Approaches to percutaneous coronary intervention of right coronary artery chronic total occlusions: Insights from a multicentre US registry

Aris Karatasakis; Dimitri Karmpaliotis; Khaldoon Alaswad; Farouc A. Jaffer; Robert W. Yeh; Mitul P. Patel; John N. Bahadorani; William L. Lombardi; R. Michael Wyman; J. Aaron Grantham; David E. Kandzari; Nicholas J. Lembo; Anthony H. Doing; Catalin Toma; Jeffrey W. Moses; Ajay J. Kirtane; Ziad Ali; Manish Parikh; Santiago Garcia; Barbara A. Danek; Judit Karacsonyi; Aya Alame; Pratik Kalsaria; Craig Thompson; Subhash Banerjee; Emmanouil S. Brilakis

doi:10.4244/EIJ-D-16-00265

Approaches to percutaneous coronary intervention of right coronary artery chronic total occlusions: Insights from a multicentre US registry

Aris Karatasakis, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul P. Patel, John N. Bahadorani, William L. Lombardi, R. Michael Wyman, J. Aaron Grantham, David E. Kandzari, Nicholas J. Lembo, Anthony H. Doing, Catalin Toma, Jeffrey W. Moses, Ajay J. Kirtane, Ziad Ali, Manish Parikh, Santiago Garcia, Barbara A. DanekJudit Karacsonyi, Aya Alame, Pratik Kalsaria, Craig Thompson, Subhash Banerjee, Emmanouil S. Brilakis

Medicine - Veteran's Administration Medical Center

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Abstract

Aims: The goal of this study was to describe the procedural characteristics, strategy selection and associated technical and efficiency outcomes for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of the right coronary artery (RCA). Methods and results: We examined the clinical and angiographic characteristics of patients who underwent RCA CTO PCI between 2012 and 2015 at 11 centres in the USA. The RCA was the CTO target vessel in 739 of 1,308 CTO PCIs (56%). Overall technical and procedural success rates were 90% and 88%, respectively. A major adverse cardiovascular event (MACE) occurred in 19 patients (2.6%). Technical success was most frequently achieved using antegrade wire escalation (38% of successful procedures) followed by retrograde (36%) and antegrade dissection/re-entry (26%). Technical success was similar between various locations of RCA CTOs (p=0.11). Compared with antegrade-only procedures, utilisation of any retrograde approach was associated with lower technical (85% vs. 95%, p<0.001) and procedural (82% vs. 94%, p<0.001) success and a higher MACE rate (3.8% vs. 1.4%, p=0.037). Conclusions: RCA CTOs represent the majority of CTO target lesions, can be treated with high success and acceptable complication rates, and require frequent use of the retrograde approach and antegrade dissection/re-entry.

Original language	English (US)
Pages (from-to)	e1326-e1335
Journal	EuroIntervention
Volume	12
Issue number	11
DOIs	https://doi.org/10.4244/EIJ-D-16-00265
State	Published - Dec 2016

Bibliographical note

Funding Information:
Research reported in this publication was supported by the Clinical and Translational Science Awards Program of the National Institutes of Health (Bethesda, MD, USA) under grant number UL1-RR024982. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Publisher Copyright:
© Europa Digital & Publishing 2016. All rights reserved.

Keywords

Chronic total occlusion
Complications
Percutaneous coronary intervention
Procedural success
Right coronary artery
Techniques

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Karatasakis, A., Karmpaliotis, D., Alaswad, K., Jaffer, F. A., Yeh, R. W., Patel, M. P., Bahadorani, J. N., Lombardi, W. L., Wyman, R. M., Grantham, J. A., Kandzari, D. E., Lembo, N. J., Doing, A. H., Toma, C., Moses, J. W., Kirtane, A. J., Ali, Z., Parikh, M., Garcia, S., ... Brilakis, E. S. (2016). Approaches to percutaneous coronary intervention of right coronary artery chronic total occlusions: Insights from a multicentre US registry. EuroIntervention, 12(11), e1326-e1335. https://doi.org/10.4244/EIJ-D-16-00265

Karatasakis, A, Karmpaliotis, D, Alaswad, K, Jaffer, FA, Yeh, RW, Patel, MP, Bahadorani, JN, Lombardi, WL, Wyman, RM, Grantham, JA, Kandzari, DE, Lembo, NJ, Doing, AH, Toma, C, Moses, JW, Kirtane, AJ, Ali, Z, Parikh, M, Garcia, S, Danek, BA, Karacsonyi, J, Alame, A, Kalsaria, P, Thompson, C, Banerjee, S & Brilakis, ES 2016, 'Approaches to percutaneous coronary intervention of right coronary artery chronic total occlusions: Insights from a multicentre US registry', EuroIntervention, vol. 12, no. 11, pp. e1326-e1335. https://doi.org/10.4244/EIJ-D-16-00265

@article{e0e3a4ea44644a5fbe7f11935dae5e00,

title = "Approaches to percutaneous coronary intervention of right coronary artery chronic total occlusions: Insights from a multicentre US registry",

abstract = "Aims: The goal of this study was to describe the procedural characteristics, strategy selection and associated technical and efficiency outcomes for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of the right coronary artery (RCA). Methods and results: We examined the clinical and angiographic characteristics of patients who underwent RCA CTO PCI between 2012 and 2015 at 11 centres in the USA. The RCA was the CTO target vessel in 739 of 1,308 CTO PCIs (56%). Overall technical and procedural success rates were 90% and 88%, respectively. A major adverse cardiovascular event (MACE) occurred in 19 patients (2.6%). Technical success was most frequently achieved using antegrade wire escalation (38% of successful procedures) followed by retrograde (36%) and antegrade dissection/re-entry (26%). Technical success was similar between various locations of RCA CTOs (p=0.11). Compared with antegrade-only procedures, utilisation of any retrograde approach was associated with lower technical (85% vs. 95%, p<0.001) and procedural (82% vs. 94%, p<0.001) success and a higher MACE rate (3.8% vs. 1.4%, p=0.037). Conclusions: RCA CTOs represent the majority of CTO target lesions, can be treated with high success and acceptable complication rates, and require frequent use of the retrograde approach and antegrade dissection/re-entry.",

keywords = "Chronic total occlusion, Complications, Percutaneous coronary intervention, Procedural success, Right coronary artery, Techniques",

author = "Aris Karatasakis and Dimitri Karmpaliotis and Khaldoon Alaswad and Jaffer, {Farouc A.} and Yeh, {Robert W.} and Patel, {Mitul P.} and Bahadorani, {John N.} and Lombardi, {William L.} and Wyman, {R. Michael} and Grantham, {J. Aaron} and Kandzari, {David E.} and Lembo, {Nicholas J.} and Doing, {Anthony H.} and Catalin Toma and Moses, {Jeffrey W.} and Kirtane, {Ajay J.} and Ziad Ali and Manish Parikh and Santiago Garcia and Danek, {Barbara A.} and Judit Karacsonyi and Aya Alame and Pratik Kalsaria and Craig Thompson and Subhash Banerjee and Brilakis, {Emmanouil S.}",

note = "Funding Information: Research reported in this publication was supported by the Clinical and Translational Science Awards Program of the National Institutes of Health (Bethesda, MD, USA) under grant number UL1-RR024982. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Publisher Copyright: {\textcopyright} Europa Digital & Publishing 2016. All rights reserved.",

year = "2016",

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doi = "10.4244/EIJ-D-16-00265",

language = "English (US)",

volume = "12",

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T1 - Approaches to percutaneous coronary intervention of right coronary artery chronic total occlusions

T2 - Insights from a multicentre US registry

AU - Karatasakis, Aris

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Jaffer, Farouc A.

AU - Yeh, Robert W.

AU - Patel, Mitul P.

AU - Bahadorani, John N.

AU - Lombardi, William L.

AU - Wyman, R. Michael

AU - Grantham, J. Aaron

AU - Kandzari, David E.

AU - Lembo, Nicholas J.

AU - Doing, Anthony H.

AU - Toma, Catalin

AU - Moses, Jeffrey W.

AU - Kirtane, Ajay J.

AU - Ali, Ziad

AU - Parikh, Manish

AU - Garcia, Santiago

AU - Danek, Barbara A.

AU - Karacsonyi, Judit

AU - Alame, Aya

AU - Kalsaria, Pratik

AU - Thompson, Craig

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

N1 - Funding Information: Research reported in this publication was supported by the Clinical and Translational Science Awards Program of the National Institutes of Health (Bethesda, MD, USA) under grant number UL1-RR024982. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Publisher Copyright: © Europa Digital & Publishing 2016. All rights reserved.

PY - 2016/12

Y1 - 2016/12

N2 - Aims: The goal of this study was to describe the procedural characteristics, strategy selection and associated technical and efficiency outcomes for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of the right coronary artery (RCA). Methods and results: We examined the clinical and angiographic characteristics of patients who underwent RCA CTO PCI between 2012 and 2015 at 11 centres in the USA. The RCA was the CTO target vessel in 739 of 1,308 CTO PCIs (56%). Overall technical and procedural success rates were 90% and 88%, respectively. A major adverse cardiovascular event (MACE) occurred in 19 patients (2.6%). Technical success was most frequently achieved using antegrade wire escalation (38% of successful procedures) followed by retrograde (36%) and antegrade dissection/re-entry (26%). Technical success was similar between various locations of RCA CTOs (p=0.11). Compared with antegrade-only procedures, utilisation of any retrograde approach was associated with lower technical (85% vs. 95%, p<0.001) and procedural (82% vs. 94%, p<0.001) success and a higher MACE rate (3.8% vs. 1.4%, p=0.037). Conclusions: RCA CTOs represent the majority of CTO target lesions, can be treated with high success and acceptable complication rates, and require frequent use of the retrograde approach and antegrade dissection/re-entry.

AB - Aims: The goal of this study was to describe the procedural characteristics, strategy selection and associated technical and efficiency outcomes for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of the right coronary artery (RCA). Methods and results: We examined the clinical and angiographic characteristics of patients who underwent RCA CTO PCI between 2012 and 2015 at 11 centres in the USA. The RCA was the CTO target vessel in 739 of 1,308 CTO PCIs (56%). Overall technical and procedural success rates were 90% and 88%, respectively. A major adverse cardiovascular event (MACE) occurred in 19 patients (2.6%). Technical success was most frequently achieved using antegrade wire escalation (38% of successful procedures) followed by retrograde (36%) and antegrade dissection/re-entry (26%). Technical success was similar between various locations of RCA CTOs (p=0.11). Compared with antegrade-only procedures, utilisation of any retrograde approach was associated with lower technical (85% vs. 95%, p<0.001) and procedural (82% vs. 94%, p<0.001) success and a higher MACE rate (3.8% vs. 1.4%, p=0.037). Conclusions: RCA CTOs represent the majority of CTO target lesions, can be treated with high success and acceptable complication rates, and require frequent use of the retrograde approach and antegrade dissection/re-entry.

KW - Chronic total occlusion

KW - Complications

KW - Percutaneous coronary intervention

KW - Procedural success

KW - Right coronary artery

KW - Techniques

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Approaches to percutaneous coronary intervention of right coronary artery chronic total occlusions: Insights from a multicentre US registry

Abstract

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