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

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20 Scopus citations

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

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Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Patel, S. M., Pokala, N. R., Menon, R. V., Kotsia, A. P., Raja, V., Christopoulos, G., Michael, T. T., Rangan, B. V., Sherbet, D., Patel, V. G., Abdullah, S. A., Hastings, J., Grodin, J. M., Banerjee, S., & Brilakis, E. S. (2015). Prevalence and treatment of "Balloon-Uncrossable" coronary chronic total occlusions. Journal of Invasive Cardiology, 27(2), 78-84.