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Outcomes of subintimal plaque modification in chronic total occlusion percutaneous coronary intervention
Author(s) -
Xenogiannis Iosif,
Choi James W.,
Alaswad Khaldoon,
Khatri Jaikirshan J.,
Doing Anthony H.,
Dattilo Phil,
Jaffer Farouc A.,
Uretsky Barry,
Krestyaninov Oleg,
Khelimskii Dmitrii,
Patel Mitul,
Mahmud Ehtisham,
Potluri Srinivasa,
Koutouzis Michalis,
Tsiafoutis Ioannis,
Jaber Wissam,
Samady Habib,
Jefferson Brian K.,
Patel Taral,
Megaly Michael S.,
Hall Allison B.,
Vemmou Evangelia,
Nikolakopoulos Ilias,
Rangan Bavana V.,
Abdullah Shuaib,
Garcia Santiago,
Banerjee Subhash,
Burke M. Nicholas,
Brilakis Emmanouil S.
Publication year - 2020
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.28614
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , interquartile range , cardiology , timi , restenosis , coronary artery disease , surgery , stent , myocardial infarction
Background When crossing into the distal true lumen fails during chronic total occlusion (CTO) percutaneous coronary intervention (PCI), subintimal plaque modification (SPM) is often performed to restore antegrade flow and facilitate subsequent lesion recanalization. Methods Between January 2012 and May 4, 2019, 4,659 CTO PCIs were included in the PROGRESS‐CTO registry, of which 935 (20%) had a prior unsuccessful attempt. Of those 935 patients, 119 (13%) had prior SPM. We analyzed the outcomes of the 58 SPM procedures for which data were available, as well as the outcomes of the 60 subsequent CTO PCI attempts. Results Mean patient age was 67 ± 9 years and 86% were men. Patients had high prevalence of cardiovascular risk factors such as dyslipidemia (91%), hypertension (93%) diabetes (48%), prior PCI (61%), and prior coronary artery bypass graft surgery (47%). The target CTO lesions often had proximal cap ambiguity (54%), moderate/severe calcification (73%), moderate/severe tortuosity (63%), and high J‐CTO score (mean 3.2 ± 1.1). The technical and procedural success of subsequent CTO PCI were high (83% for both) with an acceptable rate of in‐hospital major adverse cardiovascular events (3.3%). Technical and procedural success were higher for repeat attempts that were performed ≥60 days after the index CTO PCI (94% vs. 69%, p = .015). Median (interquartile range) subsequent procedure time was 147 (100, 215) min, contrast volume was 185 (150, 260) ml, and air kerma radiation dose was 2.5 (1.4, 4.2) Gray. Conclusion Repeat CTO PCI attempts after SPM are associated with high likelihood for successful revascularization with acceptable risks.