Usefulness of Atherectomy in Chronic Total Occlusion Interventions (from the PROGRESS-CTO Registry)

Iosif Xenogiannis, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, James W. Choi, M. Nicholas Burke, Anthony H. Doing, Phil Dattilo, Catalin Toma, A. J.Conrad Smith, Barry Uretsky, Oleg Krestyaninov, Dmitrii Khelimskii, Elizabeth Holper, Srinivas Potluri, R. Michael Wyman, David E. KandzariSantiago Garcia, Michalis Koutouzis, Ioannis Tsiafoutis, Jaikirshan J. Khatri, Wissam Jaber, Habib Samady, Brian K. Jefferson, Taral Patel, Jeffrey W. Moses, Nicholas J. Lembo, Manish Parikh, Ajay J. Kirtane, Ziad A. Ali, Darshan Doshi, Peter Tajti, Bavana Venkata Rangan, Shuaib M Abdullah, Subhash Banerjee, Emmanouil S Brilakis

Research output: Contribution to journalArticle

Abstract

There is limited data on the use of atherectomy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared the clinical and procedural characteristics and outcomes of CTO PCIs performed with or without atherectomy in a contemporary multicenter CTO PCI registry. Between 2012 and 2018, 3,607 CTO PCIs were performed at 21 participating centers. Atherectomy was used in 117 (3.2%) cases: rotational atherectomy in 105 cases, orbital atherectomy in 8, and both in 4 cases. Patients in whom atherectomy was used, were older (68 ± 8 vs 64 ± 10 years, p <0.0001) and had higher Japan-chronic total occlusion score (3.0 ± 1.2 vs 2.4 ± 1.3, p <0.0001). CTO PCI cases in which atherectomy was used had similar technical (91% vs 87%, p = 0.240) and procedural (90% vs 85%, p = 0.159) success and in-hospital major adverse cardiac event (4% vs 3%, p = 0.382) rates. However, atherectomy cases were associated with higher rates of donor vessel injury (4% vs 1%, p = 0.031), tamponade requiring pericardiocentesis (2.6% vs 0.4%, p = 0.012) and more often required use of a left ventricular assist device (9% vs 5%, p = 0.031). Atherectomy cases were associated with longer procedural duration (196 [141, 247] vs 119 [76, 180] minutes, p <0.0001), and higher patient air kerma radiation dose (3.6 [2.5, 5.6] vs 2.8 [1.6, 4.7] Gray, p = 0.001). In conclusion, atherectomy is currently performed in approximately 3% of CTO PCI cases and is associated with similar technical and procedural success and overall major adverse cardiac event rates, but higher risk for donor vessel injury and tamponade.

Original languageEnglish (US)
Pages (from-to)1422-1428
Number of pages7
JournalAmerican Journal of Cardiology
Volume123
Issue number9
DOIs
StatePublished - May 1 2019

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Atherectomy
Registries
Percutaneous Coronary Intervention
Tissue Donors
Coronary Atherectomy
Pericardiocentesis
Heart-Assist Devices
Wounds and Injuries
Japan
Air
Radiation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Usefulness of Atherectomy in Chronic Total Occlusion Interventions (from the PROGRESS-CTO Registry). / Xenogiannis, Iosif; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A.; Yeh, Robert W.; Patel, Mitul; Mahmud, Ehtisham; Choi, James W.; Burke, M. Nicholas; Doing, Anthony H.; Dattilo, Phil; Toma, Catalin; Smith, A. J.Conrad; Uretsky, Barry; Krestyaninov, Oleg; Khelimskii, Dmitrii; Holper, Elizabeth; Potluri, Srinivas; Wyman, R. Michael; Kandzari, David E.; Garcia, Santiago; Koutouzis, Michalis; Tsiafoutis, Ioannis; Khatri, Jaikirshan J.; Jaber, Wissam; Samady, Habib; Jefferson, Brian K.; Patel, Taral; Moses, Jeffrey W.; Lembo, Nicholas J.; Parikh, Manish; Kirtane, Ajay J.; Ali, Ziad A.; Doshi, Darshan; Tajti, Peter; Rangan, Bavana Venkata; Abdullah, Shuaib M; Banerjee, Subhash; Brilakis, Emmanouil S.

In: American Journal of Cardiology, Vol. 123, No. 9, 01.05.2019, p. 1422-1428.

Research output: Contribution to journalArticle

Xenogiannis, I, Karmpaliotis, D, Alaswad, K, Jaffer, FA, Yeh, RW, Patel, M, Mahmud, E, Choi, JW, Burke, MN, Doing, AH, Dattilo, P, Toma, C, Smith, AJC, Uretsky, B, Krestyaninov, O, Khelimskii, D, Holper, E, Potluri, S, Wyman, RM, Kandzari, DE, Garcia, S, Koutouzis, M, Tsiafoutis, I, Khatri, JJ, Jaber, W, Samady, H, Jefferson, BK, Patel, T, Moses, JW, Lembo, NJ, Parikh, M, Kirtane, AJ, Ali, ZA, Doshi, D, Tajti, P, Rangan, BV, Abdullah, SM, Banerjee, S & Brilakis, ES 2019, 'Usefulness of Atherectomy in Chronic Total Occlusion Interventions (from the PROGRESS-CTO Registry)', American Journal of Cardiology, vol. 123, no. 9, pp. 1422-1428. https://doi.org/10.1016/j.amjcard.2019.01.054
Xenogiannis, Iosif ; Karmpaliotis, Dimitri ; Alaswad, Khaldoon ; Jaffer, Farouc A. ; Yeh, Robert W. ; Patel, Mitul ; Mahmud, Ehtisham ; Choi, James W. ; Burke, M. Nicholas ; Doing, Anthony H. ; Dattilo, Phil ; Toma, Catalin ; Smith, A. J.Conrad ; Uretsky, Barry ; Krestyaninov, Oleg ; Khelimskii, Dmitrii ; Holper, Elizabeth ; Potluri, Srinivas ; Wyman, R. Michael ; Kandzari, David E. ; Garcia, Santiago ; Koutouzis, Michalis ; Tsiafoutis, Ioannis ; Khatri, Jaikirshan J. ; Jaber, Wissam ; Samady, Habib ; Jefferson, Brian K. ; Patel, Taral ; Moses, Jeffrey W. ; Lembo, Nicholas J. ; Parikh, Manish ; Kirtane, Ajay J. ; Ali, Ziad A. ; Doshi, Darshan ; Tajti, Peter ; Rangan, Bavana Venkata ; Abdullah, Shuaib M ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Usefulness of Atherectomy in Chronic Total Occlusion Interventions (from the PROGRESS-CTO Registry). In: American Journal of Cardiology. 2019 ; Vol. 123, No. 9. pp. 1422-1428.
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abstract = "There is limited data on the use of atherectomy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared the clinical and procedural characteristics and outcomes of CTO PCIs performed with or without atherectomy in a contemporary multicenter CTO PCI registry. Between 2012 and 2018, 3,607 CTO PCIs were performed at 21 participating centers. Atherectomy was used in 117 (3.2{\%}) cases: rotational atherectomy in 105 cases, orbital atherectomy in 8, and both in 4 cases. Patients in whom atherectomy was used, were older (68 ± 8 vs 64 ± 10 years, p <0.0001) and had higher Japan-chronic total occlusion score (3.0 ± 1.2 vs 2.4 ± 1.3, p <0.0001). CTO PCI cases in which atherectomy was used had similar technical (91{\%} vs 87{\%}, p = 0.240) and procedural (90{\%} vs 85{\%}, p = 0.159) success and in-hospital major adverse cardiac event (4{\%} vs 3{\%}, p = 0.382) rates. However, atherectomy cases were associated with higher rates of donor vessel injury (4{\%} vs 1{\%}, p = 0.031), tamponade requiring pericardiocentesis (2.6{\%} vs 0.4{\%}, p = 0.012) and more often required use of a left ventricular assist device (9{\%} vs 5{\%}, p = 0.031). Atherectomy cases were associated with longer procedural duration (196 [141, 247] vs 119 [76, 180] minutes, p <0.0001), and higher patient air kerma radiation dose (3.6 [2.5, 5.6] vs 2.8 [1.6, 4.7] Gray, p = 0.001). In conclusion, atherectomy is currently performed in approximately 3{\%} of CTO PCI cases and is associated with similar technical and procedural success and overall major adverse cardiac event rates, but higher risk for donor vessel injury and tamponade.",
author = "Iosif Xenogiannis and Dimitri Karmpaliotis and Khaldoon Alaswad and Jaffer, {Farouc A.} and Yeh, {Robert W.} and Mitul Patel and Ehtisham Mahmud and Choi, {James W.} and Burke, {M. Nicholas} and Doing, {Anthony H.} and Phil Dattilo and Catalin Toma and Smith, {A. J.Conrad} and Barry Uretsky and Oleg Krestyaninov and Dmitrii Khelimskii and Elizabeth Holper and Srinivas Potluri and Wyman, {R. Michael} and Kandzari, {David E.} and Santiago Garcia and Michalis Koutouzis and Ioannis Tsiafoutis and Khatri, {Jaikirshan J.} and Wissam Jaber and Habib Samady and Jefferson, {Brian K.} and Taral Patel and Moses, {Jeffrey W.} and Lembo, {Nicholas J.} and Manish Parikh and Kirtane, {Ajay J.} and Ali, {Ziad A.} and Darshan Doshi and Peter Tajti and Rangan, {Bavana Venkata} and Abdullah, {Shuaib M} and Subhash Banerjee and Brilakis, {Emmanouil S}",
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T1 - Usefulness of Atherectomy in Chronic Total Occlusion Interventions (from the PROGRESS-CTO Registry)

AU - Xenogiannis, Iosif

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Jaffer, Farouc A.

AU - Yeh, Robert W.

AU - Patel, Mitul

AU - Mahmud, Ehtisham

AU - Choi, James W.

AU - Burke, M. Nicholas

AU - Doing, Anthony H.

AU - Dattilo, Phil

AU - Toma, Catalin

AU - Smith, A. J.Conrad

AU - Uretsky, Barry

AU - Krestyaninov, Oleg

AU - Khelimskii, Dmitrii

AU - Holper, Elizabeth

AU - Potluri, Srinivas

AU - Wyman, R. Michael

AU - Kandzari, David E.

AU - Garcia, Santiago

AU - Koutouzis, Michalis

AU - Tsiafoutis, Ioannis

AU - Khatri, Jaikirshan J.

AU - Jaber, Wissam

AU - Samady, Habib

AU - Jefferson, Brian K.

AU - Patel, Taral

AU - Moses, Jeffrey W.

AU - Lembo, Nicholas J.

AU - Parikh, Manish

AU - Kirtane, Ajay J.

AU - Ali, Ziad A.

AU - Doshi, Darshan

AU - Tajti, Peter

AU - Rangan, Bavana Venkata

AU - Abdullah, Shuaib M

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S

PY - 2019/5/1

Y1 - 2019/5/1

N2 - There is limited data on the use of atherectomy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared the clinical and procedural characteristics and outcomes of CTO PCIs performed with or without atherectomy in a contemporary multicenter CTO PCI registry. Between 2012 and 2018, 3,607 CTO PCIs were performed at 21 participating centers. Atherectomy was used in 117 (3.2%) cases: rotational atherectomy in 105 cases, orbital atherectomy in 8, and both in 4 cases. Patients in whom atherectomy was used, were older (68 ± 8 vs 64 ± 10 years, p <0.0001) and had higher Japan-chronic total occlusion score (3.0 ± 1.2 vs 2.4 ± 1.3, p <0.0001). CTO PCI cases in which atherectomy was used had similar technical (91% vs 87%, p = 0.240) and procedural (90% vs 85%, p = 0.159) success and in-hospital major adverse cardiac event (4% vs 3%, p = 0.382) rates. However, atherectomy cases were associated with higher rates of donor vessel injury (4% vs 1%, p = 0.031), tamponade requiring pericardiocentesis (2.6% vs 0.4%, p = 0.012) and more often required use of a left ventricular assist device (9% vs 5%, p = 0.031). Atherectomy cases were associated with longer procedural duration (196 [141, 247] vs 119 [76, 180] minutes, p <0.0001), and higher patient air kerma radiation dose (3.6 [2.5, 5.6] vs 2.8 [1.6, 4.7] Gray, p = 0.001). In conclusion, atherectomy is currently performed in approximately 3% of CTO PCI cases and is associated with similar technical and procedural success and overall major adverse cardiac event rates, but higher risk for donor vessel injury and tamponade.

AB - There is limited data on the use of atherectomy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared the clinical and procedural characteristics and outcomes of CTO PCIs performed with or without atherectomy in a contemporary multicenter CTO PCI registry. Between 2012 and 2018, 3,607 CTO PCIs were performed at 21 participating centers. Atherectomy was used in 117 (3.2%) cases: rotational atherectomy in 105 cases, orbital atherectomy in 8, and both in 4 cases. Patients in whom atherectomy was used, were older (68 ± 8 vs 64 ± 10 years, p <0.0001) and had higher Japan-chronic total occlusion score (3.0 ± 1.2 vs 2.4 ± 1.3, p <0.0001). CTO PCI cases in which atherectomy was used had similar technical (91% vs 87%, p = 0.240) and procedural (90% vs 85%, p = 0.159) success and in-hospital major adverse cardiac event (4% vs 3%, p = 0.382) rates. However, atherectomy cases were associated with higher rates of donor vessel injury (4% vs 1%, p = 0.031), tamponade requiring pericardiocentesis (2.6% vs 0.4%, p = 0.012) and more often required use of a left ventricular assist device (9% vs 5%, p = 0.031). Atherectomy cases were associated with longer procedural duration (196 [141, 247] vs 119 [76, 180] minutes, p <0.0001), and higher patient air kerma radiation dose (3.6 [2.5, 5.6] vs 2.8 [1.6, 4.7] Gray, p = 0.001). In conclusion, atherectomy is currently performed in approximately 3% of CTO PCI cases and is associated with similar technical and procedural success and overall major adverse cardiac event rates, but higher risk for donor vessel injury and tamponade.

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