Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry

Georgios Christopoulos, Dimitri Karmpaliotis, Khaldoon Alaswad, Robert W. Yeh, Farouc A. Jaffer, R. Michael Wyman, William L. Lombardi, Rohan V. Menon, J. Aaron Grantham, David E. Kandzari, Nicholas Lembo, Jeffrey W. Moses, Ajay J. Kirtane, Manish Parikh, Philip Green, Matthew Finn, Santiago Garcia, Anthony Doing, Mitul Patel, John BahadoraniMuhammad Nauman J. Tarar, Georgios E. Christakopoulos, Craig A. Thompson, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

141 Scopus citations


Background A hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) prioritizing and combining all available crossing techniques was developed to optimize procedural efficacy, efficiency, and safety, but there is limited published data on its outcomes. Methods We examined the procedural techniques and outcomes of 1036 consecutive CTO PCIs performed using a hybrid approach between 2012 and 2015 at 11 US centers. Results Mean age was 65 ± 10 years and 86% of the patients were men, with a high prevalence of diabetes mellitus (43%) and prior coronary artery bypass graft surgery (34%). Most target CTOs were located in the right coronary artery (59%), followed by the left anterior descending artery (23%) and the circumflex (19%). Dual injection was used in 71%. Technical success was achieved in 91% and a major procedural complication occurred in 1.7% of cases. The final successful crossing technique was antegrade wire escalation in 46%, antegrade dissection/re-entry in 26%, and retrograde in 28%. The initial crossing strategy was successful in 58% of the lesions, whereas 39% required an additional approach. Overall, antegrade wire escalation was used in 71%, antegrade dissection/re-entry in 36%, and the retrograde approach in 42% of procedures. Median contrast volume, fluoroscopy time, and air kerma radiation dose were 260 (200-360) ml, 44 (27-72) min, and 3.4 (2.0-5.4) Gray, respectively. Conclusion Application of a hybrid approach to CTO crossing resulted in high success and low complication rates across a varied group of operators and hospital practice structures, supporting its expanding use in CTO PCI.

Original languageEnglish (US)
Pages (from-to)222-228
Number of pages7
JournalInternational Journal of Cardiology
StatePublished - Aug 28 2015
Externally publishedYes

Bibliographical note

Funding Information:
Dr. Jaffer: consultant to Boston Scientific, Siemens, and Merck, nonfinancial research support from Abbott Vascular, research grant from National Institutes of Health (HL-R01-108229).

Funding Information:
Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award Number UL1TR001105 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funding Information:
Dr. Grantham: speaking fees, consulting, and honoraria from Boston Scientific, Asahi Intecc. Research grants from Boston Scientific, Asahi Intecc, Abbott Vascular, Medtronic.

Funding Information:
Dr. Yeh: Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute.


  • Chronic total occlusion
  • Outcomes
  • Percutaneous coronary intervention
  • Techniques


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