Balloon-Assisted Subintimal Entry in Chronic Total Occlusion Percutaneous Coronary Interventions

Document Type

Conference Proceeding

Publication Date

10-24-2023

Publication Title

J Am Coll Cardiol

Abstract

Background: There are limited data on use of the balloon-assisted subintimal entry (BASE) technique in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We analyzed the baseline clinical and angiographic characteristics and outcomes of 155 CTO PCIs that used the BASE technique at 31 U.S. and non-U.S. centers between 2016 and 2023. Results: The BASE technique was used in 155 (7.9%) of 1,968 cases that used antegrade dissection and re-entry (ADR) during the study period, with an increasing trend (Figure 1). Mean age was 66 ± 10 years, 88.9% of the patients were men, and the prevalence of diabetes (44.6%), hypertension (90.5%), and dyslipidemia (88.7%) was high. Compared with 1,813 ADR cases that did not use BASE, the target vessel of the BASE cases was more commonly the right coronary artery and less commonly the left anterior descending artery. Lesions requiring BASE had longer occlusion length (42 ± 23 vs 37 ± 23 mm, P = 0.011), higher J-CTO (3.4 ± 1.0 vs 3.0 ± 1.1, P < 0.001) and PROGRESS-CTO (1.8 ± 1.0 vs 1.5 ± 1.0, P = 0.008) score and were more likely to have proximal cap ambiguity, side branch at the proximal cap, blunt/no stump, moderate-to-severe calcification, and proximal tortuosity. Technical (71.6% vs 75.5%, P = 0.334) and procedural success (71.6% vs 72.8%, P = 0.821), as well as major adverse coronary events (1.3% vs 4.1%, P = 0.124) were similar in ADR cases that used BASE and those that did not. Conclusion: The BASE technique is used in CTOs with longer occlusion length, higher J-CTO score, and more complex angiographic characteristics, and is associated with moderate success but also low major adverse coronary events.

Volume

82

Issue

17

First Page

B161

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