TY - JOUR
T1 - The efficacy of "hybrid" percutaneous coronary intervention in chronic total occlusions caused by in-stent restenosis
T2 - Insights from a US multicenter registry
AU - Christopoulos, Georgios
AU - Karmpaliotis, Dimitri
AU - Alaswad, Khaldoon
AU - Lombardi, William L.
AU - Grantham, J. Aaron
AU - Rangan, Bavana V.
AU - Kotsia, Anna P.
AU - Lembo, Nicholas
AU - Kandzari, David E.
AU - Lee, James
AU - Kalynych, Anna
AU - Carlson, Harold
AU - Garcia, Santiago
AU - Banerjee, Subhash
AU - Thompson, Craig A.
AU - Brilakis, Emmanouil S.
N1 - Publisher Copyright:
© 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Objectives To examine the success and complication rates in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) caused by in-stent restenosis (ISR). Background PCI for in-stent total occlusive disease has traditionally been associated with low success rates. We sought to examine angiographic and procedural outcomes of patients who underwent CTO PCI due to ISR using the novel "hybrid" algorithm, and compare them with patients with de novo CTOs. Methods We examined 521 consecutive patients who underwent CTO PCI at five high-volume PCI centers in the United States using the "hybrid" approach. Clinical, angiographic, and procedural outcomes were compared between CTOs due to ISR and de novo CTOs. Results The target CTO was due to ISR in 57 of 521 patients (10.9%). Compared to patients with de novo CTOs, those with CTO due to ISR had higher frequency of diabetes (56.1% vs. 39.6%, P = 0.02) and less calcification (5.3% vs. 16.2%, P <0.001), but longer occlusion length [38 (29-55) vs. 30 (20-51), P = 0.04]. Technical success in the ISR and de novo group was 89.4% and 92.5% (P = 0.43), respectively; procedural success was 86.0% and 90.3% (P = 0.31), respectively; and the incidence of major adverse cardiac events was 3.5% and 2.2% (P = 0.63), respectively. Conclusions Use of the "hybrid" approach to CTO PCI was associated with similarly high procedural success and similarly low major complication rates in patients with de novo and ISR CTOs.
AB - Objectives To examine the success and complication rates in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) caused by in-stent restenosis (ISR). Background PCI for in-stent total occlusive disease has traditionally been associated with low success rates. We sought to examine angiographic and procedural outcomes of patients who underwent CTO PCI due to ISR using the novel "hybrid" algorithm, and compare them with patients with de novo CTOs. Methods We examined 521 consecutive patients who underwent CTO PCI at five high-volume PCI centers in the United States using the "hybrid" approach. Clinical, angiographic, and procedural outcomes were compared between CTOs due to ISR and de novo CTOs. Results The target CTO was due to ISR in 57 of 521 patients (10.9%). Compared to patients with de novo CTOs, those with CTO due to ISR had higher frequency of diabetes (56.1% vs. 39.6%, P = 0.02) and less calcification (5.3% vs. 16.2%, P <0.001), but longer occlusion length [38 (29-55) vs. 30 (20-51), P = 0.04]. Technical success in the ISR and de novo group was 89.4% and 92.5% (P = 0.43), respectively; procedural success was 86.0% and 90.3% (P = 0.31), respectively; and the incidence of major adverse cardiac events was 3.5% and 2.2% (P = 0.63), respectively. Conclusions Use of the "hybrid" approach to CTO PCI was associated with similarly high procedural success and similarly low major complication rates in patients with de novo and ISR CTOs.
KW - chronic total occlusion
KW - in-stent restenosis
KW - percutaneous coronary intervention
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U2 - 10.1002/ccd.25465
DO - 10.1002/ccd.25465
M3 - Article
C2 - 24585508
AN - SCOPUS:84926188001
SN - 1522-1946
VL - 84
SP - 646
EP - 651
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 4
ER -