Tajti P, et al. - Researchers conducted this study to assess the prevalence, treatment and outcomes of balloon undilatable chronic total occlusions (CTOs). Findings revealed a common occurrence of balloon undilatable CTOs. These were associated with lower success and higher complication rates.

Methods

• In a contemporary multicenter US registry, the prevalence, clinical and angiographic characteristics, and procedural outcomes of percutaneous coronary interventions (PCIs) for balloon undilatable CTOs were examined.

Results

• Between 2012 and 2017, data on balloon undilatable lesions were available for 425 consecutive CTO PCIs in 415 patients.
• Among them guidewire crossing was successful: 52 of 425 CTOs were balloon undilatable (12%).
• Mean patient age was 65 ± 10 years.
• The patients were men (84%) in majority.
• Among patients with balloon undilatable CTOs, more frequent diabetes (67 vs 41%, P < 0.001) and heart failure (44 vs 28%, P=0.027) were observed.
• Findings revealed that balloon undilatable CTOs were longer (40 mm [interquartile range, IQR 20-50] vs 30 [IQR 15-40], P=0.016), more frequently had moderate/severe calcification (87 vs 54%, P < 0.001), and had higher J-CTO score (3.2 ± 1.1 vs 2.5 ± 1.3, P < 0.001) and PROGRESS-CTO complications score (3.9 ± 1.7 vs 3.1 ± 2.0, P < 0.005).
• They were found to be associated with lower technical and procedural success (92 vs 98%, P=0.024; and 88 vs 96%, P=0.034, respectively) and due to higher perforation rates, also had higher risk for in-hospital major adverse events (8 vs 2%, P=0.008).
• High pressure balloon inflations (64%), rotational atherectomy (31%), laser (21%), and cutting balloons (15%) were the most frequent treatments for balloon undilatable CTOs.