Coronary artery spatial distribution of chronic total occlusions

Insights from a large US registry

Santiago Garcia, M. Chadi Alraies, Aris Karatasakis, Demetris Yannopoulos, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul P. Patel, John Bahadorani, Judit Karacsonyi, Pratik Kalsaria, Barbara Danek, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To assess the spatial distribution of chronic total occlusions (CTOs) within the coronary arteries and describe procedural strategies and outcomes during CTO percutaneous coronary intervention (PCI). Background: Acute occlusions due to plaque rupture tend to cluster within the proximal third of the coronary artery. Methods: We examined the clinical and procedural characteristics of 1,348 patients according to lesion location within the coronary tree. Results: A total of 1,369 lesions in 1,348 patients (mean age 66±10 years, 85% male) were included. CTO PCI of proximal segments (n=633, 46%) was more common than of mid (n=557, 41%) and distal segments (n=179, 13%). Patients undergoing CTO PCI of proximal segments were more likely to be smokers (P<0.01), have prior coronary artery bypass graft surgery (P=0.03) and lower ejection fraction (P=0.04). CTOs occurring in proximal segments had longer length (P <0.01), proximal cap ambiguity (P<0.01), and moderate/severe calcification (P<0.01) compared to mid or distally located CTOs. Interventional collaterals were more often present in CTO PCI of proximal segments (64%, 53%, 56%, P<0.01) consistent with the higher use of retrograde approach (47%, 33%, 37%, P<0.01) relative to antegrade wire escalation (67%, 82%, 82%, P<0.01). Procedural complexity was higher in CTO PCI of proximal segments (vs. mid and distal): contrast volume= 275 ml (200-375), 260 ml (200-350), 250 ml (175-350), P=0.01; fluoroscopy time 53 minutes (32-83), 39 minutes (24-65), 40 minutes (22-72), P<0.01. However, procedural success (87%, 90%, 85%, P=0.1), technical success (89%, 91%, 88%, P=0.24), and complications rates (2.8%, 2.5%, 2.2%, P=0.88) were not different. Conclusions: The most common target vessel location for CTO PCI is the proximal coronary segment. PCI of proximal occlusions is associated with adverse clinical and angiographic characteristics and often requires use of the retrograde approach, but can be accomplished with high procedural and technical success and low complication rates.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - 2016

Fingerprint

Percutaneous Coronary Intervention
Registries
Coronary Vessels
Fluoroscopy
Coronary Artery Bypass
Rupture
Transplants

Keywords

  • Chronic total occlusion
  • Coronary artery disease
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Coronary artery spatial distribution of chronic total occlusions : Insights from a large US registry. / Garcia, Santiago; Chadi Alraies, M.; Karatasakis, Aris; Yannopoulos, Demetris; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A.; Yeh, Robert W.; Patel, Mitul P.; Bahadorani, John; Karacsonyi, Judit; Kalsaria, Pratik; Danek, Barbara; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Catheterization and Cardiovascular Interventions, 2016.

Research output: Contribution to journalArticle

Garcia, S, Chadi Alraies, M, Karatasakis, A, Yannopoulos, D, Karmpaliotis, D, Alaswad, K, Jaffer, FA, Yeh, RW, Patel, MP, Bahadorani, J, Karacsonyi, J, Kalsaria, P, Danek, B, Banerjee, S & Brilakis, ES 2016, 'Coronary artery spatial distribution of chronic total occlusions: Insights from a large US registry', Catheterization and Cardiovascular Interventions. https://doi.org/10.1002/ccd.26844
Garcia, Santiago ; Chadi Alraies, M. ; Karatasakis, Aris ; Yannopoulos, Demetris ; Karmpaliotis, Dimitri ; Alaswad, Khaldoon ; Jaffer, Farouc A. ; Yeh, Robert W. ; Patel, Mitul P. ; Bahadorani, John ; Karacsonyi, Judit ; Kalsaria, Pratik ; Danek, Barbara ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Coronary artery spatial distribution of chronic total occlusions : Insights from a large US registry. In: Catheterization and Cardiovascular Interventions. 2016.
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abstract = "Objective: To assess the spatial distribution of chronic total occlusions (CTOs) within the coronary arteries and describe procedural strategies and outcomes during CTO percutaneous coronary intervention (PCI). Background: Acute occlusions due to plaque rupture tend to cluster within the proximal third of the coronary artery. Methods: We examined the clinical and procedural characteristics of 1,348 patients according to lesion location within the coronary tree. Results: A total of 1,369 lesions in 1,348 patients (mean age 66±10 years, 85{\%} male) were included. CTO PCI of proximal segments (n=633, 46{\%}) was more common than of mid (n=557, 41{\%}) and distal segments (n=179, 13{\%}). Patients undergoing CTO PCI of proximal segments were more likely to be smokers (P<0.01), have prior coronary artery bypass graft surgery (P=0.03) and lower ejection fraction (P=0.04). CTOs occurring in proximal segments had longer length (P <0.01), proximal cap ambiguity (P<0.01), and moderate/severe calcification (P<0.01) compared to mid or distally located CTOs. Interventional collaterals were more often present in CTO PCI of proximal segments (64{\%}, 53{\%}, 56{\%}, P<0.01) consistent with the higher use of retrograde approach (47{\%}, 33{\%}, 37{\%}, P<0.01) relative to antegrade wire escalation (67{\%}, 82{\%}, 82{\%}, P<0.01). Procedural complexity was higher in CTO PCI of proximal segments (vs. mid and distal): contrast volume= 275 ml (200-375), 260 ml (200-350), 250 ml (175-350), P=0.01; fluoroscopy time 53 minutes (32-83), 39 minutes (24-65), 40 minutes (22-72), P<0.01. However, procedural success (87{\%}, 90{\%}, 85{\%}, P=0.1), technical success (89{\%}, 91{\%}, 88{\%}, P=0.24), and complications rates (2.8{\%}, 2.5{\%}, 2.2{\%}, P=0.88) were not different. Conclusions: The most common target vessel location for CTO PCI is the proximal coronary segment. PCI of proximal occlusions is associated with adverse clinical and angiographic characteristics and often requires use of the retrograde approach, but can be accomplished with high procedural and technical success and low complication rates.",
keywords = "Chronic total occlusion, Coronary artery disease, Percutaneous coronary intervention",
author = "Santiago Garcia and {Chadi Alraies}, M. and Aris Karatasakis and Demetris Yannopoulos and Dimitri Karmpaliotis and Khaldoon Alaswad and Jaffer, {Farouc A.} and Yeh, {Robert W.} and Patel, {Mitul P.} and John Bahadorani and Judit Karacsonyi and Pratik Kalsaria and Barbara Danek and Subhash Banerjee and Brilakis, {Emmanouil S.}",
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TY - JOUR

T1 - Coronary artery spatial distribution of chronic total occlusions

T2 - Insights from a large US registry

AU - Garcia, Santiago

AU - Chadi Alraies, M.

AU - Karatasakis, Aris

AU - Yannopoulos, Demetris

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Jaffer, Farouc A.

AU - Yeh, Robert W.

AU - Patel, Mitul P.

AU - Bahadorani, John

AU - Karacsonyi, Judit

AU - Kalsaria, Pratik

AU - Danek, Barbara

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2016

Y1 - 2016

N2 - Objective: To assess the spatial distribution of chronic total occlusions (CTOs) within the coronary arteries and describe procedural strategies and outcomes during CTO percutaneous coronary intervention (PCI). Background: Acute occlusions due to plaque rupture tend to cluster within the proximal third of the coronary artery. Methods: We examined the clinical and procedural characteristics of 1,348 patients according to lesion location within the coronary tree. Results: A total of 1,369 lesions in 1,348 patients (mean age 66±10 years, 85% male) were included. CTO PCI of proximal segments (n=633, 46%) was more common than of mid (n=557, 41%) and distal segments (n=179, 13%). Patients undergoing CTO PCI of proximal segments were more likely to be smokers (P<0.01), have prior coronary artery bypass graft surgery (P=0.03) and lower ejection fraction (P=0.04). CTOs occurring in proximal segments had longer length (P <0.01), proximal cap ambiguity (P<0.01), and moderate/severe calcification (P<0.01) compared to mid or distally located CTOs. Interventional collaterals were more often present in CTO PCI of proximal segments (64%, 53%, 56%, P<0.01) consistent with the higher use of retrograde approach (47%, 33%, 37%, P<0.01) relative to antegrade wire escalation (67%, 82%, 82%, P<0.01). Procedural complexity was higher in CTO PCI of proximal segments (vs. mid and distal): contrast volume= 275 ml (200-375), 260 ml (200-350), 250 ml (175-350), P=0.01; fluoroscopy time 53 minutes (32-83), 39 minutes (24-65), 40 minutes (22-72), P<0.01. However, procedural success (87%, 90%, 85%, P=0.1), technical success (89%, 91%, 88%, P=0.24), and complications rates (2.8%, 2.5%, 2.2%, P=0.88) were not different. Conclusions: The most common target vessel location for CTO PCI is the proximal coronary segment. PCI of proximal occlusions is associated with adverse clinical and angiographic characteristics and often requires use of the retrograde approach, but can be accomplished with high procedural and technical success and low complication rates.

AB - Objective: To assess the spatial distribution of chronic total occlusions (CTOs) within the coronary arteries and describe procedural strategies and outcomes during CTO percutaneous coronary intervention (PCI). Background: Acute occlusions due to plaque rupture tend to cluster within the proximal third of the coronary artery. Methods: We examined the clinical and procedural characteristics of 1,348 patients according to lesion location within the coronary tree. Results: A total of 1,369 lesions in 1,348 patients (mean age 66±10 years, 85% male) were included. CTO PCI of proximal segments (n=633, 46%) was more common than of mid (n=557, 41%) and distal segments (n=179, 13%). Patients undergoing CTO PCI of proximal segments were more likely to be smokers (P<0.01), have prior coronary artery bypass graft surgery (P=0.03) and lower ejection fraction (P=0.04). CTOs occurring in proximal segments had longer length (P <0.01), proximal cap ambiguity (P<0.01), and moderate/severe calcification (P<0.01) compared to mid or distally located CTOs. Interventional collaterals were more often present in CTO PCI of proximal segments (64%, 53%, 56%, P<0.01) consistent with the higher use of retrograde approach (47%, 33%, 37%, P<0.01) relative to antegrade wire escalation (67%, 82%, 82%, P<0.01). Procedural complexity was higher in CTO PCI of proximal segments (vs. mid and distal): contrast volume= 275 ml (200-375), 260 ml (200-350), 250 ml (175-350), P=0.01; fluoroscopy time 53 minutes (32-83), 39 minutes (24-65), 40 minutes (22-72), P<0.01. However, procedural success (87%, 90%, 85%, P=0.1), technical success (89%, 91%, 88%, P=0.24), and complications rates (2.8%, 2.5%, 2.2%, P=0.88) were not different. Conclusions: The most common target vessel location for CTO PCI is the proximal coronary segment. PCI of proximal occlusions is associated with adverse clinical and angiographic characteristics and often requires use of the retrograde approach, but can be accomplished with high procedural and technical success and low complication rates.

KW - Chronic total occlusion

KW - Coronary artery disease

KW - Percutaneous coronary intervention

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U2 - 10.1002/ccd.26844

DO - 10.1002/ccd.26844

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JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

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