Hybrid Approach Improves CTO PCI Success Rates: an Australian Experience
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
David Blusztein, M.B.B.S.
,
Royal Melbourne Hospital, Melbourne, Australia
Matthew Brooks
,
Royal Melbourne Hospital, Melbourne, Australia
Jeffrey Lefkovits
,
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
William Wilson
,
Royal Melbourne Hospital, Melbourne, Australia
Background:
Previous Australian chronic total occlusion (CTO) percutaneous coronary intervention (PCI) series have shown modest success rates. Improved CTO PCI success rates have been described using the hybrid algorithm. We examined procedural success rates and outcomes following CTO PCI at a large Australian tertiary centre with two hybrid CTO PCI trained operators.
Methods:
We prospectively evaluated all planned CTO cases performed by two hybrid CTO-trained operators within a dedicated CTO program at Royal Melbourne Hospital (RMH) since January 2016. Baseline clinical characteristics, procedural information and in-hospital outcomes were collected and analysed.
Results:
66 patients underwent planned CTO PCI (70 procedures); 2 patients had an initial failed attempt with subsequent successful PCI and 2 patients had two CTOs treated on separate occasions. Overall per-patient success rate was 87% (84% success rate at first attempt). The average age was 63±10years and 82% were male. The RCA was most commonly attempted (45%), followed by the LAD (30%) and the LCx (25%). The mean J-CTO and Progress scores were 2.3±1.3 and 1.5±1.0, respectively. J-CTO scores were >2 in 69%. 31% had undergone a prior PCI attempt by different operators. Mean lesion length was 22±12mm. The final strategy was antegrade wire escalation (AWE) in 67%, antegrade dissection reentry in 19%, retrograde wire escalation in 5% and retrograde dissection reentry in 9%. Dual injections were used in 80% and a microcatheter employed in 94%. In successful AWE cases, the final wire used was Fielder XT series (43%), Pilot 200 (22%), Confianza Pro 12 (20%), Gaia series (13%) or Sion Black (2%). Mean stent length was 47.8±25.1mm. Mean procedure time was 105±40 minutes (27% >120mins), mean dose-area product was 17005±9504cGycm2 with mean peak skin dose of 2.1±1.1Gy and mean contrast use was 207±70ml. There were no major complications and two minor complications (Ellis 1 perforation, n=1; minor vascular complication, n=1).
Conclusions:
Following the establishment of a dedicated CTO program at RMH we report an 87% success rate with a very low complication rate. This large Australian series demonstrates the value of trained CTO operators and CTO planning.
