Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention.
J Pers Med
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.
Keywords: balloon uncrossable; 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; Abi Rafeh, Nidal; Goktekin, Omer; and Brilakis, Emmanouil S, "Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention." (2023). Articles, Abstracts, and Reports. 7278.