The efficacy and safety of the "hybrid" approach to coronary chronic total occlusions

Insights from a contemporary multicenter US registry and comparison with prior studies

Georgios Christopoulos, Rohan V. Menon, Dimitri Karmpaliotis, Khaldoon Alaswad, William Lombardi, Aaron Grantham, Vishal G. Patel, Bavana V. Rangan, Anna P. Kotsia, Nicholas Lembo, David Kandzari, Harold Carlson, Santiago Garcia, Subhash Banerjee, Craig A. Thompson, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

BACKGROUND: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is challenging and has been associated with low success rates. However, recent advancements in equipment and the flexibility to switch between multiple technical approaches during the same procedure ("hybrid" percutaneous algorithm) have dramatically increased the success of CTO-PCI. We sought to compare the contemporary procedural outcomes of hybrid CTO-PCI with previously published CTO-PCI studies. METHODS: The procedural outcomes of 497 consecutive CTO-PCIs performed between January 2012 and August 2013 at five high-volume centers in the United States were compared with the pooled success and complication rates reported in 39 prior CTO-PCI series that included ≥100 patients and were published after 2000. RESULTS: The baseline clinical and angiographic characteristics of the study patients were comparable to those of previous studies. Technical and procedural success was achieved in 455 cases (91.5%) and 451 cases (90.7%), respectively, and were significantly higher than the pooled technical and procedural success rates from prior studies (76.5%, P<.001 and 75.2%, P<.001, respectively). Major procedural complications occurred in 9/497 patients (1.8%) overall and included death (2 patients), acute myocardial infarction (5 patients), repeat target vessel PCI (1 patient), and tamponade requiring pericardiocentesis (2 patients). The incidence of major complications was similar to that of prior studies (pooled rate 2.0%; P≤.72). CONCLUSION: Use of the hybrid approach to CTO-PCI is associated with higher success and similar complication rates compared to prior studies, supporting its expanded use for treating these challenging lesions.

Original languageEnglish (US)
Pages (from-to)427-432
Number of pages6
JournalJournal of Invasive Cardiology
Volume26
Issue number9
StatePublished - Sep 1 2014

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Percutaneous Coronary Intervention
Registries
Safety
Pericardiocentesis
Myocardial Infarction
Equipment and Supplies
Incidence

Keywords

  • coronary obstructions
  • percutaneous coronary interventions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

The efficacy and safety of the "hybrid" approach to coronary chronic total occlusions : Insights from a contemporary multicenter US registry and comparison with prior studies. / Christopoulos, Georgios; Menon, Rohan V.; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Lombardi, William; Grantham, Aaron; Patel, Vishal G.; Rangan, Bavana V.; Kotsia, Anna P.; Lembo, Nicholas; Kandzari, David; Carlson, Harold; Garcia, Santiago; Banerjee, Subhash; Thompson, Craig A.; Brilakis, Emmanouil S.

In: Journal of Invasive Cardiology, Vol. 26, No. 9, 01.09.2014, p. 427-432.

Research output: Contribution to journalArticle

Christopoulos, G, Menon, RV, Karmpaliotis, D, Alaswad, K, Lombardi, W, Grantham, A, Patel, VG, Rangan, BV, Kotsia, AP, Lembo, N, Kandzari, D, Carlson, H, Garcia, S, Banerjee, S, Thompson, CA & Brilakis, ES 2014, 'The efficacy and safety of the "hybrid" approach to coronary chronic total occlusions: Insights from a contemporary multicenter US registry and comparison with prior studies', Journal of Invasive Cardiology, vol. 26, no. 9, pp. 427-432.
Christopoulos, Georgios ; Menon, Rohan V. ; Karmpaliotis, Dimitri ; Alaswad, Khaldoon ; Lombardi, William ; Grantham, Aaron ; Patel, Vishal G. ; Rangan, Bavana V. ; Kotsia, Anna P. ; Lembo, Nicholas ; Kandzari, David ; Carlson, Harold ; Garcia, Santiago ; Banerjee, Subhash ; Thompson, Craig A. ; Brilakis, Emmanouil S. / The efficacy and safety of the "hybrid" approach to coronary chronic total occlusions : Insights from a contemporary multicenter US registry and comparison with prior studies. In: Journal of Invasive Cardiology. 2014 ; Vol. 26, No. 9. pp. 427-432.
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abstract = "BACKGROUND: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is challenging and has been associated with low success rates. However, recent advancements in equipment and the flexibility to switch between multiple technical approaches during the same procedure ({"}hybrid{"} percutaneous algorithm) have dramatically increased the success of CTO-PCI. We sought to compare the contemporary procedural outcomes of hybrid CTO-PCI with previously published CTO-PCI studies. METHODS: The procedural outcomes of 497 consecutive CTO-PCIs performed between January 2012 and August 2013 at five high-volume centers in the United States were compared with the pooled success and complication rates reported in 39 prior CTO-PCI series that included ≥100 patients and were published after 2000. RESULTS: The baseline clinical and angiographic characteristics of the study patients were comparable to those of previous studies. Technical and procedural success was achieved in 455 cases (91.5{\%}) and 451 cases (90.7{\%}), respectively, and were significantly higher than the pooled technical and procedural success rates from prior studies (76.5{\%}, P<.001 and 75.2{\%}, P<.001, respectively). Major procedural complications occurred in 9/497 patients (1.8{\%}) overall and included death (2 patients), acute myocardial infarction (5 patients), repeat target vessel PCI (1 patient), and tamponade requiring pericardiocentesis (2 patients). The incidence of major complications was similar to that of prior studies (pooled rate 2.0{\%}; P≤.72). CONCLUSION: Use of the hybrid approach to CTO-PCI is associated with higher success and similar complication rates compared to prior studies, supporting its expanded use for treating these challenging lesions.",
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AU - Menon, Rohan V.

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Lombardi, William

AU - Grantham, Aaron

AU - Patel, Vishal G.

AU - Rangan, Bavana V.

AU - Kotsia, Anna P.

AU - Lembo, Nicholas

AU - Kandzari, David

AU - Carlson, Harold

AU - Garcia, Santiago

AU - Banerjee, Subhash

AU - Thompson, Craig A.

AU - Brilakis, Emmanouil S.

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N2 - BACKGROUND: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is challenging and has been associated with low success rates. However, recent advancements in equipment and the flexibility to switch between multiple technical approaches during the same procedure ("hybrid" percutaneous algorithm) have dramatically increased the success of CTO-PCI. We sought to compare the contemporary procedural outcomes of hybrid CTO-PCI with previously published CTO-PCI studies. METHODS: The procedural outcomes of 497 consecutive CTO-PCIs performed between January 2012 and August 2013 at five high-volume centers in the United States were compared with the pooled success and complication rates reported in 39 prior CTO-PCI series that included ≥100 patients and were published after 2000. RESULTS: The baseline clinical and angiographic characteristics of the study patients were comparable to those of previous studies. Technical and procedural success was achieved in 455 cases (91.5%) and 451 cases (90.7%), respectively, and were significantly higher than the pooled technical and procedural success rates from prior studies (76.5%, P<.001 and 75.2%, P<.001, respectively). Major procedural complications occurred in 9/497 patients (1.8%) overall and included death (2 patients), acute myocardial infarction (5 patients), repeat target vessel PCI (1 patient), and tamponade requiring pericardiocentesis (2 patients). The incidence of major complications was similar to that of prior studies (pooled rate 2.0%; P≤.72). CONCLUSION: Use of the hybrid approach to CTO-PCI is associated with higher success and similar complication rates compared to prior studies, supporting its expanded use for treating these challenging lesions.

AB - BACKGROUND: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is challenging and has been associated with low success rates. However, recent advancements in equipment and the flexibility to switch between multiple technical approaches during the same procedure ("hybrid" percutaneous algorithm) have dramatically increased the success of CTO-PCI. We sought to compare the contemporary procedural outcomes of hybrid CTO-PCI with previously published CTO-PCI studies. METHODS: The procedural outcomes of 497 consecutive CTO-PCIs performed between January 2012 and August 2013 at five high-volume centers in the United States were compared with the pooled success and complication rates reported in 39 prior CTO-PCI series that included ≥100 patients and were published after 2000. RESULTS: The baseline clinical and angiographic characteristics of the study patients were comparable to those of previous studies. Technical and procedural success was achieved in 455 cases (91.5%) and 451 cases (90.7%), respectively, and were significantly higher than the pooled technical and procedural success rates from prior studies (76.5%, P<.001 and 75.2%, P<.001, respectively). Major procedural complications occurred in 9/497 patients (1.8%) overall and included death (2 patients), acute myocardial infarction (5 patients), repeat target vessel PCI (1 patient), and tamponade requiring pericardiocentesis (2 patients). The incidence of major complications was similar to that of prior studies (pooled rate 2.0%; P≤.72). CONCLUSION: Use of the hybrid approach to CTO-PCI is associated with higher success and similar complication rates compared to prior studies, supporting its expanded use for treating these challenging lesions.

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