Drug-Coated versus Conventional Balloons to Improve Recanalization of a Coronary Chronic Total Occlusion after Failed Attempt: The Improved-CTO Registry
Background. Chronic total occlusion (CTO) plaque modification (CTO-PM) is often used for unsuccessful CTO interventions. Methods. A multicenter, prospective study included consecutive patients with failed CTO recanalization. At the end of the failed procedure, patients received either a conventional...
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Wiley
2024-01-01
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| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2024/2797561 |
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| author | Ignacio J. Amat-Santos Giorgio Marengo Luiz F. Ybarra Jose Antonio Fernández-Diaz Ander Regueiro Alejandro Gutiérrez Javier Martín-Moreiras Juan Pablo Sánchez-Luna Jose Carlos González-Gutiérrez Clara Fernandez-Cordon Manuel Carrasco-Moraleja Stéphane Rinfret |
| author_facet | Ignacio J. Amat-Santos Giorgio Marengo Luiz F. Ybarra Jose Antonio Fernández-Diaz Ander Regueiro Alejandro Gutiérrez Javier Martín-Moreiras Juan Pablo Sánchez-Luna Jose Carlos González-Gutiérrez Clara Fernandez-Cordon Manuel Carrasco-Moraleja Stéphane Rinfret |
| author_sort | Ignacio J. Amat-Santos |
| collection | DOAJ |
| description | Background. Chronic total occlusion (CTO) plaque modification (CTO-PM) is often used for unsuccessful CTO interventions. Methods. A multicenter, prospective study included consecutive patients with failed CTO recanalization. At the end of the failed procedure, patients received either a conventional (CB) or drug-coated balloon (DCB) for CTO-PM at the operator’s discretion and underwent a new attempt of CTO recanalization ∼3 months later. Results. A total of 55 patients were enrolled (DCB: 22; CB: 33), with a median age of 66 years. The median J-score was 3, and CCS angina classes III–IV were present in 45% of the patients. After the first CTO-PCI attempt, no in-hospital cardiac deaths were registered. The overall rate of in-hospital myocardial infarction was 3.6%, without significant differences between the DCB and CB groups (4.5% after DCB vs 3.0% after CB, p=0.999). The success rate of the second CTO-PCI attempt was 86.8%, with a periprocedural complication rate of 5.7% and with an overall rate of in-hospital complications of 24.5%, without significant differences between the 2 groups (13.6% in the DCB group vs 32.2% in the CB group, p=0.195). Compared with CB, in the DCB group, the second CTO-PCI required a shorter median fluoroscopy time (33 vs 60 min, p<0.001), a lower contrast volume (170 vs 321 cc, p<0.001), and a lower radiation dose (1.7 vs 3.3 Gy, p<0.001). At 1-year follow-up, outcomes were comparable between the 2 strategies, target vessel failure occurred in 5.7% and major adverse cardiovascular events in 18.2% (13.6% in the DCB group vs 21.2% in the CB group, p=0.494). Conclusions. PM after CTO recanalization failure is safe and warrants high success rates when a second attempt is performed. A DCB strategy for CTO-PM does not seem to ensure higher success or better clinical outcomes, but its use was associated with simpler staged procedures. This trial is registered with NCT05158686. |
| format | Article |
| id | doaj-art-2091dffc3def4d6ebbe19c401879f973 |
| institution | DOAJ |
| issn | 1540-8183 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Wiley |
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| series | Journal of Interventional Cardiology |
| spelling | doaj-art-2091dffc3def4d6ebbe19c401879f9732025-08-20T03:17:55ZengWileyJournal of Interventional Cardiology1540-81832024-01-01202410.1155/2024/2797561Drug-Coated versus Conventional Balloons to Improve Recanalization of a Coronary Chronic Total Occlusion after Failed Attempt: The Improved-CTO RegistryIgnacio J. Amat-Santos0Giorgio Marengo1Luiz F. Ybarra2Jose Antonio Fernández-Diaz3Ander Regueiro4Alejandro Gutiérrez5Javier Martín-Moreiras6Juan Pablo Sánchez-Luna7Jose Carlos González-Gutiérrez8Clara Fernandez-Cordon9Manuel Carrasco-Moraleja10Stéphane Rinfret11Cardiology DepartmentCardiology DepartmentLondon Health Sciences CentreHospital Universitario Puerta de Hierro MajadahondaHospital Clínic de BarcelonaHospital Universitario Puerta del MarComplejo Hospitalario de SalamancaCardiology DepartmentCardiology DepartmentCardiology DepartmentCardiology DepartmentEmory University HospitalBackground. Chronic total occlusion (CTO) plaque modification (CTO-PM) is often used for unsuccessful CTO interventions. Methods. A multicenter, prospective study included consecutive patients with failed CTO recanalization. At the end of the failed procedure, patients received either a conventional (CB) or drug-coated balloon (DCB) for CTO-PM at the operator’s discretion and underwent a new attempt of CTO recanalization ∼3 months later. Results. A total of 55 patients were enrolled (DCB: 22; CB: 33), with a median age of 66 years. The median J-score was 3, and CCS angina classes III–IV were present in 45% of the patients. After the first CTO-PCI attempt, no in-hospital cardiac deaths were registered. The overall rate of in-hospital myocardial infarction was 3.6%, without significant differences between the DCB and CB groups (4.5% after DCB vs 3.0% after CB, p=0.999). The success rate of the second CTO-PCI attempt was 86.8%, with a periprocedural complication rate of 5.7% and with an overall rate of in-hospital complications of 24.5%, without significant differences between the 2 groups (13.6% in the DCB group vs 32.2% in the CB group, p=0.195). Compared with CB, in the DCB group, the second CTO-PCI required a shorter median fluoroscopy time (33 vs 60 min, p<0.001), a lower contrast volume (170 vs 321 cc, p<0.001), and a lower radiation dose (1.7 vs 3.3 Gy, p<0.001). At 1-year follow-up, outcomes were comparable between the 2 strategies, target vessel failure occurred in 5.7% and major adverse cardiovascular events in 18.2% (13.6% in the DCB group vs 21.2% in the CB group, p=0.494). Conclusions. PM after CTO recanalization failure is safe and warrants high success rates when a second attempt is performed. A DCB strategy for CTO-PM does not seem to ensure higher success or better clinical outcomes, but its use was associated with simpler staged procedures. This trial is registered with NCT05158686.http://dx.doi.org/10.1155/2024/2797561 |
| spellingShingle | Ignacio J. Amat-Santos Giorgio Marengo Luiz F. Ybarra Jose Antonio Fernández-Diaz Ander Regueiro Alejandro Gutiérrez Javier Martín-Moreiras Juan Pablo Sánchez-Luna Jose Carlos González-Gutiérrez Clara Fernandez-Cordon Manuel Carrasco-Moraleja Stéphane Rinfret Drug-Coated versus Conventional Balloons to Improve Recanalization of a Coronary Chronic Total Occlusion after Failed Attempt: The Improved-CTO Registry Journal of Interventional Cardiology |
| title | Drug-Coated versus Conventional Balloons to Improve Recanalization of a Coronary Chronic Total Occlusion after Failed Attempt: The Improved-CTO Registry |
| title_full | Drug-Coated versus Conventional Balloons to Improve Recanalization of a Coronary Chronic Total Occlusion after Failed Attempt: The Improved-CTO Registry |
| title_fullStr | Drug-Coated versus Conventional Balloons to Improve Recanalization of a Coronary Chronic Total Occlusion after Failed Attempt: The Improved-CTO Registry |
| title_full_unstemmed | Drug-Coated versus Conventional Balloons to Improve Recanalization of a Coronary Chronic Total Occlusion after Failed Attempt: The Improved-CTO Registry |
| title_short | Drug-Coated versus Conventional Balloons to Improve Recanalization of a Coronary Chronic Total Occlusion after Failed Attempt: The Improved-CTO Registry |
| title_sort | drug coated versus conventional balloons to improve recanalization of a coronary chronic total occlusion after failed attempt the improved cto registry |
| url | http://dx.doi.org/10.1155/2024/2797561 |
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