The impact of proximal vessel tortuosity on the outcomes of chronic total occlusion percutaneous coronary intervention

Insights from a contemporary multicenter registry

Judit Karacsonyi, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, Anthony Doing, Catalin Toma, Barry Uretsky, James Choi, Jeffrey W. Moses, Ajay Kirtane, Manish Parikh, Ziad Ali, William L. Lombardi, David E. Kandzari, Nicholas Lembo, Santiago Garcia, Michael R. Wyman & 10 others Jose R. Martinez-Parachini, Aris Karatasakis, Barbara A. Danek, Aya J. Alame, Erica Resendes, Bavana V. Rangan, Imre Ungi, Craig A. Thompson, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: We examined the impact of proximal vessel tortuosity on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: The baseline clinical and angiographic characteristics and procedural outcomes of 1618 consecutive CTO-PCIs performed between 2012 and 2016 at 14 United States centers in 1589 patients were reviewed. RESULTS: Mean patient age was 65.3 ± 10.0 years and 85% were men. Moderate/severe proximal vessel tortuosity was present in 35.7% of target lesions. Compared with non-tortuous lesions, tortuous lesions had longer length (30 mm [interquartile range, 20-50 mm] vs 28 mm [interquartile range, 16-40 mm]; P<.001), more proximal cap ambiguity (36% vs 28%; P<.01), and more frequent utilization of the retrograde approach (52% vs 37%; P<.001). Moderate/severe proximal vessel tortuosity was associated with lower technical success rates (84.1% vs 91.3%; P<.001) and procedural success rates (82.3% vs 89.9%; P<.001), but similar incidence of major cardiac adverse events (3.0% vs 2.5%; P≤.59). Moderate/severe tortuosity was associated with longer procedure time and fluoroscopy time, higher air kerma radiation dose, and larger contrast volume. CONCLUSION: In a contemporary multicenter registry, moderate/severe proximal vessel tortuosity was present in approximately one-third of target CTO lesions and was associated with more frequent use of the retrograde approach and lower success rates, but similar complication rates.

Original languageEnglish (US)
Pages (from-to)264-270
Number of pages7
JournalJournal of Invasive Cardiology
Volume29
Issue number8
StatePublished - Aug 1 2017

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Percutaneous Coronary Intervention
Registries
Fluoroscopy
Air
Radiation
Incidence

Keywords

  • chronic total occlusion
  • percutaneous coronary intervention
  • tortuosity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

The impact of proximal vessel tortuosity on the outcomes of chronic total occlusion percutaneous coronary intervention : Insights from a contemporary multicenter registry. / Karacsonyi, Judit; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A.; Yeh, Robert W.; Patel, Mitul; Mahmud, Ehtisham; Doing, Anthony; Toma, Catalin; Uretsky, Barry; Choi, James; Moses, Jeffrey W.; Kirtane, Ajay; Parikh, Manish; Ali, Ziad; Lombardi, William L.; Kandzari, David E.; Lembo, Nicholas; Garcia, Santiago; Wyman, Michael R.; Martinez-Parachini, Jose R.; Karatasakis, Aris; Danek, Barbara A.; Alame, Aya J.; Resendes, Erica; Rangan, Bavana V.; Ungi, Imre; Thompson, Craig A.; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Journal of Invasive Cardiology, Vol. 29, No. 8, 01.08.2017, p. 264-270.

Research output: Contribution to journalArticle

Karacsonyi, J, Karmpaliotis, D, Alaswad, K, Jaffer, FA, Yeh, RW, Patel, M, Mahmud, E, Doing, A, Toma, C, Uretsky, B, Choi, J, Moses, JW, Kirtane, A, Parikh, M, Ali, Z, Lombardi, WL, Kandzari, DE, Lembo, N, Garcia, S, Wyman, MR, Martinez-Parachini, JR, Karatasakis, A, Danek, BA, Alame, AJ, Resendes, E, Rangan, BV, Ungi, I, Thompson, CA, Banerjee, S & Brilakis, ES 2017, 'The impact of proximal vessel tortuosity on the outcomes of chronic total occlusion percutaneous coronary intervention: Insights from a contemporary multicenter registry', Journal of Invasive Cardiology, vol. 29, no. 8, pp. 264-270.
Karacsonyi, Judit ; Karmpaliotis, Dimitri ; Alaswad, Khaldoon ; Jaffer, Farouc A. ; Yeh, Robert W. ; Patel, Mitul ; Mahmud, Ehtisham ; Doing, Anthony ; Toma, Catalin ; Uretsky, Barry ; Choi, James ; Moses, Jeffrey W. ; Kirtane, Ajay ; Parikh, Manish ; Ali, Ziad ; Lombardi, William L. ; Kandzari, David E. ; Lembo, Nicholas ; Garcia, Santiago ; Wyman, Michael R. ; Martinez-Parachini, Jose R. ; Karatasakis, Aris ; Danek, Barbara A. ; Alame, Aya J. ; Resendes, Erica ; Rangan, Bavana V. ; Ungi, Imre ; Thompson, Craig A. ; Banerjee, Subhash ; Brilakis, Emmanouil S. / The impact of proximal vessel tortuosity on the outcomes of chronic total occlusion percutaneous coronary intervention : Insights from a contemporary multicenter registry. In: Journal of Invasive Cardiology. 2017 ; Vol. 29, No. 8. pp. 264-270.
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T1 - The impact of proximal vessel tortuosity on the outcomes of chronic total occlusion percutaneous coronary intervention

T2 - Insights from a contemporary multicenter registry

AU - Karacsonyi, Judit

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Jaffer, Farouc A.

AU - Yeh, Robert W.

AU - Patel, Mitul

AU - Mahmud, Ehtisham

AU - Doing, Anthony

AU - Toma, Catalin

AU - Uretsky, Barry

AU - Choi, James

AU - Moses, Jeffrey W.

AU - Kirtane, Ajay

AU - Parikh, Manish

AU - Ali, Ziad

AU - Lombardi, William L.

AU - Kandzari, David E.

AU - Lembo, Nicholas

AU - Garcia, Santiago

AU - Wyman, Michael R.

AU - Martinez-Parachini, Jose R.

AU - Karatasakis, Aris

AU - Danek, Barbara A.

AU - Alame, Aya J.

AU - Resendes, Erica

AU - Rangan, Bavana V.

AU - Ungi, Imre

AU - Thompson, Craig A.

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - INTRODUCTION: We examined the impact of proximal vessel tortuosity on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: The baseline clinical and angiographic characteristics and procedural outcomes of 1618 consecutive CTO-PCIs performed between 2012 and 2016 at 14 United States centers in 1589 patients were reviewed. RESULTS: Mean patient age was 65.3 ± 10.0 years and 85% were men. Moderate/severe proximal vessel tortuosity was present in 35.7% of target lesions. Compared with non-tortuous lesions, tortuous lesions had longer length (30 mm [interquartile range, 20-50 mm] vs 28 mm [interquartile range, 16-40 mm]; P<.001), more proximal cap ambiguity (36% vs 28%; P<.01), and more frequent utilization of the retrograde approach (52% vs 37%; P<.001). Moderate/severe proximal vessel tortuosity was associated with lower technical success rates (84.1% vs 91.3%; P<.001) and procedural success rates (82.3% vs 89.9%; P<.001), but similar incidence of major cardiac adverse events (3.0% vs 2.5%; P≤.59). Moderate/severe tortuosity was associated with longer procedure time and fluoroscopy time, higher air kerma radiation dose, and larger contrast volume. CONCLUSION: In a contemporary multicenter registry, moderate/severe proximal vessel tortuosity was present in approximately one-third of target CTO lesions and was associated with more frequent use of the retrograde approach and lower success rates, but similar complication rates.

AB - INTRODUCTION: We examined the impact of proximal vessel tortuosity on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: The baseline clinical and angiographic characteristics and procedural outcomes of 1618 consecutive CTO-PCIs performed between 2012 and 2016 at 14 United States centers in 1589 patients were reviewed. RESULTS: Mean patient age was 65.3 ± 10.0 years and 85% were men. Moderate/severe proximal vessel tortuosity was present in 35.7% of target lesions. Compared with non-tortuous lesions, tortuous lesions had longer length (30 mm [interquartile range, 20-50 mm] vs 28 mm [interquartile range, 16-40 mm]; P<.001), more proximal cap ambiguity (36% vs 28%; P<.01), and more frequent utilization of the retrograde approach (52% vs 37%; P<.001). Moderate/severe proximal vessel tortuosity was associated with lower technical success rates (84.1% vs 91.3%; P<.001) and procedural success rates (82.3% vs 89.9%; P<.001), but similar incidence of major cardiac adverse events (3.0% vs 2.5%; P≤.59). Moderate/severe tortuosity was associated with longer procedure time and fluoroscopy time, higher air kerma radiation dose, and larger contrast volume. CONCLUSION: In a contemporary multicenter registry, moderate/severe proximal vessel tortuosity was present in approximately one-third of target CTO lesions and was associated with more frequent use of the retrograde approach and lower success rates, but similar complication rates.

KW - chronic total occlusion

KW - percutaneous coronary intervention

KW - tortuosity

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