Background: Intravascular imaging can facilitate chronic total occlusion (CTO) percutaneous coronary intervention. Methods and Results: We examined the frequency of use and outcomes of intravascular imaging among 619 CTO percutaneous coronary interventions performed between 2012 and 2015 at 7 US centers. Mean age was 65.4±10 years and 85% of the patients were men. Intravascular imaging was used in 38%: intravascular ultrasound in 36%, optical coherence tomography in 3%, and both in 1.45%. Intravascular imaging was used for stent sizing (26.3%), stent optimization (38.0%), and CTO crossing (35.7%, antegrade in 27.9%, and retrograde in 7.8%). Intravascular imaging to facilitate crossing was used more frequently in lesions with proximal cap ambiguity (49% versus 26%, P<0.0001) and with retrograde as compared with antegrade-only cases (67% versus 31%, P<0.0001). Despite higher complexity (Japanese CTO score: 2.86±1.19 versus 2.43±1.19, P=0.001), cases in which imaging was used for crossing had similar technical and procedural success (92.8% versus 89.6%, P=0.302 and 90.1% versus 88.3%, P=0.588, respectively) and similar incidence of major cardiac adverse events (2.7% versus 3.2%, P=0.772). Use of intravascular imaging was associated with longer procedure (192 minutes [interquartile range 130, 255] versus 131 minutes [90, 192], P<0.0001) and fluoroscopy (71 minutes [44, 93] versus 39 minutes [25, 69], P<0.0001) time. Conclusions: Intravascular imaging is frequently performed during CTO percutaneous coronary intervention both for crossing and for stent selection/optimization. Despite its use in more complex lesion subsets, intravascular imaging was associated with similar rates of technical and procedural success for CTO percutaneous coronary intervention.
Bibliographical noteFunding Information:
This was work was supported by Clinical and Translational Science Awards National Institutes of Health Grant UL1-RR024982.
Dr Alaswad receives consulting fees from Terumo and Boston Scientific; and is an uncompensated consultant to Abbott Laboratories. Dr Jaffer is a consultant to Boston Scientific, Siemens, and Merck, receives nonfinancial research support from Abbott Vascular, and research grant from National Institutes of Health (HL-R01-108229). Dr Yeh receives Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Dr Grantham receives speaking fees, consulting, and honoraria from Boston Scientific and Asahi Intecc; and Research grants from Boston Scientific, Asahi Intecc, Abbott Vascular, and Medtronic. Dr Karmpaliotis is a member of the speaker bureau for Abbott Vascular, Medtronic, and Boston Scientific. Dr Kirtane receives Institutional research grants to Columbia University from Boston Scientific, Med-tronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, Glaxo SmithKline, and Eli Lilly. Dr Parikh is a member of the speaker bureau for Abbot Vascular, Medtronic, CSI, BSc; and a member of the advisory boards of Medtronic, Abbott Vascular, and Philips. Dr Ali receives grant support and is a consultant for St Jude Medical and InfraReDx. Dr Lombardi has equity with Bridgepoint Medical. Dr Kandzari receives research/grant support and consulting honoraria from Boston Scientific and Medtronic Cardiovascular, and research/grant support from Abbott. Dr Lembo is a member of the speaker bureau of Medtronic and advisory board for Abbott Vascular and Medtronic. Dr Garcia receives consulting fees from Medtronic. Dr Wyman receives Honoraria/consulting/speaking fees from Boston Scientific, Abbott Vascular, and Asahi. Dr Rangan receives Research grants from InfraReDx, Inc., and The Spectranetics Corporation. Dr Thompson is an employee of Boston Scientific. Dr Banerjee receives research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; has ownership in MDCARE Global (spouse) and intellectual property in HygeiaTel. Dr Brilakis receives consulting/speaker honoraria from Abbott Vascular, Asahi, Cardinal Health, GE Healthcare, Elsevier, and St Jude Medical; and research support from Boston Scientific and InfraRedx. His spouse is an employee of Medtronic. The remaining authors have no disclosures to report.
- Chronic total occlusion
- Intravascular ultrasound
- Optical coherence tomography
- Percutaneous coronary intervention