Prevalence, indications and management of balloon uncrossable chronic total occlusions: Insights from a contemporary multicenter US registry

Abstract

Balloon uncrossable CTOs are common, are associated with high rates of technical failure, and require specialized techniques for successful treatment. © 2016 Wiley Periodicals, Inc.

Prevalence, Presentation and Treatment of ‘Balloon Undilatable’ Chronic Total Occlusions: Insights from a Multicenter US Registry

“…Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been rapidly evolving with high success rates currently being achieved at experienced centers (1-6). Although failure to cross the occlusion with a guidewire is the most common mechanism of CTO PCI failure, additional technical challenges exist, such as inability to advance a balloon after successful guidewire crossing (balloon uncrossable lesions) (7-9), and inability to fully dilate the lesion despite multiple balloon inflations (balloon undilatable lesions) (Figure 1). Adequate preparation in such lesions is critical to avoid suboptimal stent expansion that can result in higher rates of stent thrombosis and in-stent restenosis (10,11).…”

Excimer Laser Use in Percutaneous Coronary Intervention

“…Balloon uncrossable lesions can be challenging to treat and are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing (Figure 2). These lesions are relatively common: they represented 6.4%, 24 of 373 consecutive CTO lesions in a single center study (in this series ELCA was used in 8.7% of the cases) (17) and 9%, 63 of 718 lesions in a multicenter CTO registry (ELCA was used in 18% of the lesions) (18). In the previously mentioned study by Fernandez et al, ELCA was used in 36 patients with balloon uncrossable lesions.…”

Excimer laser coronary atherectomy for uncrossable coronary lesions. A multicenter registry

“…12 ELCA appears particularly appealing to deal with uncrossable lesions in the context of CTOs, 13 as indicated by the high prevalence of such lesion subset in our series (46%) and supported by prior literature. 14,15 The prevalence of balloonuncrossable lesion is as high as 9% in CTOs, 16 and in such setting losing distal wire access to the vessel is not an option, thus inducing the operator to favor ELCA over rotational or orbital atherectomy. In line with previous studies not exclusively targeted uncrossable lesions (Table 5), the success rate in our series was high taking into account the complexity of the lesions and the beforehand high probability of failure with the conventional technology.…”