Use of Intravascular Imaging During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry

Judit Karacsonyi, Khaldoon Alaswad, Farouc A Jaffer, Robert W Yeh, Mitul Patel, John Bahadorani, Aris Karatasakis, Barbara A Danek, Anthony Doing, J Aaron Grantham, Dimitri Karmpaliotis, Jeffrey W Moses, Ajay Kirtane, Manish Parikh, Ziad Ali, William L Lombardi, David E Kandzari, Nicholas Lembo, Santiago Garcia, Michael R Wyman, Aya Alame, Phuong-Khanh J Nguyen-Trong, Erica Resendes, Pratik Kalsaria, Bavana V Rangan, Imre Ungi, Craig A Thompson, Subhash Banerjee, Emmanouil S Brilakis, Judit Karacsonyi, Khaldoon Alaswad, Farouc A Jaffer, Robert W Yeh, Mitul Patel, John Bahadorani, Aris Karatasakis, Barbara A Danek, Anthony Doing, J Aaron Grantham, Dimitri Karmpaliotis, Jeffrey W Moses, Ajay Kirtane, Manish Parikh, Ziad Ali, William L Lombardi, David E Kandzari, Nicholas Lembo, Santiago Garcia, Michael R Wyman, Aya Alame, Phuong-Khanh J Nguyen-Trong, Erica Resendes, Pratik Kalsaria, Bavana V Rangan, Imre Ungi, Craig A Thompson, Subhash Banerjee, Emmanouil S Brilakis

Abstract

Background: Intravascular imaging can facilitate chronic total occlusion (CTO) percutaneous coronary intervention.

Methods and results: We examined the frequency of use and outcomes of intravascular imaging among 619 CTO percutaneous coronary interventions performed between 2012 and 2015 at 7 US centers. Mean age was 65.4±10 years and 85% of the patients were men. Intravascular imaging was used in 38%: intravascular ultrasound in 36%, optical coherence tomography in 3%, and both in 1.45%. Intravascular imaging was used for stent sizing (26.3%), stent optimization (38.0%), and CTO crossing (35.7%, antegrade in 27.9%, and retrograde in 7.8%). Intravascular imaging to facilitate crossing was used more frequently in lesions with proximal cap ambiguity (49% versus 26%, P<0.0001) and with retrograde as compared with antegrade-only cases (67% versus 31%, P<0.0001). Despite higher complexity (Japanese CTO score: 2.86±1.19 versus 2.43±1.19, P=0.001), cases in which imaging was used for crossing had similar technical and procedural success (92.8% versus 89.6%, P=0.302 and 90.1% versus 88.3%, P=0.588, respectively) and similar incidence of major cardiac adverse events (2.7% versus 3.2%, P=0.772). Use of intravascular imaging was associated with longer procedure (192 minutes [interquartile range 130, 255] versus 131 minutes [90, 192], P<0.0001) and fluoroscopy (71 minutes [44, 93] versus 39 minutes [25, 69], P<0.0001) time.

Conclusions: Intravascular imaging is frequently performed during CTO percutaneous coronary intervention both for crossing and for stent selection/optimization. Despite its use in more complex lesion subsets, intravascular imaging was associated with similar rates of technical and procedural success for CTO percutaneous coronary intervention.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.

Keywords: chronic total occlusion; intravascular ultrasound; optical coherence tomography; percutaneous coronary intervention.

© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1
Figure 1
Flow chart of the study. CTO indicates chronic total occlusion; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Use of intravascular imaging during chronic total occlusion percutaneous coronary intervention. CART indicates controlled antegrade and retrograde tracking and dissection.
Figure 3
Figure 3
Frequency of intravascular imaging use at the study participating centers. The absolute number of the cases with intravascular imaging use is listed in parentheses.
Figure 4
Figure 4
Technical, procedural success and MACE among study procedures classified according to use of intravascular imaging for crossing. MACE indicates major cardiac adverse event.
Figure 5
Figure 5
Technical, procedural success and major cardiac adverse events according to purpose of intravascular imaging techniques. IMG indicates imaging; MACE, major cardiac adverse events.

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