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The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe: The RECHARGE Registry
Joren Maeremans1, Simon Walsh2, Paul Knaapen3
1Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Insights
The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) demonstrates high success rates (86%) and low complication rates (2.6%) in a large multicenter registry. These findings support its broader adoption by trained operators.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Medicine
Background:
- The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) aims to enhance procedural success.
- A lack of large, prospective multicenter studies has limited validation across diverse operator experiences.
Purpose of the Study:
- To evaluate the real-world effectiveness and safety of the hybrid algorithm for CTO PCI.
- To report procedural outcomes and complications in a broad patient population.
Main Methods:
- Prospective enrollment of consecutive patients undergoing hybrid CTO PCI in 17 centers (January 2014 - October 2015).
- Analysis of procedural techniques, success rates, and in-hospital complications.
- Evaluation of primary and bailout strategy effectiveness.
Main Results:
- 1,253 CTO-PCIs were performed in 1,177 patients, with an 86% overall procedure success rate and 2.6% major in-hospital complications.
- Antegrade wire escalation was the most common primary strategy (77%), successful in 60%.
- Bailout strategies, including antegrade dissection re-entry and retrograde approaches, showed success rates of 67% and 62%, respectively.
Conclusions:
- The hybrid algorithm achieves high procedural and patient success rates with a low event rate.
- Improved procedural characteristics support the wider use of the hybrid algorithm among trained CTO operators.
- Further validation in diverse settings reinforces its clinical utility.
Background:
The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to improve procedural outcomes. Large, prospective studies validating the algorithm in a broad multicenter setting with operators of different experience levels are lacking.
Objectives:
The RECHARGE (REgistry of Crossboss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom) registry aims to report achievable results using the hybrid algorithm.
Methods:
Between January 2014 and October 2015, consecutive patients undergoing hybrid CTO-PCI were prospectively enrolled in 17 centers. Procedural techniques, outcomes, and in-hospital complications were analyzed.
Results:
A total of 1,253 CTO-PCIs were performed in 1,177 patients, of which 86% were men. Mean age was 66 ± 11 years. The average Japanese CTO score was 2.0 ± 1.0, and was higher in the failure group (2.6 ± 0.6 vs. 1.9 ± 1.0; p < 0.001). Overall procedure success was 86% and major in-hospital complications occurred in 2.6%. Antegrade wire escalation was the preferred primary strategy in 77%, followed by retrograde (17%) and antegrade dissection re-entry strategies (7%). Primary strategies were successful in 60%. Consecutive strategies were applied in 34% and were successful in 74%. Antegrade dissection re-entry and retrograde strategies were the most common bailout strategies and were successful in 67% and 62%, respectively. Median procedure and fluoroscopy time were 90 (interquartile range [IQR]: 60 to 120) min and 35 (IQR: 21 to 55) min, contrast volume was 250 (IQR: 180 to 340) ml, and radiation doses (air kerma and dose area product) were 1.6 (IQR: 1.0 to 2.7) Gy and 98 (IQR: 57 to 168) Gy·cm2, respectively.
Conclusions:
High procedure and patient success rates, combined with a low event rate and improved procedural characteristics, support further use of the hybrid algorithm for a broad community of appropriately trained CTO operators.
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