The efficacy of "hybrid" percutaneous coronary intervention in chronic total occlusions caused by in-stent restenosis: Insights from a US multicenter registry

Georgios Christopoulos, Dimitri Karmpaliotis, Khaldoon Alaswad, William L. Lombardi, J. Aaron Grantham, Bavana V. Rangan, Anna P. Kotsia, Nicholas Lembo, David E. Kandzari, James Lee, Anna Kalynych, Harold Carlson, Santiago Garcia, Subhash Banerjee, Craig A. Thompson, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

Abstract

Objectives To examine the success and complication rates in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) caused by in-stent restenosis (ISR). Background PCI for in-stent total occlusive disease has traditionally been associated with low success rates. We sought to examine angiographic and procedural outcomes of patients who underwent CTO PCI due to ISR using the novel "hybrid" algorithm, and compare them with patients with de novo CTOs. Methods We examined 521 consecutive patients who underwent CTO PCI at five high-volume PCI centers in the United States using the "hybrid" approach. Clinical, angiographic, and procedural outcomes were compared between CTOs due to ISR and de novo CTOs. Results The target CTO was due to ISR in 57 of 521 patients (10.9%). Compared to patients with de novo CTOs, those with CTO due to ISR had higher frequency of diabetes (56.1% vs. 39.6%, P = 0.02) and less calcification (5.3% vs. 16.2%, P <0.001), but longer occlusion length [38 (29-55) vs. 30 (20-51), P = 0.04]. Technical success in the ISR and de novo group was 89.4% and 92.5% (P = 0.43), respectively; procedural success was 86.0% and 90.3% (P = 0.31), respectively; and the incidence of major adverse cardiac events was 3.5% and 2.2% (P = 0.63), respectively. Conclusions Use of the "hybrid" approach to CTO PCI was associated with similarly high procedural success and similarly low major complication rates in patients with de novo and ISR CTOs.

Original languageEnglish (US)
Pages (from-to)646-651
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume84
Issue number4
DOIs
StatePublished - Oct 1 2014

Keywords

  • chronic total occlusion
  • in-stent restenosis
  • percutaneous coronary intervention

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