@article{724990a22ecf40c2b96ef4bd5527100b,
title = "Impact of subintimal plaque modification procedures on health status after unsuccessful chronic total occlusion angioplasty",
abstract = "Objectives: We sought to determine the impact of subintimal plaque modification (SPM) on early health status following unsuccessful chronic total occlusion (CTO) PCI. Background: Intentionally dilating the subintimal space during unsuccessful CTO PCI to facilitate flow through dissection planes and improve success of repeat PCI attempts is a technique used by some hybrid operators, and may improve health status by restoring distal vessel flow despite unsuccessful CTO PCI. Methods: We studied 138 patients who underwent unsuccessful CTO PCI in a 12-center CTO PCI registry. Safety was assessed by comparing in-hospital outcomes of patients undergoing unsuccessful CTO PCI with and without SPM. The association between SPM and health status was quantified using the Seattle Angina Questionnaire Summary Score (SAQ SS), and the association between SPM and SAQ SS was determined using multivariable regression. Results: SPM was performed in 59 patients (42.8%). Complication rates were similar comparing those with and without SPM. At 1-month, patients treated with SPM had larger increases in SAQ SS compared to patients who were not (28.3 ± 21.7 vs. 16.8 ±20.2, P = 0.012), and SPM was associated with an adjusted mean 10.5 point (95% CI 1.4–19.7, P = 0.02) greater SAQ SS improvement through 30 days. Conclusion: SPM was performed in almost half of unsuccessful CTO PCIs and was not associated with increased procedural complications. SPM was independently associated with better patient-reported health status at 30 days. Further studies are needed to assess the necessity of subsequent PCI in patients with significant health status improvements after SPM.",
keywords = "chronic total occlusion, dyspnea, percutaneous coronary intervention",
author = "Taishi Hirai and Grantham, {J. Aaron} and James Sapontis and Cohen, {David J.} and Marso, {Steven P.} and William Lombardi and Dimitri Karmpaliotis and Jeffrey Moses and Nicholson, {William J.} 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 Salisbury, {Adam C.}",
note = "Funding Information: Boston Scientific, institutional educational grant support from Abbott Vascular, Vascular Solutions, Boston Scientific, and Asahi Intecc and part time employment and equity in Corindus Vascular Robotics (Dr. Grantham); Boston Scientific, Abbott Funding Information: Dr. Hirai has no conflicts of interest to report. Dr. Grantham reports speaking fees and honoraria from Boston Scientific, Abbott Vascular, and Asahi Intecc, institutional research grant support from Boston Scientific, institutional educational grant support from Abbott Vascular, Vascular Solutions, Boston Scientific, and Asahi Intecc and part time employment and equity in Corindus Vascular Robotics. Dr. Sapontis reports speaking fees and honoraria from Boston Scientific. Dr. Cohen reports institutional research grant support from Boston Scientific, Abbott Vascular, and Medtronic and consulting fees from Medtronic and Abbott Vascular. Dr. Marso has no conflict of interest to report. Dr. Lombardi reports speaking fees and honoraria from Boston Scientific, Abbott Vascular, and Abiomed, consultancy for Vascular Solutions, Abbott Vascular, Boston Scientific, Abiomed, and Roxwood Medical. He has Equity in Roxwood Medical and Bridgepoint Medical. His wife is an employee of Spectranetics. Dr. Karmpaliotis reports speaking fees, honoraria, and consulting fees from Abbott Vascular, Boston Scientific, Medtronic. Dr. Moses reports no relationships with industry. Dr. Nicholson reports speaking fees and honoraria from Boston Scientific and Abbott Vascular. Dr. Pershad reports speaking fees and honoraria from Boston Scientific Medtronic, Asahi Intecc, Edwards Lifesciences, and Abiomed, consultancy for Abiomed and Boston Scientific. Dr. Wyman reports speaking fees, honoraria and consulting from Boston Scientific and Abbott Vascular. Dr. Spaedy reports speaking fees and honoraria from Boston Scientific and Abbott Vascular. Dr. Cook reports speaking fees and honoraria from Boston Scientific and Abbott Vascular. Dr. Doshi reports speaking fees and consulting fees from Boston Scientific and Abbott Vascular, Consulting fees from CSI, Medtronic, and Spectranetics, and research grants from Boston Scientific. Dr. Federici reports honoraria from Boston Scientific. Ms. Nugent reports no relationships with industry. Ms. Gosch reports no relationships with industry. Dr. Spertus reports research grants from Lilly, Gilead, and Abbott Vascular. He has served as a consultant for Novartis, Amgen, Regeneron and United Healthcare. He owns the copyright to the SAQ, KCCQ and PAQ and has an equity interest in Health Outcomes Sciences. Dr. Salisbury reports research grant support from Boston Scientific and Gilead and speaking fees/honoraria from Abiomed. Publisher Copyright: {\textcopyright} 2017 Wiley Periodicals, Inc.",
year = "2018",
month = may,
day = "1",
doi = "10.1002/ccd.27380",
language = "English (US)",
volume = "91",
pages = "1035--1042",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",
number = "6",
}