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HydroDynamic Recanalization for Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the
Eleni Kladou1, Dimitrios Strepkos1, Michaella Alexandrou1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Insights
HydroDynamic Recanalization (HDR) is a novel technique for coronary chronic total occlusions (CTO). While HDR is used in complex lesions, it shows lower technical success but similar major adverse cardiac events (MACE) compared to standard CTO percutaneous coronary interventions (PCIs).
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Access Techniques
Background:
- HydroDynamic Recanalization (HDR) is an advanced technique for crossing coronary chronic total occlusions (CTOs).
- This method involves intraplaque contrast injection and guidewire advancement within a polymer jacket.
- It represents a novel approach to complex coronary interventions.
Purpose of the Study:
- To compare the technical and procedural outcomes of CTO percutaneous coronary interventions (PCIs) performed with HDR versus without HDR.
- To evaluate the safety profile of HDR in CTO PCI procedures.
- To analyze the success rates and complication profiles associated with HDR utilization.
Main Methods:
- Analysis of baseline clinical and angiographic characteristics from the multicenter PROGRESS-CTO registry.
- Comparison of outcomes between patients treated with HDR and those treated without HDR for CTO PCI.
- Statistical analysis of procedural times, technical success rates, and major adverse cardiac events (MACE).
Main Results:
- HDR was utilized in 5% of CTO PCIs, predominantly in more complex lesions (higher J-CTO and PROGRESS-CTO scores).
- HDR cases exhibited longer procedural, fluoroscopy, and crossing times, with lower technical success rates (80.0% vs. 88.5%).
- Despite increased complexity, HDR was associated with similar rates of MACE compared to non-HDR procedures.
Conclusions:
- HydroDynamic Recanalization (HDR) is applied in a small percentage of complex CTO PCIs.
- The technique is associated with increased procedural complexity and lower technical success.
- HDR demonstrates comparable safety, with similar MACE rates, to conventional CTO PCI methods.
Background:
HydroDynamic Recanalization (HDR) is a novel technique for crossing coronary chronic total occlusions (CTOs) that involves intraplaque contrast injection followed by polymer-jacketed guidewire advancement.
Aim:
The aim of this study is to compare the technical and procedural outcomes, and safety of CTO PCIs performed with HDR versus (vs.) without HDR.
Methods:
We analyzed the baseline clinical and angiographic characteristics and outcomes of HDR-treated patients in the multicenter PROGRESS-CTO registry.
Results:
Of 1807 CTO percutaneous coronary interventions (PCIs) (1797 patients) performed in 2025, HDR was utilized in 90 (5%) cases. HDR patients had similar baseline clinical characteristics with non-HDR patients, although a history of prior PCI was more common among HDR patients (75.3% vs. 60.2%, p = 0.006). HDR-treated patients were less likely to have interventional collaterals (38.2% vs. 55.4%, p = 0.002) but more likely to have in-stent restenosis (35.6% vs. 14.9%, p < 0.001). HDR cases had higher prevalence of blunt/no stump (62.2% vs. 50.1%, p = 0.025), smaller lesion diameter (2.88 ± 0.67 vs. 3.03 ± 0.55, p = 0.011), and less frequently side branch at the proximal cap (43.7% vs. 64.0%, p < 0.001). They had higher J-CTO (2.63 ± 1.10 vs. 2.29 ± 1.14, p = 0.006), PROGRESS-CTO (1.33 ± 1.02 vs. 1.13 ± 0.93, p = 0.048) and PROGRESS-CTO MACE (3.06 ± 1.55 vs. 2.65 ± 1.67, p = 0.014) scores. Antegrade wiring was both the first and the most successful crossing strategy in both groups. HDR cases had significantly longer procedural (131 [107, 174] vs. 109 [74, 151] min, p < 0.001), fluoroscopy (48 [34, 70] vs. 39 [25, 61]) min, p = 0.001), and crossing (39 [22, 86] vs. 25 [11, 56] min, p < 0.001) time compared with non-HDR cases. Technical success was lower in HDR patients (80.0% vs. 88.5%, p = 0.024), while MACE (1.1% vs. 2.6%, p = 0.7) was not different between the two groups.
Conclusions:
HDR was performed in 5% of CTO PCIs in 2025, in more complex lesions and was associated with lower technical success but similar MACE compared with patients who underwent CTO PCI without HDR.
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