Prevalence, indications and management of balloon uncrossable chronic total occlusions: Insights from a contemporary multicenter US registry

Judit Karacsonyi, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, John Bahadorani, Anthony Doing, Ziad A. Ali, Aris Karatasakis, Barbara A. Danek, Bavana V. Rangan, Aya J. Alame, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Balloon uncrossable lesions can be challenging to treat, requiring specialized techniques and equipment. Methods: We examined the prevalence, clinical and angiographic characteristics, management and procedural outcomes of balloon uncrossable lesions in a multicenter chronic total occlusion (CTO) percutaneous coronary intervention (PCI) registry. Results: Between 2012 and 2016, 718 CTO PCIs (in which the occlusion was successfully crossed with a guidewire) were performed in 701 patients at 11 US centers. Mean age was 65.6±10 years and 84% of the patients were men. Balloon uncrossable lesions represented 9% of all CTOs. Balloon uncrossable CTOs had more moderate/severe calcification (82% vs. 52%, P<0.0001), moderate/severe tortuosity (61% vs. 35% P<0.0001) and higher J-CTO score (2.95±1.32 vs. 2.43±1.23, P=0.005) as compared with the remaining lesions. Technical and procedural success was significantly lower for balloon uncrossable lesions (90.5% vs. 98.3%, P<0.0001 and 88.9% vs. 96.6% P=0.004), respectively, but the incidence of major adverse events was similar (1.6% vs. 2.2%, P=0.751). Balloon uncrossable lesions required longer procedure (208 [interquartile range: 135, 258] vs. 135 [94, 194] min, P<0.0001) and fluoroscopy (77 [52, 100] vs. 45 min [27, 75], P<0.0001) time. Techniques used to treat balloon uncrossable lesions included balloon-assisted microdissection (23%), excimer laser atherectomy (18%), and rotational atherectomy (16%). Excimer laser atherectomy and balloon-assisted microdissection were associated with the highest technical and procedural success rates. Conclusions: Balloon uncrossable CTOs are common, are associated with high rates of technical failure, and require specialized techniques for successful treatment.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - 2016

Fingerprint

Atherectomy
Excimer Lasers
Microdissection
Registries
Coronary Atherectomy
Fluoroscopy
Percutaneous Coronary Intervention
Equipment and Supplies
Incidence
Therapeutics

Keywords

  • Balloon angioplasty
  • Balloon uncrossable lesion
  • Chronic total occlusion
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Prevalence, indications and management of balloon uncrossable chronic total occlusions : Insights from a contemporary multicenter US registry. / Karacsonyi, Judit; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A.; Yeh, Robert W.; Patel, Mitul; Bahadorani, John; Doing, Anthony; Ali, Ziad A.; Karatasakis, Aris; Danek, Barbara A.; Rangan, Bavana V.; Alame, Aya J.; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Catheterization and Cardiovascular Interventions, 2016.

Research output: Contribution to journalArticle

Karacsonyi, J, Karmpaliotis, D, Alaswad, K, Jaffer, FA, Yeh, RW, Patel, M, Bahadorani, J, Doing, A, Ali, ZA, Karatasakis, A, Danek, BA, Rangan, BV, Alame, AJ, Banerjee, S & Brilakis, ES 2016, 'Prevalence, indications and management of balloon uncrossable chronic total occlusions: Insights from a contemporary multicenter US registry', Catheterization and Cardiovascular Interventions. https://doi.org/10.1002/ccd.26780
Karacsonyi, Judit ; Karmpaliotis, Dimitri ; Alaswad, Khaldoon ; Jaffer, Farouc A. ; Yeh, Robert W. ; Patel, Mitul ; Bahadorani, John ; Doing, Anthony ; Ali, Ziad A. ; Karatasakis, Aris ; Danek, Barbara A. ; Rangan, Bavana V. ; Alame, Aya J. ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Prevalence, indications and management of balloon uncrossable chronic total occlusions : Insights from a contemporary multicenter US registry. In: Catheterization and Cardiovascular Interventions. 2016.
@article{f24e0791de434099b1eee418bdddb8fa,
title = "Prevalence, indications and management of balloon uncrossable chronic total occlusions: Insights from a contemporary multicenter US registry",
abstract = "Background: Balloon uncrossable lesions can be challenging to treat, requiring specialized techniques and equipment. Methods: We examined the prevalence, clinical and angiographic characteristics, management and procedural outcomes of balloon uncrossable lesions in a multicenter chronic total occlusion (CTO) percutaneous coronary intervention (PCI) registry. Results: Between 2012 and 2016, 718 CTO PCIs (in which the occlusion was successfully crossed with a guidewire) were performed in 701 patients at 11 US centers. Mean age was 65.6±10 years and 84{\%} of the patients were men. Balloon uncrossable lesions represented 9{\%} of all CTOs. Balloon uncrossable CTOs had more moderate/severe calcification (82{\%} vs. 52{\%}, P<0.0001), moderate/severe tortuosity (61{\%} vs. 35{\%} P<0.0001) and higher J-CTO score (2.95±1.32 vs. 2.43±1.23, P=0.005) as compared with the remaining lesions. Technical and procedural success was significantly lower for balloon uncrossable lesions (90.5{\%} vs. 98.3{\%}, P<0.0001 and 88.9{\%} vs. 96.6{\%} P=0.004), respectively, but the incidence of major adverse events was similar (1.6{\%} vs. 2.2{\%}, P=0.751). Balloon uncrossable lesions required longer procedure (208 [interquartile range: 135, 258] vs. 135 [94, 194] min, P<0.0001) and fluoroscopy (77 [52, 100] vs. 45 min [27, 75], P<0.0001) time. Techniques used to treat balloon uncrossable lesions included balloon-assisted microdissection (23{\%}), excimer laser atherectomy (18{\%}), and rotational atherectomy (16{\%}). Excimer laser atherectomy and balloon-assisted microdissection were associated with the highest technical and procedural success rates. Conclusions: Balloon uncrossable CTOs are common, are associated with high rates of technical failure, and require specialized techniques for successful treatment.",
keywords = "Balloon angioplasty, Balloon uncrossable lesion, Chronic total occlusion, Percutaneous coronary intervention",
author = "Judit Karacsonyi and Dimitri Karmpaliotis and Khaldoon Alaswad and Jaffer, {Farouc A.} and Yeh, {Robert W.} and Mitul Patel and John Bahadorani and Anthony Doing and Ali, {Ziad A.} and Aris Karatasakis and Danek, {Barbara A.} and Rangan, {Bavana V.} and Alame, {Aya J.} and Subhash Banerjee and Brilakis, {Emmanouil S.}",
year = "2016",
doi = "10.1002/ccd.26780",
language = "English (US)",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",

}

TY - JOUR

T1 - Prevalence, indications and management of balloon uncrossable chronic total occlusions

T2 - Insights from a contemporary multicenter US registry

AU - Karacsonyi, Judit

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Jaffer, Farouc A.

AU - Yeh, Robert W.

AU - Patel, Mitul

AU - Bahadorani, John

AU - Doing, Anthony

AU - Ali, Ziad A.

AU - Karatasakis, Aris

AU - Danek, Barbara A.

AU - Rangan, Bavana V.

AU - Alame, Aya J.

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2016

Y1 - 2016

N2 - Background: Balloon uncrossable lesions can be challenging to treat, requiring specialized techniques and equipment. Methods: We examined the prevalence, clinical and angiographic characteristics, management and procedural outcomes of balloon uncrossable lesions in a multicenter chronic total occlusion (CTO) percutaneous coronary intervention (PCI) registry. Results: Between 2012 and 2016, 718 CTO PCIs (in which the occlusion was successfully crossed with a guidewire) were performed in 701 patients at 11 US centers. Mean age was 65.6±10 years and 84% of the patients were men. Balloon uncrossable lesions represented 9% of all CTOs. Balloon uncrossable CTOs had more moderate/severe calcification (82% vs. 52%, P<0.0001), moderate/severe tortuosity (61% vs. 35% P<0.0001) and higher J-CTO score (2.95±1.32 vs. 2.43±1.23, P=0.005) as compared with the remaining lesions. Technical and procedural success was significantly lower for balloon uncrossable lesions (90.5% vs. 98.3%, P<0.0001 and 88.9% vs. 96.6% P=0.004), respectively, but the incidence of major adverse events was similar (1.6% vs. 2.2%, P=0.751). Balloon uncrossable lesions required longer procedure (208 [interquartile range: 135, 258] vs. 135 [94, 194] min, P<0.0001) and fluoroscopy (77 [52, 100] vs. 45 min [27, 75], P<0.0001) time. Techniques used to treat balloon uncrossable lesions included balloon-assisted microdissection (23%), excimer laser atherectomy (18%), and rotational atherectomy (16%). Excimer laser atherectomy and balloon-assisted microdissection were associated with the highest technical and procedural success rates. Conclusions: Balloon uncrossable CTOs are common, are associated with high rates of technical failure, and require specialized techniques for successful treatment.

AB - Background: Balloon uncrossable lesions can be challenging to treat, requiring specialized techniques and equipment. Methods: We examined the prevalence, clinical and angiographic characteristics, management and procedural outcomes of balloon uncrossable lesions in a multicenter chronic total occlusion (CTO) percutaneous coronary intervention (PCI) registry. Results: Between 2012 and 2016, 718 CTO PCIs (in which the occlusion was successfully crossed with a guidewire) were performed in 701 patients at 11 US centers. Mean age was 65.6±10 years and 84% of the patients were men. Balloon uncrossable lesions represented 9% of all CTOs. Balloon uncrossable CTOs had more moderate/severe calcification (82% vs. 52%, P<0.0001), moderate/severe tortuosity (61% vs. 35% P<0.0001) and higher J-CTO score (2.95±1.32 vs. 2.43±1.23, P=0.005) as compared with the remaining lesions. Technical and procedural success was significantly lower for balloon uncrossable lesions (90.5% vs. 98.3%, P<0.0001 and 88.9% vs. 96.6% P=0.004), respectively, but the incidence of major adverse events was similar (1.6% vs. 2.2%, P=0.751). Balloon uncrossable lesions required longer procedure (208 [interquartile range: 135, 258] vs. 135 [94, 194] min, P<0.0001) and fluoroscopy (77 [52, 100] vs. 45 min [27, 75], P<0.0001) time. Techniques used to treat balloon uncrossable lesions included balloon-assisted microdissection (23%), excimer laser atherectomy (18%), and rotational atherectomy (16%). Excimer laser atherectomy and balloon-assisted microdissection were associated with the highest technical and procedural success rates. Conclusions: Balloon uncrossable CTOs are common, are associated with high rates of technical failure, and require specialized techniques for successful treatment.

KW - Balloon angioplasty

KW - Balloon uncrossable lesion

KW - Chronic total occlusion

KW - Percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=84997724775&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84997724775&partnerID=8YFLogxK

U2 - 10.1002/ccd.26780

DO - 10.1002/ccd.26780

M3 - Article

C2 - 27650935

AN - SCOPUS:84997724775

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

ER -