Prevalence and treatment of "Balloon-Uncrossable" coronary chronic total occlusions

Siddharth M. Patel, Nagendra R. Pokala, Rohan V. Menon, Anna P. Kotsia, Vijay Raja, George Christopoulos, Tesfaldet T. Michael, Bavana V. Rangan, Daniel Sherbet, Vishal G. Patel, Shuaib A. Abdullah, Jeffrey Hastings, Jerrold M. Grodin, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

BACKGROUND: The frequency and outcomes of "balloon-uncrossable" coronary chronic total occlusions (CTOs) have receive1d limited study. METHODS: We retrospectively examined 373 consecutive CTO percutaneous coronary interventions (PCIs) performed at our institution between 2005 and 2013 to determine the frequency and treatment of balloon-uncrossable CTOs. RESULTS: Mean age was 63.7 ± 8.3 years and 98.9% of the patients were men. Twenty-four patients (6.4%, 95% confidence intervals 4.2% to 9.4%) were found to have a balloon-uncrossable CTO. Compared to the other CTO PCI patients, those with balloon-uncrossable CTOs had similar clinical and angiographic characteristics. Successful crossing of the balloon-uncrossable CTO was achieved in 22 of 24 patients (91.7%) using a variety of techniques, such as successive balloon inflations (43.5%), microcatheter advancement (21.7%), laser (8.7%), techniques that increase guide catheter support (13.0%), and subintimal lesion crossing (13.0%). Patients with balloon-uncrossable CTOs had longer procedure time (184.5 ± 77.9 vs 134.0 ± 69.0 min, P<.01), fluoroscopy time (55.2 ± 24.9 vs 37.9 ± 20.8 min, P<.01), and received high contrast volume (404.4 ± 137.9 vs 351.7 ± 138.5 mL, P≤.08), but had similar incidence of major complications (8.3% vs 3.2%, P≤.25) as compared with patients who did not have balloon-uncrossable CTOs. CONCLUSION: Balloon-uncrossable CTOs are encountered in 6.4% of contemporary CTO PCIs and can be successfully treated in most patients using a variety of techniques.

Original languageEnglish (US)
Pages (from-to)78-84
Number of pages7
JournalJournal of Invasive Cardiology
Volume27
Issue number2
StatePublished - Feb 1 2015

Fingerprint

Percutaneous Coronary Intervention
Therapeutics
Fluoroscopy
Economic Inflation
Lasers
Catheters
Confidence Intervals
Incidence

Keywords

  • balloon angioplasty
  • chronic total occlusion
  • complications
  • percutaneous coronary intervention
  • techniques

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Patel, S. M., Pokala, N. R., Menon, R. V., Kotsia, A. P., Raja, V., Christopoulos, G., ... Brilakis, E. S. (2015). Prevalence and treatment of "Balloon-Uncrossable" coronary chronic total occlusions. Journal of Invasive Cardiology, 27(2), 78-84.

Prevalence and treatment of "Balloon-Uncrossable" coronary chronic total occlusions. / Patel, Siddharth M.; Pokala, Nagendra R.; Menon, Rohan V.; Kotsia, Anna P.; Raja, Vijay; Christopoulos, George; Michael, Tesfaldet T.; Rangan, Bavana V.; Sherbet, Daniel; Patel, Vishal G.; Abdullah, Shuaib A.; Hastings, Jeffrey; Grodin, Jerrold M.; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Journal of Invasive Cardiology, Vol. 27, No. 2, 01.02.2015, p. 78-84.

Research output: Contribution to journalArticle

Patel, SM, Pokala, NR, Menon, RV, Kotsia, AP, Raja, V, Christopoulos, G, Michael, TT, Rangan, BV, Sherbet, D, Patel, VG, Abdullah, SA, Hastings, J, Grodin, JM, Banerjee, S & Brilakis, ES 2015, 'Prevalence and treatment of "Balloon-Uncrossable" coronary chronic total occlusions', Journal of Invasive Cardiology, vol. 27, no. 2, pp. 78-84.
Patel SM, Pokala NR, Menon RV, Kotsia AP, Raja V, Christopoulos G et al. Prevalence and treatment of "Balloon-Uncrossable" coronary chronic total occlusions. Journal of Invasive Cardiology. 2015 Feb 1;27(2):78-84.
Patel, Siddharth M. ; Pokala, Nagendra R. ; Menon, Rohan V. ; Kotsia, Anna P. ; Raja, Vijay ; Christopoulos, George ; Michael, Tesfaldet T. ; Rangan, Bavana V. ; Sherbet, Daniel ; Patel, Vishal G. ; Abdullah, Shuaib A. ; Hastings, Jeffrey ; Grodin, Jerrold M. ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Prevalence and treatment of "Balloon-Uncrossable" coronary chronic total occlusions. In: Journal of Invasive Cardiology. 2015 ; Vol. 27, No. 2. pp. 78-84.
@article{1b140738ceb74d5c802f21717c5140c6,
title = "Prevalence and treatment of {"}Balloon-Uncrossable{"} coronary chronic total occlusions",
abstract = "BACKGROUND: The frequency and outcomes of {"}balloon-uncrossable{"} coronary chronic total occlusions (CTOs) have receive1d limited study. METHODS: We retrospectively examined 373 consecutive CTO percutaneous coronary interventions (PCIs) performed at our institution between 2005 and 2013 to determine the frequency and treatment of balloon-uncrossable CTOs. RESULTS: Mean age was 63.7 ± 8.3 years and 98.9{\%} of the patients were men. Twenty-four patients (6.4{\%}, 95{\%} confidence intervals 4.2{\%} to 9.4{\%}) were found to have a balloon-uncrossable CTO. Compared to the other CTO PCI patients, those with balloon-uncrossable CTOs had similar clinical and angiographic characteristics. Successful crossing of the balloon-uncrossable CTO was achieved in 22 of 24 patients (91.7{\%}) using a variety of techniques, such as successive balloon inflations (43.5{\%}), microcatheter advancement (21.7{\%}), laser (8.7{\%}), techniques that increase guide catheter support (13.0{\%}), and subintimal lesion crossing (13.0{\%}). Patients with balloon-uncrossable CTOs had longer procedure time (184.5 ± 77.9 vs 134.0 ± 69.0 min, P<.01), fluoroscopy time (55.2 ± 24.9 vs 37.9 ± 20.8 min, P<.01), and received high contrast volume (404.4 ± 137.9 vs 351.7 ± 138.5 mL, P≤.08), but had similar incidence of major complications (8.3{\%} vs 3.2{\%}, P≤.25) as compared with patients who did not have balloon-uncrossable CTOs. CONCLUSION: Balloon-uncrossable CTOs are encountered in 6.4{\%} of contemporary CTO PCIs and can be successfully treated in most patients using a variety of techniques.",
keywords = "balloon angioplasty, chronic total occlusion, complications, percutaneous coronary intervention, techniques",
author = "Patel, {Siddharth M.} and Pokala, {Nagendra R.} and Menon, {Rohan V.} and Kotsia, {Anna P.} and Vijay Raja and George Christopoulos and Michael, {Tesfaldet T.} and Rangan, {Bavana V.} and Daniel Sherbet and Patel, {Vishal G.} and Abdullah, {Shuaib A.} and Jeffrey Hastings and Grodin, {Jerrold M.} and Subhash Banerjee and Brilakis, {Emmanouil S.}",
year = "2015",
month = "2",
day = "1",
language = "English (US)",
volume = "27",
pages = "78--84",
journal = "Journal of Invasive Cardiology",
issn = "1042-3931",
publisher = "HMP Communications",
number = "2",

}

TY - JOUR

T1 - Prevalence and treatment of "Balloon-Uncrossable" coronary chronic total occlusions

AU - Patel, Siddharth M.

AU - Pokala, Nagendra R.

AU - Menon, Rohan V.

AU - Kotsia, Anna P.

AU - Raja, Vijay

AU - Christopoulos, George

AU - Michael, Tesfaldet T.

AU - Rangan, Bavana V.

AU - Sherbet, Daniel

AU - Patel, Vishal G.

AU - Abdullah, Shuaib A.

AU - Hastings, Jeffrey

AU - Grodin, Jerrold M.

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - BACKGROUND: The frequency and outcomes of "balloon-uncrossable" coronary chronic total occlusions (CTOs) have receive1d limited study. METHODS: We retrospectively examined 373 consecutive CTO percutaneous coronary interventions (PCIs) performed at our institution between 2005 and 2013 to determine the frequency and treatment of balloon-uncrossable CTOs. RESULTS: Mean age was 63.7 ± 8.3 years and 98.9% of the patients were men. Twenty-four patients (6.4%, 95% confidence intervals 4.2% to 9.4%) were found to have a balloon-uncrossable CTO. Compared to the other CTO PCI patients, those with balloon-uncrossable CTOs had similar clinical and angiographic characteristics. Successful crossing of the balloon-uncrossable CTO was achieved in 22 of 24 patients (91.7%) using a variety of techniques, such as successive balloon inflations (43.5%), microcatheter advancement (21.7%), laser (8.7%), techniques that increase guide catheter support (13.0%), and subintimal lesion crossing (13.0%). Patients with balloon-uncrossable CTOs had longer procedure time (184.5 ± 77.9 vs 134.0 ± 69.0 min, P<.01), fluoroscopy time (55.2 ± 24.9 vs 37.9 ± 20.8 min, P<.01), and received high contrast volume (404.4 ± 137.9 vs 351.7 ± 138.5 mL, P≤.08), but had similar incidence of major complications (8.3% vs 3.2%, P≤.25) as compared with patients who did not have balloon-uncrossable CTOs. CONCLUSION: Balloon-uncrossable CTOs are encountered in 6.4% of contemporary CTO PCIs and can be successfully treated in most patients using a variety of techniques.

AB - BACKGROUND: The frequency and outcomes of "balloon-uncrossable" coronary chronic total occlusions (CTOs) have receive1d limited study. METHODS: We retrospectively examined 373 consecutive CTO percutaneous coronary interventions (PCIs) performed at our institution between 2005 and 2013 to determine the frequency and treatment of balloon-uncrossable CTOs. RESULTS: Mean age was 63.7 ± 8.3 years and 98.9% of the patients were men. Twenty-four patients (6.4%, 95% confidence intervals 4.2% to 9.4%) were found to have a balloon-uncrossable CTO. Compared to the other CTO PCI patients, those with balloon-uncrossable CTOs had similar clinical and angiographic characteristics. Successful crossing of the balloon-uncrossable CTO was achieved in 22 of 24 patients (91.7%) using a variety of techniques, such as successive balloon inflations (43.5%), microcatheter advancement (21.7%), laser (8.7%), techniques that increase guide catheter support (13.0%), and subintimal lesion crossing (13.0%). Patients with balloon-uncrossable CTOs had longer procedure time (184.5 ± 77.9 vs 134.0 ± 69.0 min, P<.01), fluoroscopy time (55.2 ± 24.9 vs 37.9 ± 20.8 min, P<.01), and received high contrast volume (404.4 ± 137.9 vs 351.7 ± 138.5 mL, P≤.08), but had similar incidence of major complications (8.3% vs 3.2%, P≤.25) as compared with patients who did not have balloon-uncrossable CTOs. CONCLUSION: Balloon-uncrossable CTOs are encountered in 6.4% of contemporary CTO PCIs and can be successfully treated in most patients using a variety of techniques.

KW - balloon angioplasty

KW - chronic total occlusion

KW - complications

KW - percutaneous coronary intervention

KW - techniques

UR - http://www.scopus.com/inward/record.url?scp=84922683672&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84922683672&partnerID=8YFLogxK

M3 - Article

C2 - 25661758

AN - SCOPUS:84922683672

VL - 27

SP - 78

EP - 84

JO - Journal of Invasive Cardiology

JF - Journal of Invasive Cardiology

SN - 1042-3931

IS - 2

ER -