Allana SS, Kostantinis S, Simsek B, Karacsonyi J, Rempakos A, Alaswad K, Krestyaninov O, Khelimskiid D, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Patel MP, Mahmud E, Koutouzis M, Tsiafoutis I, Gorgulu S, Elbarouni B, Nicholson W, Jaber W, Rinfret S, Rafeh NA, Goktekin O, ElGuindy AM, Sandoval Y, Burke MN, Rangan BV, and Brilakis ES
Background: Distal vessel quality is a key parameter in the global chronic total occlusion (CTO) crossing algorithm., Objectives: The study sought to evaluate the association of distal vessel quality with the outcomes of CTO percutaneous coronary intervention., Methods: We examined the clinical and angiographic characteristics and procedural outcomes of 10,028 CTO percutaneous coronary interventions performed at 39 U.S. and non-U.S. centers between 2012 and 2022. A poor-quality distal vessel was defined as <2 mm diameter or with significant diffuse atherosclerotic disease. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke., Results: A total of 33% of all CTO lesions had poor-quality distal vessel. When compared with good-quality distal vessels, CTO lesions with a poor-quality distal vessel had higher J-CTO (Japanese chronic total occlusion) scores (2.7 ± 1.1 vs 2.2 ± 1.3; P < 0.01), lower technical (79.9% vs 86.9%; P < 0.01) and procedural (78.0% vs 86.8%; P < 0.01) success, and higher incidence of MACE (2.5% vs 1.7%; P < 0.01) and perforation (6.4% vs 3.7%; P < 0.01). A poor-quality distal vessel was independently associated with technical failure and MACE. Poor-quality distal vessels were associated with higher use of the retrograde approach (25.2% vs 14.9%; P < 0.01) and higher air kerma radiation dose (2.4 [IQR: 1.3-4.0] Gy vs 2.0 [IQR: 1.1-3.5] Gy; P < 0.01)., Conclusions: A poor-quality distal vessel in CTO lesions is associated with higher lesion complexity, higher need for retrograde crossing, lower technical and procedural success, higher incidence of MACE and coronary perforation, and higher radiation dose., Competing Interests: Funding Support and Author Disclosures The authors are grateful for the philanthropic support of the generous anonymous donors, and the philanthropic support of Drs Mary Ann and Donald A. Sens, Mrs. Diane and Dr Cline Hickok, Mrs Wilma and Mr Dale Johnson, the Mrs Charlotte and Mr Jerry Golinvaux Family Fund, the Roehl Family Foundation, and the Joseph Durda Foundation. The generous gifts of these donors to the Minneapolis Heart Institute Foundation and Center for Coronary Artery Disease helped support this research project. Dr Allana has served as a consultant for Boston Scientific Corporation. Dr Alaswad has served as a consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and Cardiovascular Systems Inc. Dr Karmpaliotis has received honoraria from Boston Scientific, Abbott Vascular, and Abiomed; and owns equity in Saranas, Soundbite, and Traverse Vascular. Dr Jaffer has conducted sponsored research for Canon, Siemens, Shockwave, Teleflex, Mercator, Boston Scientific, HeartFlow, and Amarin; has served as a consultant for Boston Scientific, Siemens, Magenta Medical, International Medical Device Solutions, Asahi Intecc, Biotronik, Philips, Intravascular Imaging, and DurVena; owns equity interest in Intravascular Imaging Inc and DurVena; and his employer, Massachusetts General Hospital, has licensing arrangements with Terumo, Canon, and Spectrawave, for which he has the right to receive royalties. Dr Khatri has received personal honoraria for proctoring and speaking for Abbott Vascular, Medtronic, Terumo, and Shockwave Medical. Dr Poommipanit has served as a consultant for Medtronic, Asahi Intecc, Abbott Vascular, and Boston Scientific. Dr Patel has received consulting honoraria from Abbott, Medtronic, Terumo, and Cardiovascular Systems. Dr Mahmud has served as a consultant for Abiomed, Medtronic, and Boston Scientific; and has served as chair for multiple Data, Safety and Monitoring Boards. Dr Nicholson has served as a proctor and on the Speakers Bureau and advisory board for Abbott Vascular, Boston Scientific, and Asahi Intecc; and owns reports intellectual property with Vascular Solutions. Dr Jaber received received research and educational funds from Medtronic, Inari Medical; has served as a consultant for Medtronic, Inari Medical; has received a proctoring fees from Abbott Vascular; and has served on the advisory board for Medtronic. Dr Rinfret has served as a consultant for Abbott Vascular, Abiomed, Boston Scientific Corporation, SoundBite Medical, and Teleflex. Dr Abi-Rafeh has served as a proctor for and received speaker honoraria from Boston Scientific and Abbott Vascular. Dr ElGuindy has received consulting honoraria from Medtronic, Boston Scientific, Asahi Intecc, and Abbott; proctorship fees from Medtronic, Boston Scientific, Asahi Intecc, and Terumo; and educational grants from Medtronic. Dr Sandoval has served on the advisory board for Roche Diagnostics and Abbott Diagnostics without personal compensation; and as a speaker without personal financial compensation for Abbott Diagnostics. Dr Burke has received consulting and speaker honoraria from Abbott Vascular and Boston Scientific. Dr Brilakis has received consulting/speaker honoraria from Abbott Vascular, the American Heart Association (associate editor for Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), ControlRad, CSI, Elsevier, GE Healthcare, IMDS, InfraRedx, Medicure, Medtronic, Opsens, Siemens, and Teleflex; has received research support from Boston Scientific and GE Healthcare; is the owner of Hippocrates LLC; and is a shareholder for MHI Ventures, Cleerly Health, and Stallion Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)