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Hybrid approach improves success of chronic total occlusion angioplasty

Lookup NU author(s): Dr Alan Bagnall, Dr Mohaned Egred


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Objectives Treatment options for coronary chronic total occlusions (CTO) are limited, with low historical success rates from percutaneous coronary intervention (PCI). We report procedural outcomes of CTO PCI from 7 centres with dedicated CTO operators trained in hybrid approaches comprising antegrade/retrograde wire escalation (AWE/RWE) and dissection re-entry (ADR/RDR) techniques.Methods Clinical and procedural data were collected from consecutive unselected patients with CTO between 2012 and 2014. Lesion complexity was graded by the Multicentre CTO Registry of Japan (J-CTO) score, with 2 defined as complex. Success was defined as thrombolysis in myocardial infarction 3 flow with <30% residual stenosis, subclassified as at first attempt or overall. Inhospital complications and 30-day major adverse cardiovascular events (MACEs, death/myocardial infarction/unplanned target vessel revascularisation) were recorded.Results 1156 patients were included. Despite high complexity (mean J-CTO score 2.51.3), success rates were 79% (first attempt) and 90% (overall) with 30-day MACE of 1.6%. AWE was highly effective in less complex lesions (J-CTO 1 94% success vs 79% in J-CTO score 2). ADR/RDR was used more commonly in complex lesions (J-CTO1 15% vs J-CTO 2 56%). Need for multiple approaches during each attempt increased with lesion complexity (17% J-CTO 1 vs 48% J-CTO 2). Lesion modification (investment procedures') at the end of unsuccessful first attempts increased the chance of subsequent success (96% vs 71%).Conclusions Hybrid-trained operators can achieve overall success rates of 90% in real world practice with acceptable MACE. Use of dissection re-entry and investment procedures maintains high success rates in complex lesions. The hybrid approach represents a significant advance in CTO treatment.

Publication metadata

Author(s): Wilson WM, Walsh SJ, Yan AT, Hanratty CG, Bagnall AJ, Egred M, Smith E, Oldroyd KG, McEntegart M, Irving J, Strange J, Douglas H, Spratt JC

Publication type: Article

Publication status: Published

Journal: Heart

Year: 2016

Volume: 102

Issue: 18

Pages: 1486-U4

Print publication date: 01/09/2016

Online publication date: 10/05/2016

Acceptance date: 16/04/2016

ISSN (print): 1355-6037

ISSN (electronic): 1468-201X

Publisher: BMJ Publishing Group


DOI: 10.1136/heartjnl-2015-308891


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