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

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus

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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jah31711-fig-0005: Technical, procedural success and major cardiac adverse events according to purpose of intravascular imaging techniques. IMG indicates imaging; MACE, major cardiac adverse events.

Mentions: Among CTOs successfully crossed with a guidewire, cases in which imaging was used for stent sizing and optimization were more complex, as reflected by higher Japanese Chronic Total Occlusion (2.65±1.17 versus 2.38±1.22, P=0.013) and Progress CTO (1.39±1.09 versus 1.19±0.98, P=0.035) scores (Tables 4 and 5). They were also more likely to have moderate/severe calcification (63% versus 47%, P=0.001), longer occlusion length (30 mm [20, 50] versus 28 mm [15, 40], P=0.030) or be due to in‐stent restenosis (23% versus 14%, P=0.015) and required longer procedure (162 minutes [113, 216] versus 133 minutes [91, 201], P=0.001) and fluoroscopy (52 minutes [33, 81] versus 40 minutes [26, 73], P=0.014) time with a trend for higher air kerma radiation dose (3.90 Gray [2.48, 5.46] versus 3.48 Gray [2.13, 5.34], P=0.249) and contrast volume (300 mL [228, 368] versus 277 mL [200, 370], P=0.106). Use of intravascular imaging was associated with similar technical (97.7% versus 97.5%, P=0.854) and procedural (97.1% versus 95.4%, P=0.347) success rates and similarly low MACE rates (2.3% versus 3.1%, P=0.622) (Figure 5). There was a trend toward larger number of stents in procedures where intravascular imaging was used for stent sizing/and/or optimization (2.7±1.3 versus 2.5±1.2, P=0.07).


Use of Intravascular Imaging During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry
Technical, procedural success and major cardiac adverse events according to purpose of intravascular imaging techniques. IMG indicates imaging; MACE, major cardiac adverse events.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015304&req=5

jah31711-fig-0005: Technical, procedural success and major cardiac adverse events according to purpose of intravascular imaging techniques. IMG indicates imaging; MACE, major cardiac adverse events.
Mentions: Among CTOs successfully crossed with a guidewire, cases in which imaging was used for stent sizing and optimization were more complex, as reflected by higher Japanese Chronic Total Occlusion (2.65±1.17 versus 2.38±1.22, P=0.013) and Progress CTO (1.39±1.09 versus 1.19±0.98, P=0.035) scores (Tables 4 and 5). They were also more likely to have moderate/severe calcification (63% versus 47%, P=0.001), longer occlusion length (30 mm [20, 50] versus 28 mm [15, 40], P=0.030) or be due to in‐stent restenosis (23% versus 14%, P=0.015) and required longer procedure (162 minutes [113, 216] versus 133 minutes [91, 201], P=0.001) and fluoroscopy (52 minutes [33, 81] versus 40 minutes [26, 73], P=0.014) time with a trend for higher air kerma radiation dose (3.90 Gray [2.48, 5.46] versus 3.48 Gray [2.13, 5.34], P=0.249) and contrast volume (300 mL [228, 368] versus 277 mL [200, 370], P=0.106). Use of intravascular imaging was associated with similar technical (97.7% versus 97.5%, P=0.854) and procedural (97.1% versus 95.4%, P=0.347) success rates and similarly low MACE rates (2.3% versus 3.1%, P=0.622) (Figure 5). There was a trend toward larger number of stents in procedures where intravascular imaging was used for stent sizing/and/or optimization (2.7±1.3 versus 2.5±1.2, P=0.07).

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus