The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry.

The aim of this study was to determine the techniques and outcomes of hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a diverse group of patients and operators on 2 continents. CTO PCI has been evolving with constant improvement of equipment and techniques. Contemporary outcomes of CTO PCI were examined by analyzing the clinical, angiographic, and procedural characteristics of 3,122 CTO interventions performed in 3,055 patients at 20 centers in the United States, Europe, and Russia. The mean age was 65 ± 10 years, and 85% of the patients were men, with high prevalence of diabetes (43%), prior myocardial infarction (46%), prior coronary artery bypass graft surgery (33%), and prior PCI (65%). The CTO target vessels were the right coronary artery (55%), left anterior descending coronary artery (24%), and left circumflex coronary artery (20%). The mean J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores were 2.4 ± 1.3 and 1.3 ± 1.0, respectively. The overall technical and procedural success rate was 87% and 85%, respectively, and the rate of in-hospital major complications was 3.0%. The final successful crossing strategy was antegrade wire escalation in 52.0%, retrograde in 27.1%, and antegrade dissection re-entry in 20.9%; >1 crossing strategy was required in 40.9%. Median contrast volume, air kerma radiation dose, and procedure and fluoroscopy time were 270 ml (interquartile range: 200 to 360 ml), 2.9 Gy (interquartile range: 1.7 to 4.7 Gy), 123 min (interquartile range: 81 to 188 min) and 47 min (interquartile range: 29 to 77 min), respectively. CTO PCI is currently being performed with high success and acceptable complication rates among various experienced centers in the United States, Europe, and Russia. (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO]; NCT02061436).

Tajti P ，Karmpaliotis D ，Alaswad K ，Jaffer FA ，Yeh RW ，Patel M ，Mahmud E ，Choi JW ，Burke MN ，Doing AH ，Dattilo P ，Toma C ，Smith AJC ，Uretsky B ，Holper E ，Wyman RM ，Kandzari DE ，Garcia S ，Krestyaninov O ，Khelimskii D ，Koutouzis M ，Tsiafoutis I ，Moses JW ，Lembo NJ ，Parikh M ，Kirtane AJ ，Ali ZA ，Doshi D ，Rangan BV ，Ungi I ，Banerjee S ，Brilakis ES ... -  《-》

Procedural Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusions Via the Radial Approach: Insights From an International Chronic Total Occlusion Registry.

This study examined the frequency and outcomes of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Radial access improves the safety of PCI, but its role in CTO PCI remains controversial. We compared the clinical, angiographic, and procedural characteristics of 3,790 CTO interventions performed between 2012 and 2018 via radial-only access (RA) (n = 747) radial-femoral access (RFA) (n = 844) and femoral-only access (n = 2,199) access at 23 centers in the United States, Europe, and Russia. Patients' mean age was 65 ± 10 years, and 85% were men. Transradial access (RA and RFA) was used in 42% of CTO interventions and significantly increased over time from 11% in 2012 to 67% in 2018 (p < 0.001). RA patients were younger (age 62 ± 10 years vs. 64 ± 10 years and 65 ± 10 years; p < 0.001), less likely to have undergone prior coronary artery bypass graft surgery (18% vs. 39% and 35%; p < 0.001), and less likely to have undergone prior PCI (60% vs. 63% and 66%; p = 0.005) compared with those who underwent RFA and femoral-only access PCI. RA CTO PCI lesions had lower J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 1.4 vs. 2.6 ± 1.3 and 2.5 ± 1.3; p < 0.001) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) complication (2.3 ± 1.9 vs. 3.2 ± 2.0 and 3.2 ± 1.9; p < 0.001) scores. The mean sheath size was significantly smaller in the RA group (6.6 ± 0.7 vs. 7.0 ± 0.6 and 7.3 ± 0.8; p < 0.0001), although it increased with lesion complexity. Antegrade dissection re-entry (20% vs. 33% and 32%; p < 0.001) was less commonly used with RA, whereas use of retrograde techniques was highest with RFA (47%). The overall rates of technical success (89% vs. 88% vs. 86%; p = 0.061), procedural success (86% vs. 85% vs. 85%; p = 0.528), and in-hospital major complication (2.47% vs. 3.40% vs. 2.18%; p = 0.830) were similar in all 3 groups, whereas major bleeding was lower in the RA group (0.55% vs. 1.94% and 0.88%; p = 0.013). Transradial access is increasingly being used for CTO PCI and is associated with similar technical and procedural success and lower major bleeding rates compared with femoral-only access interventions. (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO]; NCT02061436).

Tajti P ，Alaswad K ，Karmpaliotis D ，Jaffer FA ，Yeh RW ，Patel M ，Mahmud E ，Choi JW ，Burke MN ，Doing AH ，Dattilo P ，Toma C ，Smith AJC ，Uretsky BF ，Holper E ，Potluri S ，Wyman RM ，Kandzari DE ，Garcia S ，Krestyaninov O ，Khelimskii D ，Koutouzis M ，Tsiafoutis I ，Khatri JJ ，Jaber W ，Samady H ，Jefferson B ，Patel T ，Abdullah S ，Moses JW ，Lembo NJ ，Parikh M ，Kirtane AJ ，Ali ZA ，Doshi D ，Xenogiannis I ，Stanberry LI ，Rangan BV ，Ungi I ，Banerjee S ，Brilakis ES ... -  《-》

Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry.

A hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) prioritizing and combining all available crossing techniques was developed to optimize procedural efficacy, efficiency, and safety, but there is limited published data on its outcomes. We examined the procedural techniques and outcomes of 1036 consecutive CTO PCIs performed using a hybrid approach between 2012 and 2015 at 11 US centers. Mean age was 65 ± 10 years and 86% of the patients were men, with a high prevalence of diabetes mellitus (43%) and prior coronary artery bypass graft surgery (34%). Most target CTOs were located in the right coronary artery (59%), followed by the left anterior descending artery (23%) and the circumflex (19%). Dual injection was used in 71%. Technical success was achieved in 91% and a major procedural complication occurred in 1.7% of cases. The final successful crossing technique was antegrade wire escalation in 46%, antegrade dissection/re-entry in 26%, and retrograde in 28%. The initial crossing strategy was successful in 58% of the lesions, whereas 39% required an additional approach. Overall, antegrade wire escalation was used in 71%, antegrade dissection/re-entry in 36%, and the retrograde approach in 42% of procedures. Median contrast volume, fluoroscopy time, and air kerma radiation dose were 260 (200-360) ml, 44 (27-72) min, and 3.4 (2.0-5.4) Gray, respectively. Application of a hybrid approach to CTO crossing resulted in high success and low complication rates across a varied group of operators and hospital practice structures, supporting its expanding use in CTO PCI.

Christopoulos G ，Karmpaliotis D ，Alaswad K ，Yeh RW ，Jaffer FA ，Wyman RM ，Lombardi WL ，Menon RV ，Grantham JA ，Kandzari DE ，Lembo N ，Moses JW ，Kirtane AJ ，Parikh M ，Green P ，Finn M ，Garcia S ，Doing A ，Patel M ，Bahadorani J ，Tarar MN ，Christakopoulos GE ，Thompson CA ，Banerjee S ，Brilakis ES ... -  《-》

In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery.

Tajti P ，Karmpaliotis D ，Alaswad K ，Jaffer FA ，Yeh RW ，Patel M ，Mahmud E ，Choi JW ，Burke MN ，Doing AH ，Dattilo P ，Toma C ，Smith AJC ，Uretsky B ，Holper E ，Potluri S ，Wyman RM ，Kandzari DE ，Garcia S ，Krestyaninov O ，Khelimskii D ，Koutouzis M ，Tsiafoutis I ，Jaber W ，Samady H ，Moses JW ，Lembo NJ ，Parikh M ，Kirtane AJ ，Ali ZA ，Doshi D ，Xenogiannis I ，Stanberry LI ，Rangan BV ，Ungi I ，Banerjee S ，Brilakis ES ... -  《-》

Contemporary In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions: Insights from the MENATA (Middle East, North Africa, Turkey, and Asia) Chapter of the PROGRESS-CTO Registry.

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been rapidly evolving in different parts of the world. We examined the clinical and angiographic characteristics and procedural outcomes of 1,079 consecutive CTO PCIs performed in 1,063 patients at 10 centers in the Middle East, North Africa, Turkey, and Asia regions between 2018 and 2022. The mean age was 61 ± 10 years and 82% of the patients were men. The prevalence of diabetes (49%) and previous PCI (50%) was high. The most common target vessel was the right coronary artery (51%), followed by the left anterior descending artery (33%) and the circumflex artery (15%). The mean Japanese CTO score was 2.1 ± 1.2 and mean PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) score was 1.2 ± 1.0. The technical and procedural success rates were high (91% and 90%, respectively) with a low incidence (1.6%) of in-hospital major adverse cardiac events. The incidence of perforation was 4.6% (n = 50): guidewire exit was the most common mechanism of perforation (48%) and 14 patients required pericardiocentesis (28%). Antegrade wire escalation was the most common crossing strategy used (91%), followed by retrograde approach (24%) and antegrade dissection and re-entry (12%). Median contrast volume, air kerma radiation dose, and fluoroscopy time were 300 (200 to 400) ml, 3.7 (2.0 to 6.3) Gy, and 40 (25 to 65) minutes, respectively. In conclusion, high success and acceptable complication rates are currently achieved at experienced centers in the Middle East, North Africa, Turkey, and Asia regions using a combination of crossing strategies.

Gorgulu S ，Kostantinis S ，ElGuindy AM ，Abi Rafeh N ，Simsek B ，Rempakos A ，Karacsonyi J ，Kalay N ，Samir A ，Jaoudeh FA ，Maalouf A ，Soylu K ，Yildirim U ，Tigen MK ，Cincin A ，Kalyanasundaram A ，Aygul N ，Altunkeser BB ，El Sayed A ，Sadek Y ，Shelton C ，Jbara K ，Vemmou E ，Nikolakopoulos I ，Mastrodemos OC ，Rangan BV ，Allana SS ，Sandoval Y ，Burke MN ，Brilakis ES ，Goktekin O ... -  《-》