Comparative Assessment of Procedure Cost and Outcomes Between Guidewire and Crossing Device Strategies to Cross
Subhash Banerjee1, Haekyung Jeon-Slaughter1, Shirling Tsai1
1University of Texas Southwestern Medical Center, Dallas, Texas; VA North Texas Health Care System, Dallas, Texas.
Insights
Dedicated chronic total occlusion (CTO) devices improve technical success and reduce reintervention and amputation rates for peripheral artery CTOs. These devices offer a net cost savings of $423.80 per procedure at 12 months.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Peripheral artery chronic total occlusion (CTO) interventions are common.
- Limited data exist on the comparative costs and outcomes of wire-catheter versus dedicated CTO devices.
Purpose of the Study:
- To compare the actual procedural costs and clinical outcomes of wire-catheter versus dedicated CTO device strategies for crossing peripheral artery CTOs.
Main Methods:
- Retrospective analysis of the Excellence in Peripheral Artery Disease Intervention (XLPAD) registry.
- Comparison of cost and 30-day/12-month outcomes for wire-catheter versus CTO device strategies in infrainguinal CTO treatment.
Main Results:
- Dedicated CTO devices were used in 18% of cases, associated with higher technical success (74% vs. 65%) and increased cost ($7,800 vs. $4,973).
- CTO device use led to lower 12-month repeat revascularization (11.3% vs. 17.2%) and amputation rates (2.8% vs. 8.5%).
- The net cost for CTO crossing devices was $423.80 per procedure at 12 months.
Conclusions:
- Wire-catheter approaches are most common for peripheral artery CTOs.
- Dedicated CTO crossing devices enhance technical success and reduce reintervention and amputation rates.
- CTO crossing devices represent a cost-effective strategy with a net saving of $423.80 per procedure at 12 months.
Objectives:
The aim of this study was to assess actual procedural costs and outcomes comparing wire-catheter and dedicated chronic total occlusion (CTO) device strategies to cross peripheral artery CTOs.
Background:
Peripheral artery CTO interventions are frequently performed, but there are limited data on actual procedural costs and outcomes comparing wire-catheter and dedicated CTO devices.
Methods:
The XLPAD (Excellence in Peripheral Artery Disease Intervention) registry (NCT01904851) was accessed to retrospectively compare cost and 30-day and 12-month outcomes of wire-catheter and crossing device strategies for treatment of infrainguinal peripheral artery CTO.
Results:
Of all 3,234 treated lesions, 42% (n = 1,362) were CTOs in 1,006 unique patients. Wire-catheter approaches were used in 82% of CTOs, whereas dedicated CTO devices were used in 18% (p < 0.0001). CTO crossing device use was associated with significantly higher technical success (74% vs. 65%; p < 0.0001) and mean procedure cost ($7,800.09 vs. $4,973.24; p < 0.0001). Because 12-month repeat revascularization (11.3% vs. 17.2%; p = 0.02) and amputation rates (2.8% vs. 8.5%; p = 0.002) in the CTO crossing device arm were lower compared with the wire-catheter group, the net cost for an initial CTO crossing device strategy was $423.80 per procedure.
Conclusions:
An initial wire-catheter approach to cross a peripheral artery CTO is most frequently adopted. The use of dedicated CTO crossing devices provides significantly higher technical success and lower reintervention and amputation rates, at a net cost of $423.80 per procedure at 12 months.
