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Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
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Outcomes of subintimal plaque modification in chronic total occlusion percutaneous coronary intervention

Iosif Xenogiannis1, James W Choi2, Khaldoon Alaswad3

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

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|December 5, 2019
PubMed

Insights

Subintimal plaque modification (SPM) can help restore blood flow during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Repeat CTO PCI attempts after SPM show high success rates for revascularization with manageable risks.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Interventions

Background:

  • Subintimal plaque modification (SPM) is a technique used in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) when initial attempts to cross into the true lumen fail.
  • SPM aims to restore antegrade flow and facilitate subsequent lesion recanalization.

Purpose of the Study:

  • To analyze the outcomes of repeat CTO PCI attempts following prior subintimal plaque modification (SPM).
  • To evaluate the success rates and safety of revascularization in patients undergoing CTO PCI after SPM.

Main Methods:

  • The study analyzed data from the PROGRESS-CTO registry, including 4,659 CTO PCIs.
  • Outcomes were assessed for 58 SPM procedures and 60 subsequent CTO PCI attempts within the registry.
  • Patient demographics, lesion characteristics, procedural details, and clinical outcomes were retrospectively analyzed.

Main Results:

  • Patients undergoing repeat CTO PCI after SPM were predominantly male (86%) with significant cardiovascular risk factors.
  • The target CTO lesions frequently exhibited complex characteristics, including ambiguous proximal caps, calcification, and tortuosity.
  • Subsequent CTO PCI attempts demonstrated high technical (83%) and procedural (83%) success rates, with a low in-hospital major adverse cardiovascular event rate (3.3%).
  • Success rates were significantly higher for repeat procedures performed ≥60 days after the initial CTO PCI (94% vs. 69%, p=0.015).

Conclusions:

  • Repeat CTO PCI after subintimal plaque modification is associated with a high probability of successful revascularization.
  • The procedure carries an acceptable risk profile for patients undergoing treatment for complex chronic total occlusions.
Abstract

Keywords:
STARchronic total occlusioninvestment procedurepercutaneous coronary interventionsubintimal plaque modification

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