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A "minimalistic hybrid algorithm" in coronary chronic total occlusion revascularization: Procedural and clinical
Carlo Zivelonghi1,2, Jan Peter van Kuijk1, Enrico Poletti1,3
1Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands.
Insights
A new "Minimalistic Hybrid Algorithm" for coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) reduces the need for large catheters and femoral access. This approach is feasible and effective, achieving high procedural success rates with fewer complications.
Area of Science:
- Interventional Cardiology
- Vascular Medicine
- Medical Device Technology
Background:
- Percutaneous recanalization of coronary chronic total occlusions (CTOs) traditionally uses dual-access and large-bore catheters, often via a transfemoral approach.
- This approach carries risks of vascular complications and patient discomfort.
Purpose of the Study:
- To evaluate the outcomes of a novel "Minimalistic Hybrid Algorithm" for CTO percutaneous coronary intervention (PCI).
- To assess the feasibility and efficacy of minimizing dual-access, large-bore catheters, and femoral access.
- To reduce vascular complications and patient discomfort without compromising procedural success.
Main Methods:
- A single-center registry of consecutive patients undergoing CTO PCI between March 2016 and October 2017.
- Application of the "Minimalistic Hybrid Algorithm" to reduce reliance on traditional methods.
- Collection of data on algorithm applicability, procedural success rates, and patient demographics/angiographic characteristics.
Main Results:
- 91% (91 out of 100) of CTO PCI procedures were successfully approached using the minimalistic algorithm.
- Procedural success rate was 89% for the minimalistic approach, comparable to large multicenter experiences.
- The approach utilized single-catheter access in 52 procedures (predominantly trans-radial) and dual-catheter access in 39 procedures (biradial or radial-femoral).
Conclusions:
- The "Minimalistic Hybrid Algorithm" is a feasible alternative for CTO PCI in clinical practice.
- This approach effectively limits the routine use of large-bore catheters and transfemoral access.
- The minimalistic strategy yields good procedural outcomes, potentially reducing vascular complications and improving patient comfort.
Background:
Percutaneous recanalization of coronary chronic total occlusions (CTOs) traditionally relies on the use of dual-access and large bore catheters, with trans-femoral approach adoption in most cases.
Objectives:
Aim of this manuscript is to describe the outcomes of an alternative hybrid algorithm, called "Minimalistic Hybrid Algorithm," which has the purpose to minimize the use of double access, large bore catheters, and femoral approach in order to minimize the risk of vascular complications and patient's discomfort, without compromising efficacy.
Methods:
In this single-center registry, a "minimalistic" approach was attempted in consecutive patients undergoing CTO PCI between March 2016 and October 2017. Data regarding the applicability of this algorithm and the related procedural success rates were collected, together with common demographic and angiographic characteristics.
Results:
Of the 100 CTO PCI performed in the study period, 91(91%) were successfully approached according to the novel algorithm. Mean J-CTO score of all minimalistic procedures was 1.9 ± 1.2, with 31(34%) patients presenting with J-CTO score ≥3. In 52 procedures, the approach consisted of single-catheter access, 49(94.2%) of which were trans-radial. Out of the 39 patients approached with dual-catheters, 26(69.2%) were biradial, and 8(21%) radial-femoral. Procedural success in patients approached with the minimalistic algorithm was 89%, in line with the results of large-multicenter experiences nowadays available.
Conclusions:
Our results show that an alternative algorithm limiting the routine use of large bore catheters and trans-femoral approach is feasible in the clinical practice and yields good procedural outcomes.