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Contrast Utilization During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary
Georgios E Christakopoulos, Dimitri Karmpaliotis, Khaldoon Alaswad
1Dallas VA Medical Center (111A); 4500 South Lancaster Road, Dallas, TX 75216 USA. esbrilakis@ gmail.com.
Insights
High contrast volume during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is linked to specific patient and procedural factors. Understanding these can help manage contrast use and reduce risks like contrast-induced nephropathy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Nephrology
Background:
- High contrast volume in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) may increase the risk of contrast-induced nephropathy.
- Identifying factors associated with contrast volume is crucial for patient safety.
Purpose of the Study:
- To examine the clinical, angiographic, and procedural variables associated with contrast volume administered during CTO-PCI procedures.
- To identify predictors of high contrast utilization in CTO-PCI.
Main Methods:
- Retrospective analysis of 1330 CTO-PCI procedures from 12 experienced centers in the United States.
- Evaluation of associations between patient demographics, lesion characteristics, and procedural elements with contrast volume used.
Main Results:
- Mean contrast volume was 289 ± 138 mL, with 33% of patients receiving >320 mL.
- Multivariable analysis identified moderate/severe calcification, distal cap at bifurcation, ad hoc CTO-PCI, dual arterial access, 8 Fr guide catheters, and antegrade/retrograde approaches as independently associated with higher contrast use.
- Diabetes, larger target vessel diameter, and interventional collaterals were associated with lower contrast utilization.
Conclusions:
- Several baseline clinical, angiographic, and procedural factors are significantly associated with contrast volume administration during CTO-PCI.
- These findings can inform strategies to optimize contrast use and mitigate risks in CTO-PCI.
Background:
Administration of a large amount of contrast volume during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to contrast-induced nephropathy.
Methods:
We examined the association of clinical, angiographic and procedural variables with contrast volume administered during 1330 CTO-PCI procedures performed at 12 experienced United States centers.
Results:
Technical and procedural success was 90% and 88%, respectively, and mean contrast volume was 289 ± 138 mL. Approximately 33% of patients received >320 mL of contrast (high contrast utilization group). On univariable analysis, male gender (P=.01), smoking (P=.01), prior coronary artery bypass graft surgery (P=.04), moderate or severe calcification (P=.01), moderate or severe tortuosity (P=.04), proximal cap ambiguity (P=.01), distal cap at a bifurcation (P<.001), side branch at the proximal cap (P<.001), blunt/no stump (P=.01), occlusion length (P<.001), higher J-CTO score (P=.02), use of antegrade dissection and reentry or retrograde approach (P<.001), ad hoc CTO-PCI (P=.04), dual arterial access (P<.001), and 8 Fr guide catheters (P<.001) were associated with higher contrast volume; conversely, diabetes mellitus (P=.01) and in-stent restenosis (P=.01) were associated with lower contrast volume. On multivariable analysis, moderate/severe calcification (P=.04), distal cap at a bifurcation (P<.001), ad hoc CTO-PCI (P<.001), dual arterial access (P=.01), 8 Fr guide catheters (P=.02), and use of antegrade dissection/reentry or the retrograde approach (P<.001) were independently associated with higher contrast use, whereas diabetes (P=.02), larger target vessel diameter (P=.03), and presence of "interventional" collaterals (P<.001) were associated with lower contrast utilization.
Conclusions:
Several baseline clinical, angiographic, and procedural characteristics are associated with higher contrast volume administration during CTO-PCI.
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