Balloon-assisted subintimal entry (BASE) in chronic total occlusion percutaneous coronary interventions

Area of Science:

• Interventional Cardiology
• Cardiovascular Interventions
• Percutaneous Coronary Intervention

Background:

• Limited data exists on the application of the balloon-assisted subintimal entry (BASE) technique in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
• Understanding the utilization and outcomes of the BASE technique is crucial for complex CTO PCI strategies.

Purpose of the Study:

• To analyze the clinical and angiographic characteristics of CTO PCI cases using the BASE technique.
• To evaluate the outcomes associated with the BASE technique in CTO PCI.
• To compare BASE technique utilization with other antegrade dissection and re-entry (ADR) strategies.

Main Methods:

• A retrospective analysis of 155 CTO PCIs utilizing the BASE technique across 31 centers (2016-2023).
• Comparison of baseline characteristics and outcomes between BASE technique cases and non-BASE ADR cases.
• Inclusion of angiographic complexity metrics such as J-CTO and PROGRESS-CTO scores.

Main Results:

• The BASE technique was employed in 7.9% of ADR cases, predominantly in older male patients with high prevalence of traditional cardiovascular risk factors.
• Lesions treated with BASE were characterized by longer occlusion length, higher J-CTO and PROGRESS-CTO scores, and more complex angiographic features.
• Technical success (71.6% vs. 75.5%), procedural success (71.6% vs. 72.8%), and MACE (1.3% vs. 4.1%) were similar between BASE and non-BASE ADR groups.

Conclusions:

• The BASE technique is applied to CTOs presenting with longer occlusions, higher complexity scores, and challenging angiographic characteristics.
• The BASE technique demonstrates moderate technical and procedural success rates.
• Utilization of the BASE technique is associated with a low rate of major adverse cardiac events (MACE).