ABSTRACT

Background - The prevalence, treatment and outcomes of balloon undilatable chronic total occlusions (CTOs) have received limited study.

Methods - We examined the prevalence, clinical and angiographic characteristics, and procedural outcomes of percutaneous coronary interventions (PCIs) for balloon undilatable CTOs in a contemporary multicenter US registry.

Results - Between 2012 and 2017 data on balloon undilatable lesions were available for 425 consecutive CTO PCIs in 415 patients in whom guidewire crossing was successful: 52 of 425 CTOs were balloon undilatable (12%). Mean patient age was 65 ± 10 years and most patients were men (84%). Patients with balloon undilatable CTOs were more likely to be diabetic (67 vs. 41%, P< 0.001) and have heart failure (44 vs. 28%, P= 0.027). Balloon undilatable CTOs were longer (40 mm [interquartile range, IQR 20-50] vs. 30 [IQR 15-40], P= 0.016), more likely to have moderate/severe calcification (87 vs. 54%, P< 0.001), and had higher J-CTO score (3.2 ± 1.1 vs. 2.5 ± 1.3, P< 0.001) and PROGRESS-CTO complications score (3.9 ± 1.7 vs. 3.1 ± 2.0, P< 0.005). They were associated with lower technical and procedural success (92 vs. 98%, P= 0.024; and 88 vs. 96%, P= 0.034, respectively) and higher risk for in-hospital major adverse events (8 vs. 2%, P= 0.008) due to higher perforation rates. The most frequent treatments for balloon undilatable CTOs were high pressure balloon inflations (64%), rotational atherectomy (31%), laser (21%), and cutting balloons (15%).

Conclusions - Balloon undilatable CTOs are common and are associated with lower success and higher complication rates.

Clinical Trial Registration - NCT02061436, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO)

© 2018 Wiley Periodicals, Inc.