, Nicholas Lembo, Jeffrey W. Moses, Ajay J. Kirtane, Manish Parikh, Philip Green, Matthew Finn, Santiago Garcia, Anthony Doing, Mitul Patel, John BahadoraniMuhammad Nauman J Tarar, Georgios E. Christakopoulos, Craig A. Thompson, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

Background A hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) prioritizing and combining all available crossing techniques was developed to optimize procedural efficacy, efficiency, and safety, but there is limited published data on its outcomes. Methods We examined the procedural techniques and outcomes of 1036 consecutive CTO PCIs performed using a hybrid approach between 2012 and 2015 at 11 US centers. Results Mean age was 65 ± 10 years and 86% of the patients were men, with a high prevalence of diabetes mellitus (43%) and prior coronary artery bypass graft surgery (34%). Most target CTOs were located in the right coronary artery (59%), followed by the left anterior descending artery (23%) and the circumflex (19%). Dual injection was used in 71%. Technical success was achieved in 91% and a major procedural complication occurred in 1.7% of cases. The final successful crossing technique was antegrade wire escalation in 46%, antegrade dissection/re-entry in 26%, and retrograde in 28%. The initial crossing strategy was successful in 58% of the lesions, whereas 39% required an additional approach. Overall, antegrade wire escalation was used in 71%, antegrade dissection/re-entry in 36%, and the retrograde approach in 42% of procedures. Median contrast volume, fluoroscopy time, and air kerma radiation dose were 260 (200-360) ml, 44 (27-72) min, and 3.4 (2.0-5.4) Gray, respectively. Conclusion Application of a hybrid approach to CTO crossing resulted in high success and low complication rates across a varied group of operators and hospital practice structures, supporting its expanding use in CTO PCI.

Original languageEnglish (US)
Pages (from-to)222-228
Number of pages7
JournalInternational Journal of Cardiology
Volume198
DOIs
StatePublished - Aug 28 2015

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Percutaneous Coronary Intervention
Group Practice Hospitals
Registries
Dissection
Fluoroscopy
Coronary Artery Bypass
Coronary Vessels
Diabetes Mellitus
Arteries
Air
Radiation
Transplants
Safety
Injections

Keywords

  • Chronic total occlusion
  • Outcomes
  • Percutaneous coronary intervention
  • Techniques

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry. / Christopoulos, Georgios; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Yeh, Robert W.; Jaffer, Farouc A.; Wyman, R. Michael; Lombardi, William L.; Menon, Rohan V.; Grantham, J. Aaron; Kandzari, David E.; Lembo, Nicholas; Moses, Jeffrey W.; Kirtane, Ajay J.; Parikh, Manish; Green, Philip; Finn, Matthew; Garcia, Santiago; Doing, Anthony; Patel, Mitul; Bahadorani, John; Tarar, Muhammad Nauman J; Christakopoulos, Georgios E.; Thompson, Craig A.; Banerjee, Subhash; Brilakis, Emmanouil S.

In: International Journal of Cardiology, Vol. 198, 28.08.2015, p. 222-228.

Research output: Contribution to journalArticle

Christopoulos, G, Karmpaliotis, D, Alaswad, K, Yeh, RW, Jaffer, FA, Wyman, RM, Lombardi, WL, Menon, RV, Grantham, JA, Kandzari, DE, Lembo, N, Moses, JW, Kirtane, AJ, Parikh, M, Green, P, Finn, M, Garcia, S, Doing, A, Patel, M, Bahadorani, J, Tarar, MNJ, Christakopoulos, GE, Thompson, CA, Banerjee, S & Brilakis, ES 2015, 'Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry', International Journal of Cardiology, vol. 198, pp. 222-228. https://doi.org/10.1016/j.ijcard.2015.06.093
Christopoulos, Georgios ; Karmpaliotis, Dimitri ; Alaswad, Khaldoon ; Yeh, Robert W. ; Jaffer, Farouc A. ; Wyman, R. Michael ; Lombardi, William L. ; Menon, Rohan V. ; Grantham, J. Aaron ; Kandzari, David E. ; Lembo, Nicholas ; Moses, Jeffrey W. ; Kirtane, Ajay J. ; Parikh, Manish ; Green, Philip ; Finn, Matthew ; Garcia, Santiago ; Doing, Anthony ; Patel, Mitul ; Bahadorani, John ; Tarar, Muhammad Nauman J ; Christakopoulos, Georgios E. ; Thompson, Craig A. ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry. In: International Journal of Cardiology. 2015 ; Vol. 198. pp. 222-228.
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abstract = "Background A hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) prioritizing and combining all available crossing techniques was developed to optimize procedural efficacy, efficiency, and safety, but there is limited published data on its outcomes. Methods We examined the procedural techniques and outcomes of 1036 consecutive CTO PCIs performed using a hybrid approach between 2012 and 2015 at 11 US centers. Results Mean age was 65 ± 10 years and 86{\%} of the patients were men, with a high prevalence of diabetes mellitus (43{\%}) and prior coronary artery bypass graft surgery (34{\%}). Most target CTOs were located in the right coronary artery (59{\%}), followed by the left anterior descending artery (23{\%}) and the circumflex (19{\%}). Dual injection was used in 71{\%}. Technical success was achieved in 91{\%} and a major procedural complication occurred in 1.7{\%} of cases. The final successful crossing technique was antegrade wire escalation in 46{\%}, antegrade dissection/re-entry in 26{\%}, and retrograde in 28{\%}. The initial crossing strategy was successful in 58{\%} of the lesions, whereas 39{\%} required an additional approach. Overall, antegrade wire escalation was used in 71{\%}, antegrade dissection/re-entry in 36{\%}, and the retrograde approach in 42{\%} of procedures. Median contrast volume, fluoroscopy time, and air kerma radiation dose were 260 (200-360) ml, 44 (27-72) min, and 3.4 (2.0-5.4) Gray, respectively. Conclusion Application of a hybrid approach to CTO crossing resulted in high success and low complication rates across a varied group of operators and hospital practice structures, supporting its expanding use in CTO PCI.",
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T1 - Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry

AU - Christopoulos, Georgios

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Yeh, Robert W.

AU - Jaffer, Farouc A.

AU - Wyman, R. Michael

AU - Lombardi, William L.

AU - Menon, Rohan V.

AU - Grantham, J. Aaron

AU - Kandzari, David E.

AU - Lembo, Nicholas

AU - Moses, Jeffrey W.

AU - Kirtane, Ajay J.

AU - Parikh, Manish

AU - Green, Philip

AU - Finn, Matthew

AU - Garcia, Santiago

AU - Doing, Anthony

AU - Patel, Mitul

AU - Bahadorani, John

AU - Tarar, Muhammad Nauman J

AU - Christakopoulos, Georgios E.

AU - Thompson, Craig A.

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2015/8/28

Y1 - 2015/8/28

N2 - Background A hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) prioritizing and combining all available crossing techniques was developed to optimize procedural efficacy, efficiency, and safety, but there is limited published data on its outcomes. Methods We examined the procedural techniques and outcomes of 1036 consecutive CTO PCIs performed using a hybrid approach between 2012 and 2015 at 11 US centers. Results Mean age was 65 ± 10 years and 86% of the patients were men, with a high prevalence of diabetes mellitus (43%) and prior coronary artery bypass graft surgery (34%). Most target CTOs were located in the right coronary artery (59%), followed by the left anterior descending artery (23%) and the circumflex (19%). Dual injection was used in 71%. Technical success was achieved in 91% and a major procedural complication occurred in 1.7% of cases. The final successful crossing technique was antegrade wire escalation in 46%, antegrade dissection/re-entry in 26%, and retrograde in 28%. The initial crossing strategy was successful in 58% of the lesions, whereas 39% required an additional approach. Overall, antegrade wire escalation was used in 71%, antegrade dissection/re-entry in 36%, and the retrograde approach in 42% of procedures. Median contrast volume, fluoroscopy time, and air kerma radiation dose were 260 (200-360) ml, 44 (27-72) min, and 3.4 (2.0-5.4) Gray, respectively. Conclusion Application of a hybrid approach to CTO crossing resulted in high success and low complication rates across a varied group of operators and hospital practice structures, supporting its expanding use in CTO PCI.

AB - Background A hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) prioritizing and combining all available crossing techniques was developed to optimize procedural efficacy, efficiency, and safety, but there is limited published data on its outcomes. Methods We examined the procedural techniques and outcomes of 1036 consecutive CTO PCIs performed using a hybrid approach between 2012 and 2015 at 11 US centers. Results Mean age was 65 ± 10 years and 86% of the patients were men, with a high prevalence of diabetes mellitus (43%) and prior coronary artery bypass graft surgery (34%). Most target CTOs were located in the right coronary artery (59%), followed by the left anterior descending artery (23%) and the circumflex (19%). Dual injection was used in 71%. Technical success was achieved in 91% and a major procedural complication occurred in 1.7% of cases. The final successful crossing technique was antegrade wire escalation in 46%, antegrade dissection/re-entry in 26%, and retrograde in 28%. The initial crossing strategy was successful in 58% of the lesions, whereas 39% required an additional approach. Overall, antegrade wire escalation was used in 71%, antegrade dissection/re-entry in 36%, and the retrograde approach in 42% of procedures. Median contrast volume, fluoroscopy time, and air kerma radiation dose were 260 (200-360) ml, 44 (27-72) min, and 3.4 (2.0-5.4) Gray, respectively. Conclusion Application of a hybrid approach to CTO crossing resulted in high success and low complication rates across a varied group of operators and hospital practice structures, supporting its expanding use in CTO PCI.

KW - Chronic total occlusion

KW - Outcomes

KW - Percutaneous coronary intervention

KW - Techniques

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