Incidence, Mechanisms, Treatment, and Outcomes of Coronary Artery Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention

Kostantinis, Spyridon; Şimşek, Bahadir; Karácsonyi, Judit; Alaswad, Khaldoon; Krestyaninov, Oleg; Khelimskii, Dmitrii; Karmpaliotis, Dimitri; Jaffer, Farouc A.; Khatri, Jaikirshan; Poommipanit, Paul; Rinfret, Stéphane; Nicholson, William J.; Patel, Mitul; Mahmud, Ehtisham; Koutouzis, Michael; Tsiafoutis, Ioannis; Benton, Stewart M.; Davies, Rhian; Toma, Catalin; Kerrigan, Jimmy; Haddad, Elias V.; Abi-Rafeh, Nidal; ElGuindy, Ahmed; Göktekín, Ömer; Mastrodemos, Olga C.; Rangan, Bavana V.; Burke, M. Nicholas; Brilakis, Emmanouil S.

doi:10.1016/j.amjcard.2022.07.004

Cited by 10 publications

(7 citation statements)

References 20 publications

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“…12 CTO PCI carries increased risk of complications compared with non-CTO PCI due to complex coronary anatomy (calcification, tortuosity, multivessel disease), difficulties with CTO crossing and comorbidities (left ventricular disfunction, particularly in the donor vessel is being instrumented during retrograde procedures). 1,[13][14][15] How can we identify patients who are more likely to need MCS? We recently developed risk scores for estimating the risk of periprocedural in-hospital major adverse cardiovascular events (MACE), mortality, pericardiocentesis, and acute myocardial infarction (MI) in patients undergoing CTO PCI 11 , but there are currently no risk scores for assessing the need for urgent MCS in CTO PCI.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be complex procedures with approximately 85-90% technical success rates at experienced centers but also relatively high incidence of major adverse cardiac events (1-3%). [1][2][3][4] Urgent mechanical circulatory support (MCS) might be necessary in some complication cases. The use of mechanical circulatory devices to support high-risk elective PCI has become more common in part due to increasing number of patients considered inoperable or high risk for surgical revascularization.…”

Section: Introductionmentioning

confidence: 99%

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Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention

Karácsonyi

Stanberry

Şimşek

et al. 2023

Preprint

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Background: Estimating the likelihood of urgent mechanical circulatory support (MCS) can facilitate procedural planning and clinical decision making in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We analyzed 2,784 CTO PCIs performed between 2012 and 2021 at 12 centers. The variable importance was estimated by a bootstrap applying a random forest algorithm to a propensity-matched sample (a ratio of 1:5 matching cases with controls on center). The identified variables were used to predict the risk of urgent MCS. The performance of the risk model was assessed in-sample as well as on 2411 out-of-sample procedures who did not require urgent MCS. Results: Urgent MCS was used in 62 (2.2%) of cases. Patients who required urgent MCS were older (70 [63, 77] vs. 66 [58, 73] years, p=0.003) compared with those who did not require urgent MCS. Technical (68% vs. 87%, p<0.001) and procedural successes (40% vs. 85%, p<0.001) were lower in the urgent MCS group compared with no urgent MCS cases. The risk model for urgent MCS use included retrograde crossing strategy, left ventricular ejection fraction, and lesion length. The resulting model demonstrated good calibration and discriminatory capacity with AUC (95%CI) of 0.79 (0.73, 0.86) and specificity and sensitivity of 86% and 52%, respectively. On the out-of-sample set, the specificity of the model was 87%. Conclusion: The PROGRESS CTO MCS score can help estimate the risk of urgent MCS use during CTO PCI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention

Karácsonyi

Stanberry

Şimşek

et al. 2023

Preprint

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“…The perforation rate was similar to the rest of the ADR cases, as observed in prior studies. [20][21][22][23] Our study has limitations. The PROGRESS-CTO is an observational registry with all inherent limitations.…”

Section: Base Is a Dissection Technique That Was First Described By V...mentioning

confidence: 94%

Balloon‐assisted subintimal entry (BASE) in chronic total occlusion percutaneous coronary interventions

Alexandrou,

Rempakos,

Al Ogaili

et al. 2023

Cathet Cardio Intervent

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BackgroundThere is limited data on the use of the balloon‐assisted subintimal entry (BASE) technique in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).MethodsWe analyzed the baseline clinical and angiographic characteristics and outcomes of 155 CTO PCIs that utilized the BASE technique at 31 US and non‐US centers between 2016 and 2023.ResultsThe BASE technique was used in 155 (7.9%) of 1968 antegrade dissection and re‐entry (ADR) cases performed during the study period. The 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 1813 ADR cases that did not use BASE, the target vessel of the BASE cases was more commonly the RCA and less commonly the LAD. Lesions requiring BASE had longer occlusion length (42 ± 23 vs. 37 ± 23 mm, p = 0.011), higher Japanese CTO (J‐CTO) (3.4 ± 1.0 vs. 3.0 ± 1.1, p < 0.001) and PROGRESS‐CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention chronic total occlusion) (1.8 ± 1.0 vs. 1.5 ± 1.0, p = 0.008) scores, 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 cardiac events (MACE) (1.3% vs. 4.1%, p = 0.124), were similar in ADR cases that used BASE and those that did not.ConclusionsThe 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 MACE.

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“…Complication rates in CTO PCI are higher than non-CTO PCI, with coronary artery perforation occurring in approximately 5% of CTO PCIs. [18][19][20][21] The main indication of CTO PCI is the alleviation of symptoms. Limited randomized controlled trials have not shown improvement in hard clinical events such as MACE.…”

Section: Indications and Prevention Of Periprocedural Death In Cto Pcimentioning

confidence: 99%

Periprocedural Mortality in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry

Şimşek

Rempakos

Kostantinis

et al. 2023

Circ: Cardiovascular Interventions

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BACKGROUND: Death is a rare but devastating complication of chronic total occlusion (CTO) percutaneous coronary intervention. METHODS: We examined the clinical characteristics and procedural outcomes of patients who died periprocedurally in the Prospective Global Registry for the Study of CTO Interventions (PROGRESS-CTO). RESULTS: Of the 12 928 patients who underwent CTO percutaneous coronary intervention between 2012 and 2022, 52 (0.4%) died during the index hospitalization. Patients who died were more likely to have a history of heart failure (43% versus 28%; P =0.023). The J-CTO ([Multicenter CTO Registry of Japan]; 2.8±1.1 versus 2.4±1.3; P =0.019), PROGRESS-CTO mortality (2.6±0.9 versus 1.6±1.1; P <0.001), and PROGRESS-CTO pericardiocentesis (2.9±1.1 versus 1.9±1.3; P <0.001) scores were higher in patients who died. In these patients, the use of left ventricular assist devices was also higher (41% versus 3.5%; P <0.001), and retrograde crossing was more often the first crossing strategy (33% versus 13%; P <0.001). The cause of death was cardiac in 43 patients (83%) and noncardiac in 9 patients (17%). Complications leading to cardiac death were: tamponade in 30 patients (58%), acute myocardial infarction in 9 (17.3%), and cardiac arrest/shock in 4 (7.7%). Noncardiac causes of death were: stroke in 3 (5.8%), renal failure in 2 (3.8%), respiratory distress in 2 (3.8%), and hemorrhagic shock in 2 (3.8%). CONCLUSIONS: Approximately 0.4% of patients who underwent CTO percutaneous coronary intervention died during the index hospitalization. The main cause of death was tamponade in 58%. PROGRESS-CTO complication scores might help in risk stratification and procedural planning in patients undergoing CTO percutaneous coronary intervention. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02061436.

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Incidence, Mechanisms, Treatment, and Outcomes of Coronary Artery Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention

Cited by 10 publications

References 20 publications

Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention

Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention

Balloon‐assisted subintimal entry (BASE) in chronic total occlusion percutaneous coronary interventions

Periprocedural Mortality in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry

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