Impact of proximal cap ambiguity on the procedural techniques and outcomes of chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO Registry.

Proximal cap ambiguity is a key parameter in the global chronic total occlusion (CTO) percutaneous coronary intervention (PCI) crossing algorithm. We examined the baseline characteristics and procedural outcomes of 9718 CTO PCIs performed in 9498 patients at 41 US and non-US centers between 2012 and 2022. Proximal cap ambiguity was present in 35% of CTO lesions. Patients whose lesions had proximal cap ambiguity were more likely to have had prior coronary artery bypass graft surgery (37% vs. 24%; p < 0.001). Lesions with proximal cap ambiguity were more complex with higher J-CTO score (3.1 ± 1.0 vs. 2.0 ± 1.2; p < 0.001) and lower technical (79% vs. 90%; p < 0.001) and procedural (77% vs. 89%; p < 0.001) success rates compared with nonambiguous CTO lesions. The incidence of major adverse cardiovascular events (MACE) was higher in cases with proximal cap ambiguity (2.5% vs. 1.7%; p < 0.001). The retrograde approach was more commonly used among cases with ambiguous proximal cap (50% vs. 21%; p < 0.001) and was more likely to be the final successful crossing strategy (29% vs. 13%; p < 0.001). The antegrade dissection and re-entry (ADR) "move-the-cap" techniques were also more common among cases with proximal cap ambiguity. Proximal cap ambiguity in CTO lesions is associated with higher utilization of the retrograde approach and ADR, lower technical and procedural success rates, and higher incidence of in-hospital MACE.

Kostantinis S ，Simsek B ，Karacsonyi J ，Rempakos A ，Alaswad K ，Megaly M ，Krestyaninov O ，Khelimskii D ，Karmpaliotis D ，Jaffer FA ，Khatri JJ ，Poommipanit P ，Patel MP ，Mahmud E ，Koutouzis M ，Tsiafoutis I ，Gorgulu S ，Elbarouni B ，Nicholson W ，Jaber W ，Rinfret S ，Abi Rafeh N ，Goktekin O ，ElGuindy AM ，Allana SS ，Rangan BV ，Sandoval Y ，Burke MN ，Brilakis ES ... -  《-》

Impact of Proximal Cap Ambiguity on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Multicenter US Registry.

Karatasakis A ，Danek BA ，Karmpaliotis D ，Alaswad K ，Jaffer FA ，Yeh RW ，Patel MP ，Bahadorani JN ，Wyman RM ，Lombardi WL ，Grantham JA ，Kandzari DE ，Lembo NJ ，Doing AH ，Moses JW ，Kirtane AJ ，Garcia S ，Parikh MA ，Ali ZA ，Karacsonyi J ，Kalra S ，Rangan BV ，Kalsaria P ，Thompson CA ，Banerjee S ，Brilakis ES ... -  《-》

Geographic diversity in chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-CTO registry.

Alexandrou M ，Rempakos A ，Mutlu D ，Al Ogaili A ，Choi JW ，Poommipanit P ，Alaswad K ，Basir MB ，Davies R ，Jaffer FA ，Chandwaney RH ，Azzalini L ，Aygul N ，ElGuindy AM ，Jefferson BK ，Gorgulu S ，Khatri JJ ，Krestyaninov O ，Khelimskii D ，Frizzell J ，Elbarouni B ，Goktekin O ，McEntegart MB ，Rangan BV ，Mastrodemos OC ，Burke MN ，Sandoval Y ，Brilakis ES ... -  《-》

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

There is limited data on the use of the balloon-assisted subintimal entry (BASE) technique in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We 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. The 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. The 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.

Alexandrou M ，Rempakos A ，Al Ogaili A ，Choi JW ，Poommipanit P ，Alaswad K ，Basir MB ，Davies R ，Benton S ，Jaffer FA ，Chandwaney RH ，Azzalini L ，Kearney KE ，ElGuindy AM ，Abi Rafeh N ，Goktekin O ，Gorgulu S ，Khatri JJ ，Aygul N ，Vo MN ，Cincin A ，Rangan BV ，Mastrodemos OC ，Allana SS ，Sandoval Y ，Burke MN ，Brilakis ES ... -  《-》

Preprocedural coronary computed tomography angiography in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry.

Preprocedural coronary computed tomography angiography (CCTA) can be useful in procedural planning for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical, angiographic and procedural characteristics and outcomes of cases with vs. without preprocedural CCTA in PROGRESS-CTO (NCT02061436). Multivariable logistic regression was used to adjust for confounding factors. Of 7034 CTO PCI cases, preprocedural CCTA was used in 375 (5.3%) with increasing frequency over time. Patients with preprocedural CCTA had a higher prevalence of prior coronary artery bypass graft surgery (39% vs. 27%, p < 0.001) and angiographically unfavorable characteristics including higher prevalence of proximal cap ambiguity (52% vs. 33%, p < 0.001) and moderate/severe calcification (59% vs. 41%, p < 0.001) compared with those without CCTA. CCTA helped resolve proximal cap ambiguity in 27%, identified significant calcium not seen on diagnostic angiography in 18%, changed estimated CTO length by >5 mm in 10%, and was performed as part of initial coronary artery disease work up in 19%. CCTA cases had higher J-CTO (2.6 ± 1.2 vs. 2.3 ± 1.3, p < 0.001) and PROGRESS-CTO (1.3 ± 1.0 vs. 1.2 ± 1.0 p = 0.027) scores. After adjusting for potential confounders, cases with preprocedural CCTA had similar technical success (odds ratio [OR]: 1.18, 95% confidence interval [CI], 0.83-1.67) and incidence of major adverse cardiovascular events (OR: 1.47, 95% CI, 0.72-3.00). Preprocedural CCTA was used in ~5% of CTO PCI cases. While CCTA may help with procedural planning, especially in complex cases, technical success and MACE were similar with or without CCTA.

Simsek B ，Jaffer FA ，Kostantinis S ，Karacsonyi J ，Koike H ，Doshi D ，Alaswad K ，Gorgulu S ，Goktekin O ，Khatri J ，Poommipanit P ，Krestyaninov O ，Davies R ，ElGuindy A ，Jefferson BK ，Patel T ，Patel M ，Rinfret S ，Jaber WA ，Nicholson W ，Abi Rafeh N ，Yildirim U ，Soylu K ，Allana S ，Rangan BV ，Mastrodemos OC ，Sandoval Y ，Burke MN ，Brilakis ES ... -  《-》