Plaque modification in calcified chronic total occlusions: the PLACCTON study

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Severe calcification affects over 50% of coronary chronic total occlusions (CTOs) posing challenges for percutaneous intervention.
• Plaque modification devices (PMDs) are employed to address complex lesion characteristics during CTO procedures.

Purpose of the Study:

• To evaluate the contemporary utilization patterns of PMDs in patients undergoing percutaneous coronary intervention for CTOs.
• To assess the procedural outcomes and mid-term clinical impact associated with the use of PMDs in CTO interventions.

Main Methods:

• Analysis of data from the prospective, multicenter Iberian CTO registry (2015-2020).
• Comparison of procedural success, complications, and long-term survival between patients treated with and without PMDs.
• Inclusion of 2235 patients, with PMDs used in 134 (7%) cases.

Main Results:

• PMDs were utilized in 7% of CTO interventions, predominantly in older patients with higher lesion complexity (Syntax and J-CTO scores).
• Procedural success rates significantly increased with PMD use (96.3% vs. 87.2%, P=.001) without a rise in complications (3.2% vs. 3.7%, P=.615).
• At 2-year follow-up, survival rates were similar between groups (94.3% vs. 94.3%, P=.967), despite the higher baseline risk in the PMD group.

Conclusions:

• In CTO interventions, PMDs are associated with enhanced procedural success following successful wire crossing.
• The use of PMDs in complex CTOs is safe, with no increase in procedural complications.
• Comparable mid-term outcomes suggest potential technical and prognostic benefits from broader PMD utilization in CTO PCI.