Toggle Main Menu Toggle Search

Open Access padlockePrints

Hybrid approach improves success of chronic total occlusion angioplasty

Lookup NU author(s): Dr Alan Bagnall, Dr Mohaned Egred

Downloads

Full text for this publication is not currently held within this repository. Alternative links are provided below where available.


Abstract

Objectives Treatment options for coronary chronic total occlusions (CTO) are limited, with low historical success rates from percutaneous coronary intervention (PCI). We report procedural outcomes of CTO PCI from 7 centres with dedicated CTO operators trained in hybrid approaches comprising antegrade/retrograde wire escalation (AWE/RWE) and dissection re-entry (ADR/RDR) techniques.Methods Clinical and procedural data were collected from consecutive unselected patients with CTO between 2012 and 2014. Lesion complexity was graded by the Multicentre CTO Registry of Japan (J-CTO) score, with 2 defined as complex. Success was defined as thrombolysis in myocardial infarction 3 flow with <30% residual stenosis, subclassified as at first attempt or overall. Inhospital complications and 30-day major adverse cardiovascular events (MACEs, death/myocardial infarction/unplanned target vessel revascularisation) were recorded.Results 1156 patients were included. Despite high complexity (mean J-CTO score 2.51.3), success rates were 79% (first attempt) and 90% (overall) with 30-day MACE of 1.6%. AWE was highly effective in less complex lesions (J-CTO 1 94% success vs 79% in J-CTO score 2). ADR/RDR was used more commonly in complex lesions (J-CTO1 15% vs J-CTO 2 56%). Need for multiple approaches during each attempt increased with lesion complexity (17% J-CTO 1 vs 48% J-CTO 2). Lesion modification (investment procedures') at the end of unsuccessful first attempts increased the chance of subsequent success (96% vs 71%).Conclusions Hybrid-trained operators can achieve overall success rates of 90% in real world practice with acceptable MACE. Use of dissection re-entry and investment procedures maintains high success rates in complex lesions. The hybrid approach represents a significant advance in CTO treatment.


Publication metadata

Author(s): Wilson WM, Walsh SJ, Yan AT, Hanratty CG, Bagnall AJ, Egred M, Smith E, Oldroyd KG, McEntegart M, Irving J, Strange J, Douglas H, Spratt JC

Publication type: Article

Publication status: Published

Journal: Heart

Year: 2016

Volume: 102

Issue: 18

Pages: 1486-U4

Print publication date: 01/09/2016

Online publication date: 10/05/2016

Acceptance date: 16/04/2016

ISSN (print): 1355-6037

ISSN (electronic): 1468-201X

Publisher: BMJ Publishing Group

URL: http://dx.doi.org/10.1136/heartjnl-2015-308891

DOI: 10.1136/heartjnl-2015-308891


Altmetrics

Altmetrics provided by Altmetric


Share