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Observational Study
. 2016 Aug 20;5(8):e003890.
doi: 10.1161/JAHA.116.003890.

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

Judit Karacsonyi  1 , Khaldoon Alaswad  2 , Farouc A Jaffer  3 , Robert W Yeh  4 , Mitul Patel  5 , John Bahadorani  5 , Aris Karatasakis  6 , Barbara A Danek  6 , Anthony Doing  7 , J Aaron Grantham  8 , Dimitri Karmpaliotis  9 , Jeffrey W Moses  9 , Ajay Kirtane  9 , Manish Parikh  9 , Ziad Ali  9 , William L Lombardi  10 , David E Kandzari  11 , Nicholas Lembo  11 , Santiago Garcia  12 , Michael R Wyman  13 , Aya Alame  6 , Phuong-Khanh J Nguyen-Trong  6 , Erica Resendes  6 , Pratik Kalsaria  6 , Bavana V Rangan  6 , Imre Ungi  14 , Craig A Thompson  15 , Subhash Banerjee  6 , Emmanouil S Brilakis  16
Affiliations
Observational Study

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

Judit Karacsonyi et al. J Am Heart Assoc. .

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.

Keywords: chronic total occlusion; intravascular ultrasound; optical coherence tomography; percutaneous coronary intervention.

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Figures

Figure 1
Figure 1
Flow chart of the study. CTO indicates chronic total occlusion; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Use of intravascular imaging during chronic total occlusion percutaneous coronary intervention. CART indicates controlled antegrade and retrograde tracking and dissection.
Figure 3
Figure 3
Frequency of intravascular imaging use at the study participating centers. The absolute number of the cases with intravascular imaging use is listed in parentheses.
Figure 4
Figure 4
Technical, procedural success and MACE among study procedures classified according to use of intravascular imaging for crossing. MACE indicates major cardiac adverse event.
Figure 5
Figure 5
Technical, procedural success and major cardiac adverse events according to purpose of intravascular imaging techniques. IMG indicates imaging; MACE, major cardiac adverse events.
See this image and copyright information in PMC

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