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Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous

Evandro M Filho1, Gustavo N Araujo2,3, Guilherme P Machado4

  • 1Santa Casa de Misericórdia de Maceió, Maceió, Brazil.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|March 3, 2024
PubMed

Insights

Guide catheter extensions (GCEs) improve procedural success in chronic total occlusion percutaneous coronary intervention (CTO PCI). While GCEs are used in complex cases, they do not increase adverse outcomes like death or stroke.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Devices

Background:

  • Guide catheter extensions (GCEs) enhance support and facilitate device delivery during percutaneous coronary intervention (PCI).
  • However, concerns exist regarding potential increased risks of complications with aggressive instrumentation using GCEs.

Purpose of the Study:

  • To evaluate the impact of GCEs on procedural success and complication rates in patients undergoing chronic total occlusion (CTO) PCI.
  • To compare outcomes between patients who did and did not receive GCEs during CTO PCI.

Main Methods:

  • Analysis of data from the multicenter LATAM CTO Registry, including 3049 patients from August 2010 to August 2021.
  • Procedural success defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) included death, myocardial infarction, target vessel revascularization, and stroke.
  • Propensity score matching (PSM) was employed to balance baseline characteristics between GCE and non-GCE groups.

Main Results:

  • GCEs were utilized in 14.5% of patients, often in older individuals with more comorbidities and complex coronary anatomy (higher J-CTO score).
  • After PSM, procedural success was significantly higher in the GCE group (87.7%) compared to the non-GCE group (80.5%), p=0.007.
  • Incidence of coronary perforation, bleeding, in-hospital death, and MACCE were similar between the groups post-PSM.

Conclusions:

  • In contemporary CTO PCI, GCE use is associated with improved procedural success.
  • Despite being used in patients with more complex anatomy and comorbidities, GCEs did not lead to a higher incidence of adverse outcomes.
  • GCEs represent a valuable tool for enhancing procedural success in complex CTO PCI without increasing major complications.
Abstract

Keywords:
chronic total occlusioncoronary artery diseaseguide extension catheterpercutaneous coronary intervention

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