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
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M3 - Article
C2 - 25661758
AN - SCOPUS:84922683672
SN - 1042-3931
VL - 27
SP - 78
EP - 84
JO - Journal of Invasive Cardiology
JF - Journal of Invasive Cardiology
IS - 2
ER -