TCT-98 Calcium Modification Strategies in Dissection and Re-Entry Versus Wiring Techniques in Chronic Total Occlusion Percutaneous Coronary Intervention

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Conference Proceeding

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Background: The use of calcium modification strategies in dissection and re-entry compared with wiring techniques in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the procedural outcomes of 1,241 CTO PCIs that required the use of 1 or more calcium modification strategies at 42 centers from 2012 to 2023. Results: A calcium modification strategy was used as part of a dissection and re-entry strategy in 23% and as part of wiring technique in 77%. The most common calcium modification strategy in the dissection and re-entry group was scoring balloon (29.5%) and rotational atherectomy (29.5%), followed by laser atherectomy (20.7%) and intravascular lithotripsy (IVL) (18.3%). In the wiring group, rotational atherectomy (38.3%) was the most frequently used calcium modification therapy, followed by laser atherectomy (25.8%), IVL (17.8%), and scoring balloon (15.3%). Technical success was overall similar (95.1% vs 96.9%; P = 0.155) in the 2 groups, but was higher when IVL (100.0% vs 96.2%; P = 0.011) or scoring balloon (98.6% vs 94.0%; P = 0.049) was used in wiring cases. The incidence of major adverse cardiovascular events (MACE) was higher in the dissection and re-entry group (5.3% vs 2.4%; P = 0.014), especially among cases where scoring balloon (8.4% vs 2.1%; P = 0.023) or rotational atherectomy (9.5% vs 3.6%; P = 0.019) was used. [Formula presented] Conclusion: The use of calcium modification strategies in dissection and re-entry was associated with similar technical success but higher incidence of MACE and perforation compared with wiring techniques. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

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