January 29, 2018
Study Examines Prevalence, Presentation, and Treatment of Balloon Undilatable CTOs
January 29, 2018—Online in Catheterization and Cardiovascular Interventions, Peter Tajti, MD, et al published findings from an evaluation of the prevalence, clinical and angiographic characteristics, and procedural outcomes of percutaneous coronary interventions (PCIs) for balloon undilatable chronic total occlusions (CTOs) in the contemporary multicenter PROGRESS CTO Registry.
The investigators concluded that balloon undilatable CTOs are common and are associated with lower success and higher complication rates.
As summarized in Catheterization and Cardiovascular Interventions, 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. In these patients, 12% (52 of 425) of CTOs were balloon undilatable. 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 < .001) and have heart failure (44% vs 28%; P = .027).
Balloon undilatable CTOs were longer (40 mm [interquartile range, 20–50 mm] vs 30 mm [interquartile range, 15–40 mm]; P = .016), more likely to have moderate/severe calcification (87% vs 54%; P < .001), and had a higher J-CTO score (3.2 ± 1.1 vs 2.5 ± 1.3; P < .001) and PROGRESS-CTO complications score (3.9 ± 1.7 vs 3.1 ± 2.0; P < .005).
Additionally, balloon undilatable CTOs were associated with lower technical and procedural success (92% vs 98%; P = .024 and 88% vs 96%; P = .034, respectively) and a higher risk for in-hospital major adverse events (8% vs 2%; P = .008) because of 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%), reported the investigators in Catheterization and Cardiovascular Interventions.