Comparative Assessment of Procedure Cost and Outcomes Between Guidewire and Crossing Device Strategies to Cross Peripheral Artery Chronic Total Occlusions

Subhash Banerjee, Haekyung Jeon-Slaughter, Shirling Tsai, Atif Mohammad, Mazin Foteh, Mazen Abu-Fadel, Osvaldo S. Gigliotti, Ian Cawich, Gerardo Rodriguez, Dharam Kumbhani, Tayo Addo, Michael Luna, Tony S. Das, Anand Prasad, Ehrin J. Armstrong, Nicolas W. Shammas, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives The aim of this study was to assess actual procedural costs and outcomes comparing wire-catheter and dedicated chronic total occlusion (CTO) device strategies to cross peripheral artery CTOs. Background Peripheral artery CTO interventions are frequently performed, but there are limited data on actual procedural costs and outcomes comparing wire-catheter and dedicated CTO devices. Methods The XLPAD (Excellence in Peripheral Artery Disease Intervention) registry (NCT01904851) was accessed to retrospectively compare cost and 30-day and 12-month outcomes of wire-catheter and crossing device strategies for treatment of infrainguinal peripheral artery CTO. Results Of all 3,234 treated lesions, 42% (n = 1,362) were CTOs in 1,006 unique patients. Wire-catheter approaches were used in 82% of CTOs, whereas dedicated CTO devices were used in 18% (p < 0.0001). CTO crossing device use was associated with significantly higher technical success (74% vs. 65%; p < 0.0001) and mean procedure cost ($7,800.09 vs. $4,973.24; p < 0.0001). Because 12-month repeat revascularization (11.3% vs. 17.2%; p = 0.02) and amputation rates (2.8% vs. 8.5%; p = 0.002) in the CTO crossing device arm were lower compared with the wire-catheter group, the net cost for an initial CTO crossing device strategy was $423.80 per procedure. Conclusions An initial wire-catheter approach to cross a peripheral artery CTO is most frequently adopted. The use of dedicated CTO crossing devices provides significantly higher technical success and lower reintervention and amputation rates, at a net cost of $423.80 per procedure at 12 months.

Original languageEnglish (US)
Pages (from-to)2243-2252
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume9
Issue number21
DOIs
StatePublished - Nov 14 2016

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Arteries
Costs and Cost Analysis
Equipment and Supplies
Catheters
Amputation
Peripheral Arterial Disease
Registries

Keywords

  • chronic total occlusion
  • cost-benefit analysis
  • peripheral artery disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparative Assessment of Procedure Cost and Outcomes Between Guidewire and Crossing Device Strategies to Cross Peripheral Artery Chronic Total Occlusions. / Banerjee, Subhash; Jeon-Slaughter, Haekyung; Tsai, Shirling; Mohammad, Atif; Foteh, Mazin; Abu-Fadel, Mazen; Gigliotti, Osvaldo S.; Cawich, Ian; Rodriguez, Gerardo; Kumbhani, Dharam; Addo, Tayo; Luna, Michael; Das, Tony S.; Prasad, Anand; Armstrong, Ehrin J.; Shammas, Nicolas W.; Brilakis, Emmanouil S.

In: JACC: Cardiovascular Interventions, Vol. 9, No. 21, 14.11.2016, p. 2243-2252.

Research output: Contribution to journalArticle

Banerjee, Subhash ; Jeon-Slaughter, Haekyung ; Tsai, Shirling ; Mohammad, Atif ; Foteh, Mazin ; Abu-Fadel, Mazen ; Gigliotti, Osvaldo S. ; Cawich, Ian ; Rodriguez, Gerardo ; Kumbhani, Dharam ; Addo, Tayo ; Luna, Michael ; Das, Tony S. ; Prasad, Anand ; Armstrong, Ehrin J. ; Shammas, Nicolas W. ; Brilakis, Emmanouil S. / Comparative Assessment of Procedure Cost and Outcomes Between Guidewire and Crossing Device Strategies to Cross Peripheral Artery Chronic Total Occlusions. In: JACC: Cardiovascular Interventions. 2016 ; Vol. 9, No. 21. pp. 2243-2252.
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abstract = "Objectives The aim of this study was to assess actual procedural costs and outcomes comparing wire-catheter and dedicated chronic total occlusion (CTO) device strategies to cross peripheral artery CTOs. Background Peripheral artery CTO interventions are frequently performed, but there are limited data on actual procedural costs and outcomes comparing wire-catheter and dedicated CTO devices. Methods The XLPAD (Excellence in Peripheral Artery Disease Intervention) registry (NCT01904851) was accessed to retrospectively compare cost and 30-day and 12-month outcomes of wire-catheter and crossing device strategies for treatment of infrainguinal peripheral artery CTO. Results Of all 3,234 treated lesions, 42{\%} (n = 1,362) were CTOs in 1,006 unique patients. Wire-catheter approaches were used in 82{\%} of CTOs, whereas dedicated CTO devices were used in 18{\%} (p < 0.0001). CTO crossing device use was associated with significantly higher technical success (74{\%} vs. 65{\%}; p < 0.0001) and mean procedure cost ($7,800.09 vs. $4,973.24; p < 0.0001). Because 12-month repeat revascularization (11.3{\%} vs. 17.2{\%}; p = 0.02) and amputation rates (2.8{\%} vs. 8.5{\%}; p = 0.002) in the CTO crossing device arm were lower compared with the wire-catheter group, the net cost for an initial CTO crossing device strategy was $423.80 per procedure. Conclusions An initial wire-catheter approach to cross a peripheral artery CTO is most frequently adopted. The use of dedicated CTO crossing devices provides significantly higher technical success and lower reintervention and amputation rates, at a net cost of $423.80 per procedure at 12 months.",
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AU - Banerjee, Subhash

AU - Jeon-Slaughter, Haekyung

AU - Tsai, Shirling

AU - Mohammad, Atif

AU - Foteh, Mazin

AU - Abu-Fadel, Mazen

AU - Gigliotti, Osvaldo S.

AU - Cawich, Ian

AU - Rodriguez, Gerardo

AU - Kumbhani, Dharam

AU - Addo, Tayo

AU - Luna, Michael

AU - Das, Tony S.

AU - Prasad, Anand

AU - Armstrong, Ehrin J.

AU - Shammas, Nicolas W.

AU - Brilakis, Emmanouil S.

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N2 - Objectives The aim of this study was to assess actual procedural costs and outcomes comparing wire-catheter and dedicated chronic total occlusion (CTO) device strategies to cross peripheral artery CTOs. Background Peripheral artery CTO interventions are frequently performed, but there are limited data on actual procedural costs and outcomes comparing wire-catheter and dedicated CTO devices. Methods The XLPAD (Excellence in Peripheral Artery Disease Intervention) registry (NCT01904851) was accessed to retrospectively compare cost and 30-day and 12-month outcomes of wire-catheter and crossing device strategies for treatment of infrainguinal peripheral artery CTO. Results Of all 3,234 treated lesions, 42% (n = 1,362) were CTOs in 1,006 unique patients. Wire-catheter approaches were used in 82% of CTOs, whereas dedicated CTO devices were used in 18% (p < 0.0001). CTO crossing device use was associated with significantly higher technical success (74% vs. 65%; p < 0.0001) and mean procedure cost ($7,800.09 vs. $4,973.24; p < 0.0001). Because 12-month repeat revascularization (11.3% vs. 17.2%; p = 0.02) and amputation rates (2.8% vs. 8.5%; p = 0.002) in the CTO crossing device arm were lower compared with the wire-catheter group, the net cost for an initial CTO crossing device strategy was $423.80 per procedure. Conclusions An initial wire-catheter approach to cross a peripheral artery CTO is most frequently adopted. The use of dedicated CTO crossing devices provides significantly higher technical success and lower reintervention and amputation rates, at a net cost of $423.80 per procedure at 12 months.

AB - Objectives The aim of this study was to assess actual procedural costs and outcomes comparing wire-catheter and dedicated chronic total occlusion (CTO) device strategies to cross peripheral artery CTOs. Background Peripheral artery CTO interventions are frequently performed, but there are limited data on actual procedural costs and outcomes comparing wire-catheter and dedicated CTO devices. Methods The XLPAD (Excellence in Peripheral Artery Disease Intervention) registry (NCT01904851) was accessed to retrospectively compare cost and 30-day and 12-month outcomes of wire-catheter and crossing device strategies for treatment of infrainguinal peripheral artery CTO. Results Of all 3,234 treated lesions, 42% (n = 1,362) were CTOs in 1,006 unique patients. Wire-catheter approaches were used in 82% of CTOs, whereas dedicated CTO devices were used in 18% (p < 0.0001). CTO crossing device use was associated with significantly higher technical success (74% vs. 65%; p < 0.0001) and mean procedure cost ($7,800.09 vs. $4,973.24; p < 0.0001). Because 12-month repeat revascularization (11.3% vs. 17.2%; p = 0.02) and amputation rates (2.8% vs. 8.5%; p = 0.002) in the CTO crossing device arm were lower compared with the wire-catheter group, the net cost for an initial CTO crossing device strategy was $423.80 per procedure. Conclusions An initial wire-catheter approach to cross a peripheral artery CTO is most frequently adopted. The use of dedicated CTO crossing devices provides significantly higher technical success and lower reintervention and amputation rates, at a net cost of $423.80 per procedure at 12 months.

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KW - cost-benefit analysis

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