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Guide catheter extension use in chronic total occlusion percutaneous coronary intervention: insights from the
Ahmed Al-Ogaili1, Deniz Mutlu1, Michaella Alexandrou1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Insights
Guide catheter extensions (GCE) use in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) increased significantly. While technical success was similar, GCE use was linked to more complex lesions and a higher incidence of major adverse cardiovascular events (MACE).
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Limited data exists on guide catheter extension (GCE) utilization during percutaneous coronary intervention (PCI) for chronic total occlusions (CTO).
- Understanding GCE trends and outcomes is crucial for optimizing CTO PCI procedures.
Purpose of the Study:
- To analyze the frequency and temporal trends of GCE use in CTO PCI.
- To compare clinical and angiographic characteristics and outcomes between CTO PCI cases with and without GCE use.
Main Methods:
- Retrospective analysis of a large multicenter CTO PCI registry (2012-2023).
- Inclusion of 14,521 CTO PCI cases, with GCE use documented in 4,106 (28%).
- Comparison of lesion complexity, procedural techniques, technical success, and major adverse cardiovascular events (MACE) between GCE and no-GCE groups.
Main Results:
- GCE use increased from 18.8% in 2012 to 29.9% in 2023.
- CTO PCI cases requiring GCEs exhibited more complex lesion characteristics (calcification, tortuosity, ambiguity) and higher J-CTO scores.
- Advanced techniques (retrograde, antegrade dissection and re-entry) were more common with GCE use.
- Technical success rates were similar (86.6% vs 86.8%, P = .816).
- Major adverse cardiovascular events (MACE) (3.8% vs 2.4%, P < .0001) and procedural complications (11.2% vs 8.7%, P < .0001) were significantly higher in the GCE group.
Conclusions:
- Guide catheter extension use in CTO PCI has substantially increased over the past decade.
- CTO PCI cases necessitating GCEs represent a more complex patient subset.
- While not impacting technical success, GCE use is associated with an increased risk of MACE and procedural complications.
Abstract:
There are limited data on the use of guide catheter extensions (GCE) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the frequency and temporal trends of GCE use in a large multicenter CTO-PCI registry and compared the clinical and angiographic characteristics and outcomes of cases with vs without GCE use. A GCE was used in 4106 of 14 521 CTO PCIs (28%) with increasing frequency from 18.8% in 2012 to 29.9% in 2023. The most used GCE size was 6 French (Fr) (45%), followed by 7 Fr (34%), and 8 Fr (21%). CTOs that required GCE use were more likely to have unfavorable lesion characteristics such as moderate-to-severe calcification (59% vs 40%, P less than .0001), moderate-to-severe tortuosity (35% vs 28%, P less than .0001), proximal cap ambiguity (39% vs 33%, P less than .0001), and had higher J-CTO scores (2.78 ± 1.15 vs 2.20 ± 1.27, P less than .0001). Advanced techniques like the retrograde approach (44% vs 24%, P less than .0001) and antegrade dissection and re-entry (28% vs 17%, P less than .0001) were more likely to be used in GCE cases. Technical success (86.6% vs 86.8%, P = .816) was similar between the 2 groups. However, major adverse cardiovascular events (MACE) (3.8% vs 2.4%, P less than .0001) and procedural complications (11.2% vs 8.7%, P less than .0001) were more frequent in the GCE group. In summary, GCE use in CTO PCI significantly increased between 2012 and 2023. Cases that required GCEs were more complex and had similar technical success, but higher incidence of MACE compared with cases that did not require GCEs.
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