Karacsonyi J, Simsek B, Kostantinis S, Alaswad K, Krestyaninov O, Karmpaliotis D, Kirtane A, McEntegart M, Khatri J, Poommipanit P, Jaffer F, Choi J, Mahmud E, Patel M, Koutouzis M, Tsiafoutis I, Elbarouni B, Jaber W, Rinfret S, Jefferson B, Patel T, Gorgulu S, ElGuindy A, Abi-Rafeh N, Goktekin O, Ungi I, Rangan B, Mastrodemos O, Sandoval Y, Allana S, Burke MN, and Brilakis E. TCT-110 Use of Atherectomy in Chronic Total Occlusion Percutaneous Coronary Intervention. J Am Coll Cardiol 2022; 80(12):B45.
J Am Coll Cardiol
Background: There is limited data on the atherectomy use for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods: We analyzed 11,118 CTO PCIs performed in the PROGRESS-CTO Registry, between 2012 and June 2022 at 42 centers, comparing the baseline clinical, angiographic characteristics and procedural outcomes with vs without atherectomy.
Results: Atherectomy was used in 498 cases (4.5%): rotational atherectomy in 415 cases (3.7%) and orbital atherectomy in 105 cases (0.9%) and both techniques in 22 cases (0.2%). The mean patient age was 65.4 ± 10 years and 81.4% were men. Patients, where atherectomy was used, were older (68.9 ± 10 vs 64.2 ± 10, P < 0.001) and more likely to have diabetes mellitus (53.9% vs 42.5%, P < 0.001) compared with non-atherectomy patients. Atherectomy cases had higher J-CTO (2.74 ± 1.09 vs 2.34 ± 1.27, P < 0.001) scores and higher technical (93.6% vs 86.0%, P < 0.001) and procedural success rates (89.8% vs 84.6%, P = 0.002) compared with cases where atherectomy was not used. The incidence of major adverse cardiac events was also higher in the atherectomy group (4.67% vs 1.91%, P < 0.001), with higher rates of pericardiocentesis (2.43% vs 0.79%, P < 0.001). Atherectomy cases were associated with longer fluoroscopy time (61 [42-91] vs 42 [25-68] minutes, P < 0.001). Temporal trends of atherectomy use are demonstrated in the Figure.
Conclusion: Atherectomy is used in 4.5% of CTO PCI cases and is associated with higher patient and angiographic complexity, higher technical and procedural success rates but also higher major complication rates compared to non-atherectomy cases.
Categories: CORONARY: Coronary Atherectomy, Plaque Modification, Lithotripsy, and Thrombectomy