Prevalence, presentation and treatment of 'balloon undilatable' chronic total occlusions: Multicenter us experience
Tajti P, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh R, Patel M, Mahmud E, Choi J, Burke N, Doing A, Toma C, Uretsky B, Holper E, Wyman RM, Lombardi W, Kandzari D, Lembo N, Garcia S, Krestyaninov O, Khelimskii D, Koutouzis M, Tsiafoutis I, Moses J, Kirtane AJ, Parikh M, Hatem R, Ali Z, Karatasakis A, Karacsonyi J, Danek BA, Rangan B, Brilakis E. Prevalence, presentation and treatment of 'balloon undilatable' chronic total occlusions: Multicenter us experience. J Am Coll Cardiol. 2017;70(18):B9-B10.
J Am Coll Cardiol
BACKGROUND The prevalence, treatment and outcomes of balloon undilatable chronic totalocclusions (CTOs) is poorly studied. METHODS We examined the prevalence, clinical and angiographic characteristics, and procedural outcomes ofpercutaneous coronary interventions (PCI) for balloon undilatable CTO lesions in a contemporary multicenter US registry. Between 2015 and 2017 data on balloon undilatable lesions were available for 425 consecutive CTO PCIs in 415 patients in whom guidewire crossing was successful. RESULTS Mean patient age was 65±10 years and most patients were men (84%). Fifty-two of 425 CTOs successfully crossed with a guidewire were balloon undilatable (13%). Patients with balloon undilatable CTOs were more likely to be diabetic (67% vs. 41%, p=0.0006) and have heart failure (43% vs. 28%%, p=0.03). Balloon undilatable CTOs were longer (40 mm [IQR 20-50] vs. 30mm [IQR 15-40], p=0.02), more likely to have moderate/severe calcification (87% vs. 53%, p<0.01), and had higher J-CTO score (3.2±1.1 vs. 2.5±1.3, p<0.01) and PROGRESS Complication score (3.8±1.7 vs. 3.1±2.0, p<0.01). They were associated with lower technical and procedural success (92% vs. 98%, p=0.02; and 88% vs. 96%, 0.03) and higher risk for in-hospital major adverse events (8% vs. 2%, p=0.02). The most frequent treatments for 'balloon undilatable' CTOs were high-pressure balloon inflation (64%), rotational atherectomy (31%), laser (21%), and cutting balloons (15%). CONCLUSION Balloon undilatable CTOs are common (13%) and are associated with lower technical success and higher complication rates. (Figure Presented).