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Prevalence, Presentation and Treatment of 'Balloon Undilatable' Chronic Total Occlusions: Insights from a Multicenter

Peter Tajti1,2,3, Dimitri Karmpaliotis4, Khaldoon Alaswad5

  • 1Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|January 24, 2018
PubMed

Insights

Balloon undilatable chronic total occlusions (CTOs) are common, occurring in 12% of cases. These challenging CTOs are linked to reduced procedural success and increased complications during percutaneous coronary interventions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Limited research exists on the prevalence, treatment, and outcomes of balloon-undilatable chronic total occlusions (CTOs).
  • Understanding these challenging lesions is crucial for improving percutaneous coronary intervention (PCI) strategies.

Purpose of the Study:

  • To investigate the prevalence, clinical and angiographic features, and procedural outcomes of balloon-undilatable CTOs.
  • To identify factors associated with successful PCI in these complex cases.

Main Methods:

  • A multicenter US registry analyzed data from 425 consecutive CTO PCIs (2012-2017).
  • Patients with successful guidewire crossing were assessed for balloon-undilatable lesions.
  • Clinical, angiographic, and procedural data were collected and compared.

Main Results:

  • Balloon-undilatable CTOs represented 12% (52/425) of cases and were associated with diabetes and heart failure.
  • These lesions were longer, more calcified, and had higher J-CTO and PROGRESS-CTO scores.
  • Technical and procedural success rates were lower (92% and 88%), with higher in-hospital major adverse events (8%) due to perforations.

Conclusions:

  • Balloon-undilatable CTOs are a significant subset of CTOs encountered in PCI.
  • These lesions present greater complexity and are associated with poorer procedural outcomes and higher complication risks.
  • Effective treatment strategies, including high-pressure balloons, rotational atherectomy, and laser, are essential.
Abstract

Keywords:
chronic total occlusioncomplex coronary interventionpercutaneous coronary intervention

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