Intravascular lithotripsy in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry

Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, Rhian E. Davies, Stewart Benton, William Nicholson, Stephane Rinfret, Wissam A. Jaber, Leah Raj, Pratik B. Sandesara, Khaldoon Alaswad, Mir Babar Basir, Michael Megaly, Jaikirshan J. Khatri, Laura D. Young, Farouc A. Jaffer, Nidal Abi Rafeh, Mitul P. Patel, Jimmy L. Kerrigan, Elias V. HaddadPhil Dattilo, Yader Sandoval, Daniel R. Schimmel, Abdul M. Sheikh, Ahmed M. ElGuindy, Omer Goktekin, Olga C. Mastrodemos, Bavana Venkata Rangan, M. Nicholas Burke, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The use of intravascular lithotripsy (IVL) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 82 CTO PCIs that required IVL at 14 centers between 2020 and 2022. Results: During the study period, IVL was used in 82 of 3301 (2.5%) CTO PCI procedures (0.4% in 2020 and 7% in 2022; p for trend < 0.001). Mean patient age was 69 ± 11 years and 79% were men. The prevalence of hypertension (95%), diabetes mellitus (62%), and prior PCI (61%) was high. The most common target vessel was the right coronary artery (54%), followed by the left circumflex (23%). The mean J-CTO and PROGRESS-CTO scores were 2.8 ± 1.1 and 1.3 ± 1.0, respectively. Antegrade wiring was the final successful crossing strategy in 65% and the retrograde approach was used in 22%. IVL was used in 10% of all heavily calcified lesions and 11% of all balloon undilatable lesions. The 3.5 mm lithotripsy balloon was the most commonly used balloon (28%). The mean number of pulses per lithotripsy run was 33 ± 32 and the median duration of lithotripsy was 80 (interquartile range: 40−103) seconds. Technical and procedural success was achieved in 77 (94%) and 74 (90%) cases, respectively. Two (2.4%) Ellis Class 2 perforations occurred after IVL use and were managed conservatively. Conclusion: IVL is increasingly being used in CTO PCI with encouraging outcomes.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - 2022
Externally publishedYes

Keywords

  • calcified lesions
  • chronic total occlusion
  • coronary artery disease
  • coronary calcification
  • intravascular lithotripsy
  • percutaneous coronary intervention
  • stents
  • undilatable lesions

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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