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Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention
- Karacsonyi, Judit;
- Kostantinis, Spyridon;
- Simsek, Bahadir;
- Rempakos, Athanasios;
- Allana, Salman S;
- Alaswad, Khaldoon;
- Krestyaninov, Oleg;
- Khatri, Jaikirshan;
- Poommipanit, Paul;
- Jaffer, Farouc A;
- Choi, James;
- Patel, Mitul;
- Gorgulu, Sevket;
- Koutouzis, Michalis;
- Tsiafoutis, Ioannis;
- Sheikh, Abdul M;
- ElGuindy, Ahmed;
- Elbarouni, Basem;
- Patel, Taral;
- Jefferson, Brian;
- Wollmuth, Jason R;
- Yeh, Robert;
- Karmpaliotis, Dimitrios;
- Kirtane, Ajay J;
- McEntegart, Margaret B;
- Masoumi, Amirali;
- Davies, Rhian;
- Rangan, Bavana V;
- Mastrodemos, Olga C;
- Doshi, Darshan;
- Sandoval, Yader;
- Basir, Mir B;
- Megaly, Michael S;
- Ungi, Imre;
- Rafeh, Nidal Abi;
- Goktekin, Omer;
- Brilakis, Emmanouil S
- et al.
Published Web Location
https://doi.org/10.3390/jpm13030515Abstract
Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions.
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