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Prevalence and outcomes of balloon undilatable chronic total occlusions: Insights from the PROGRESS-CTO

Bahadir Simsek1, Spyridon Kostantinis1, Judit Karacsonyi1

  • 1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.

International Journal of Cardiology
|April 28, 2022
PubMed

Insights

About 8.5% of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) involve balloon undilatable lesions. These challenging cases have lower success rates and increased risk of major adverse cardiovascular events (MACE).

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Devices

Background:

  • Balloon undilatable lesions are a significant challenge in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
  • Limited research exists on the prevalence, treatment strategies, and clinical outcomes associated with these difficult-to-treat lesions.

Purpose of the Study:

  • To investigate the clinical characteristics of patients with balloon undilatable lesions during CTO PCI.
  • To evaluate the procedural outcomes and identify factors associated with success and complications in this patient subset.

Main Methods:

  • Analysis of data from the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO) database (NCT02061436).
  • Inclusion of 6535 CTO PCI cases performed between 2012 and 2022.
  • Comparison of patient demographics, comorbidities, lesion characteristics, interventional techniques, and in-hospital outcomes between balloon undilatable lesions and others.

Main Results:

  • Balloon undilatable lesions were identified in 8.5% (558/6535) of CTO PCIs.
  • Patients with undilatable lesions were older and had a higher prevalence of diabetes, prior PCI, myocardial infarction, and coronary artery bypass graft surgery.
  • Treatment of undilatable lesions was associated with lower technical success (90.9% vs. 93.8%) and a higher incidence of in-hospital major adverse cardiovascular events (MACE) (5.0% vs. 1.3%).

Conclusions:

  • Approximately 1 in 12 CTO lesions present as balloon undilatable, posing a significant challenge.
  • The management of balloon undilatable lesions is linked to reduced technical success rates and increased in-hospital MACE.
  • Further research into optimal strategies for these complex lesions is warranted.
Abstract

Keywords:
Balloon uncrossableBalloon undilatableChronic total occlusionComplicationsPercutaneous coronary intervention

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