Document Type

Conference Proceeding

Publication Date


Publication Title

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





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