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Prevalence, Presentation and Treatment of ‘Balloon Undilatable’ Chronic Total Occlusions: Insights from a Multicenter US Registry
Author(s) -
Tajti Peter,
Karmpaliotis Dimitri,
Alaswad Khaldoon,
Toma Catalin,
Choi James W.,
Jaffer Farouc A.,
Doing Anthony H.,
Patel Mitul,
Mahmud Ehtisham,
Uretsky Barry,
Karatasakis Aris,
Karacsonyi Judit,
Danek Barbara A.,
Rangan Bavana V.,
Banerjee Subhash,
Ungi Imre,
Brilakis Emmanouil S.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27510
Subject(s) - medicine , presentation (obstetrics) , balloon , multicenter study , surgery , randomized controlled trial
Background The prevalence, treatment and outcomes of balloon undilatable chronic total occlusions (CTOs) have received limited study. Methods We examined the prevalence, clinical and angiographic characteristics, and procedural outcomes of percutaneous coronary interventions (PCIs) for balloon undilatable CTOs in a contemporary multicenter US registry. Results Between 2012 and 2017 data on balloon undilatable lesions were available for 425 consecutive CTO PCIs in 415 patients in whom guidewire crossing was successful: 52 of 425 CTOs were balloon undilatable (12%). Mean patient age was 65 ± 10 years and most patients were men (84%). Patients with balloon undilatable CTOs were more likely to be diabetic (67 vs. 41%, P < 0.001) and have heart failure (44 vs. 28%, P = 0.027). Balloon undilatable CTOs were longer (40 mm [interquartile range, IQR 20‐50] vs. 30 [IQR 15‐40], P = 0.016), more likely to have moderate/severe calcification (87 vs. 54%, P < 0.001), and had higher J‐CTO score (3.2 ± 1.1 vs. 2.5 ± 1.3, P < 0.001) and PROGRESS‐CTO complications score (3.9 ± 1.7 vs. 3.1 ± 2.0, P < 0.005). They were associated with lower technical and procedural success (92 vs. 98%, P = 0.024; and 88 vs. 96%, P = 0.034, respectively) and higher risk for in‐hospital major adverse events (8 vs. 2%, P = 0.008) due to higher perforation rates. The most frequent treatments for balloon undilatable CTOs were high pressure balloon inflations (64%), rotational atherectomy (31%), laser (21%), and cutting balloons (15%). Conclusions Balloon undilatable CTOs are common and are associated with lower success and higher complication rates.