Contrast Utilization during Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from a Contemporary Multicenter Registry

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

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND: Administration of a large amount of contrast volume during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to contrast-induced nephropathy. METHODS: We examined the association of clinical, angiographic and procedural variables with contrast volume administered during 1330 CTO-PCI procedures performed at 12 experienced United States centers. RESULTS: Technical and procedural success was 90% and 88%, respectively, and mean contrast volume was 289 ± 138 mL. Approximately 33% of patients received >320 mL of contrast (high contrast utilization group). On univariable analysis, male gender (P≤.01), smoking (P≤.01), prior coronary artery bypass graft surgery (P≤.04), moderate or severe calcification (P≤.01), moderate or severe tortuosity (P≤.04), proximal cap ambiguity (P≤.01), distal cap at a bifurcation (P<.001), side branch at the proximal cap (P<.001), blunt/no stump (P≤.01), occlusion length (P<.001), higher J-CTO score (P≤.02), use of antegrade dissection and reentry or retrograde approach (P<.001), ad hoc CTO-PCI (P≤.04), dual arterial access (P<.001), and 8 Fr guide catheters (P<.001) were associated with higher contrast volume; conversely, diabetes mellitus (P≤.01) and in-stent restenosis (P≤.01) were associated with lower contrast volume. On multivariable analysis, moderate/severe calcification (P≤.04), distal cap at a bifurcation (P<.001), ad hoc CTO-PCI (P<.001), dual arterial access (P≤.01), 8 Fr guide catheters (P≤.02), and use of antegrade dissection/reentry or the retrograde approach (P<.001) were independently associated with higher contrast use, whereas diabetes (P≤.02), larger target vessel diameter (P≤.03), and presence of interventional collaterals (P<.001) were associated with lower contrast utilization. CONCLUSIONS: Several baseline clinical, angiographic, and procedural characteristics are associated with higher contrast volume administration during CTO-PCI.

Original languageEnglish (US)
Pages (from-to)288-294
Number of pages7
JournalJournal of Invasive Cardiology
Volume28
Issue number7
StatePublished - Jul 1 2016

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Percutaneous Coronary Intervention
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Dissection
Catheters
Coronary Artery Bypass
Stents
Diabetes Mellitus
Smoking
Transplants

Keywords

  • air kerma
  • chronic total occlusion
  • complications
  • contrast volume
  • fluoroscopy
  • percutaneous coronary intervention
  • radiation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Contrast Utilization during Chronic Total Occlusion Percutaneous Coronary Intervention : Insights from a Contemporary Multicenter Registry. / Christakopoulos, Georgios E.; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Yeh, Robert W.; Jaffer, Farouc A.; Wyman, R. Michael; Lombardi, William; Grantham, J. Aaron; Kandzari, David A.; Lembo, Nicholas; Moses, Jeffrey W.; Kirtane, Ajay; Parikh, Manish; Green, Philip; Finn, Matthew; Garcia, Santiago; Doing, Anthony; Patel, Mitul; Bahadorani, John; Christopoulos, Georgios; Karatasakis, Aris; Thompson, Craig A.; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Journal of Invasive Cardiology, Vol. 28, No. 7, 01.07.2016, p. 288-294.

Research output: Contribution to journalArticle

Christakopoulos, GE, Karmpaliotis, D, Alaswad, K, Yeh, RW, Jaffer, FA, Wyman, RM, Lombardi, W, Grantham, JA, Kandzari, DA, Lembo, N, Moses, JW, Kirtane, A, Parikh, M, Green, P, Finn, M, Garcia, S, Doing, A, Patel, M, Bahadorani, J, Christopoulos, G, Karatasakis, A, Thompson, CA, Banerjee, S & Brilakis, ES 2016, 'Contrast Utilization during Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from a Contemporary Multicenter Registry', Journal of Invasive Cardiology, vol. 28, no. 7, pp. 288-294.
Christakopoulos, Georgios E. ; Karmpaliotis, Dimitri ; Alaswad, Khaldoon ; Yeh, Robert W. ; Jaffer, Farouc A. ; Wyman, R. Michael ; Lombardi, William ; Grantham, J. Aaron ; Kandzari, David A. ; Lembo, Nicholas ; Moses, Jeffrey W. ; Kirtane, Ajay ; Parikh, Manish ; Green, Philip ; Finn, Matthew ; Garcia, Santiago ; Doing, Anthony ; Patel, Mitul ; Bahadorani, John ; Christopoulos, Georgios ; Karatasakis, Aris ; Thompson, Craig A. ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Contrast Utilization during Chronic Total Occlusion Percutaneous Coronary Intervention : Insights from a Contemporary Multicenter Registry. In: Journal of Invasive Cardiology. 2016 ; Vol. 28, No. 7. pp. 288-294.
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abstract = "BACKGROUND: Administration of a large amount of contrast volume during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to contrast-induced nephropathy. METHODS: We examined the association of clinical, angiographic and procedural variables with contrast volume administered during 1330 CTO-PCI procedures performed at 12 experienced United States centers. RESULTS: Technical and procedural success was 90{\%} and 88{\%}, respectively, and mean contrast volume was 289 ± 138 mL. Approximately 33{\%} of patients received >320 mL of contrast (high contrast utilization group). On univariable analysis, male gender (P≤.01), smoking (P≤.01), prior coronary artery bypass graft surgery (P≤.04), moderate or severe calcification (P≤.01), moderate or severe tortuosity (P≤.04), proximal cap ambiguity (P≤.01), distal cap at a bifurcation (P<.001), side branch at the proximal cap (P<.001), blunt/no stump (P≤.01), occlusion length (P<.001), higher J-CTO score (P≤.02), use of antegrade dissection and reentry or retrograde approach (P<.001), ad hoc CTO-PCI (P≤.04), dual arterial access (P<.001), and 8 Fr guide catheters (P<.001) were associated with higher contrast volume; conversely, diabetes mellitus (P≤.01) and in-stent restenosis (P≤.01) were associated with lower contrast volume. On multivariable analysis, moderate/severe calcification (P≤.04), distal cap at a bifurcation (P<.001), ad hoc CTO-PCI (P<.001), dual arterial access (P≤.01), 8 Fr guide catheters (P≤.02), and use of antegrade dissection/reentry or the retrograde approach (P<.001) were independently associated with higher contrast use, whereas diabetes (P≤.02), larger target vessel diameter (P≤.03), and presence of interventional collaterals (P<.001) were associated with lower contrast utilization. CONCLUSIONS: Several baseline clinical, angiographic, and procedural characteristics are associated with higher contrast volume administration during CTO-PCI.",
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T1 - Contrast Utilization during Chronic Total Occlusion Percutaneous Coronary Intervention

T2 - Insights from a Contemporary Multicenter Registry

AU - Christakopoulos, Georgios E.

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Yeh, Robert W.

AU - Jaffer, Farouc A.

AU - Wyman, R. Michael

AU - Lombardi, William

AU - Grantham, J. Aaron

AU - Kandzari, David A.

AU - Lembo, Nicholas

AU - Moses, Jeffrey W.

AU - Kirtane, Ajay

AU - Parikh, Manish

AU - Green, Philip

AU - Finn, Matthew

AU - Garcia, Santiago

AU - Doing, Anthony

AU - Patel, Mitul

AU - Bahadorani, John

AU - Christopoulos, Georgios

AU - Karatasakis, Aris

AU - Thompson, Craig A.

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2016/7/1

Y1 - 2016/7/1

N2 - BACKGROUND: Administration of a large amount of contrast volume during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to contrast-induced nephropathy. METHODS: We examined the association of clinical, angiographic and procedural variables with contrast volume administered during 1330 CTO-PCI procedures performed at 12 experienced United States centers. RESULTS: Technical and procedural success was 90% and 88%, respectively, and mean contrast volume was 289 ± 138 mL. Approximately 33% of patients received >320 mL of contrast (high contrast utilization group). On univariable analysis, male gender (P≤.01), smoking (P≤.01), prior coronary artery bypass graft surgery (P≤.04), moderate or severe calcification (P≤.01), moderate or severe tortuosity (P≤.04), proximal cap ambiguity (P≤.01), distal cap at a bifurcation (P<.001), side branch at the proximal cap (P<.001), blunt/no stump (P≤.01), occlusion length (P<.001), higher J-CTO score (P≤.02), use of antegrade dissection and reentry or retrograde approach (P<.001), ad hoc CTO-PCI (P≤.04), dual arterial access (P<.001), and 8 Fr guide catheters (P<.001) were associated with higher contrast volume; conversely, diabetes mellitus (P≤.01) and in-stent restenosis (P≤.01) were associated with lower contrast volume. On multivariable analysis, moderate/severe calcification (P≤.04), distal cap at a bifurcation (P<.001), ad hoc CTO-PCI (P<.001), dual arterial access (P≤.01), 8 Fr guide catheters (P≤.02), and use of antegrade dissection/reentry or the retrograde approach (P<.001) were independently associated with higher contrast use, whereas diabetes (P≤.02), larger target vessel diameter (P≤.03), and presence of interventional collaterals (P<.001) were associated with lower contrast utilization. CONCLUSIONS: Several baseline clinical, angiographic, and procedural characteristics are associated with higher contrast volume administration during CTO-PCI.

AB - BACKGROUND: Administration of a large amount of contrast volume during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to contrast-induced nephropathy. METHODS: We examined the association of clinical, angiographic and procedural variables with contrast volume administered during 1330 CTO-PCI procedures performed at 12 experienced United States centers. RESULTS: Technical and procedural success was 90% and 88%, respectively, and mean contrast volume was 289 ± 138 mL. Approximately 33% of patients received >320 mL of contrast (high contrast utilization group). On univariable analysis, male gender (P≤.01), smoking (P≤.01), prior coronary artery bypass graft surgery (P≤.04), moderate or severe calcification (P≤.01), moderate or severe tortuosity (P≤.04), proximal cap ambiguity (P≤.01), distal cap at a bifurcation (P<.001), side branch at the proximal cap (P<.001), blunt/no stump (P≤.01), occlusion length (P<.001), higher J-CTO score (P≤.02), use of antegrade dissection and reentry or retrograde approach (P<.001), ad hoc CTO-PCI (P≤.04), dual arterial access (P<.001), and 8 Fr guide catheters (P<.001) were associated with higher contrast volume; conversely, diabetes mellitus (P≤.01) and in-stent restenosis (P≤.01) were associated with lower contrast volume. On multivariable analysis, moderate/severe calcification (P≤.04), distal cap at a bifurcation (P<.001), ad hoc CTO-PCI (P<.001), dual arterial access (P≤.01), 8 Fr guide catheters (P≤.02), and use of antegrade dissection/reentry or the retrograde approach (P<.001) were independently associated with higher contrast use, whereas diabetes (P≤.02), larger target vessel diameter (P≤.03), and presence of interventional collaterals (P<.001) were associated with lower contrast utilization. CONCLUSIONS: Several baseline clinical, angiographic, and procedural characteristics are associated with higher contrast volume administration during CTO-PCI.

KW - air kerma

KW - chronic total occlusion

KW - complications

KW - contrast volume

KW - fluoroscopy

KW - percutaneous coronary intervention

KW - radiation

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