Intravascular lithotripsy in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry

Spyridon Kostantinis; Bahadir Simsek; Judit Karacsonyi; Rhian E. Davies; Stewart Benton; William Nicholson; Stephane Rinfret; Wissam A. Jaber; Leah Raj; Pratik B. Sandesara; Khaldoon Alaswad; Mir Babar Basir; Michael Megaly; Jaikirshan J. Khatri; Laura D. Young; Farouc A. Jaffer; Nidal Abi Rafeh; Mitul P. Patel; Jimmy L. Kerrigan; Elias V. Haddad; Phil Dattilo; Yader Sandoval; Daniel R. Schimmel; Abdul M. Sheikh; Ahmed M. ElGuindy; Omer Goktekin; Olga C. Mastrodemos; Bavana V. Rangan; M. Nicholas Burke; Emmanouil S. Brilakis

doi:10.1002/ccd.30354

Intravascular lithotripsy in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry

Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, Rhian E. Davies, Stewart Benton, William Nicholson, Stephane Rinfret, Wissam A. Jaber, Leah Raj, Pratik B. Sandesara, Khaldoon Alaswad, Mir Babar Basir, Michael Megaly, Jaikirshan J. Khatri, Laura D. Young, Farouc A. Jaffer, Nidal Abi Rafeh, Mitul P. Patel, Jimmy L. Kerrigan, Elias V. HaddadPhil Dattilo, Yader Sandoval, Daniel R. Schimmel, Abdul M. Sheikh, Ahmed M. ElGuindy, Omer Goktekin, Olga C. Mastrodemos, Bavana V. Rangan, M. Nicholas Burke, Emmanouil S. Brilakis^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Background: The use of intravascular lithotripsy (IVL) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 82 CTO PCIs that required IVL at 14 centers between 2020 and 2022. Results: During the study period, IVL was used in 82 of 3301 (2.5%) CTO PCI procedures (0.4% in 2020 and 7% in 2022; p for trend < 0.001). Mean patient age was 69 ± 11 years and 79% were men. The prevalence of hypertension (95%), diabetes mellitus (62%), and prior PCI (61%) was high. The most common target vessel was the right coronary artery (54%), followed by the left circumflex (23%). The mean J-CTO and PROGRESS-CTO scores were 2.8 ± 1.1 and 1.3 ± 1.0, respectively. Antegrade wiring was the final successful crossing strategy in 65% and the retrograde approach was used in 22%. IVL was used in 10% of all heavily calcified lesions and 11% of all balloon undilatable lesions. The 3.5 mm lithotripsy balloon was the most commonly used balloon (28%). The mean number of pulses per lithotripsy run was 33 ± 32 and the median duration of lithotripsy was 80 (interquartile range: 40−103) seconds. Technical and procedural success was achieved in 77 (94%) and 74 (90%) cases, respectively. Two (2.4%) Ellis Class 2 perforations occurred after IVL use and were managed conservatively. Conclusion: IVL is increasingly being used in CTO PCI with encouraging outcomes.

Original language	English (US)
Pages (from-to)	512-519
Number of pages	8
Journal	Catheterization and Cardiovascular Interventions
Volume	100
Issue number	4
DOIs	https://doi.org/10.1002/ccd.30354
State	Published - Oct 1 2022

Keywords

calcified lesions
chronic total occlusion
coronary artery disease
coronary calcification
intravascular lithotripsy
percutaneous coronary intervention
stents
undilatable lesions

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Radiology Nuclear Medicine and imaging

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/ccd.30354

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Kostantinis, S., Simsek, B., Karacsonyi, J., Davies, R. E., Benton, S., Nicholson, W., Rinfret, S., Jaber, W. A., Raj, L., Sandesara, P. B., Alaswad, K., Basir, M. B., Megaly, M., Khatri, J. J., Young, L. D., Jaffer, F. A., Abi Rafeh, N., Patel, M. P., Kerrigan, J. L., ... Brilakis, E. S. (2022). Intravascular lithotripsy in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry. Catheterization and Cardiovascular Interventions, 100(4), 512-519. https://doi.org/10.1002/ccd.30354

@article{2c491a91148e43378d34f748e27ac659,

title = "Intravascular lithotripsy in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry",

abstract = "Background: The use of intravascular lithotripsy (IVL) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 82 CTO PCIs that required IVL at 14 centers between 2020 and 2022. Results: During the study period, IVL was used in 82 of 3301 (2.5%) CTO PCI procedures (0.4% in 2020 and 7% in 2022; p for trend < 0.001). Mean patient age was 69 ± 11 years and 79% were men. The prevalence of hypertension (95%), diabetes mellitus (62%), and prior PCI (61%) was high. The most common target vessel was the right coronary artery (54%), followed by the left circumflex (23%). The mean J-CTO and PROGRESS-CTO scores were 2.8 ± 1.1 and 1.3 ± 1.0, respectively. Antegrade wiring was the final successful crossing strategy in 65% and the retrograde approach was used in 22%. IVL was used in 10% of all heavily calcified lesions and 11% of all balloon undilatable lesions. The 3.5 mm lithotripsy balloon was the most commonly used balloon (28%). The mean number of pulses per lithotripsy run was 33 ± 32 and the median duration of lithotripsy was 80 (interquartile range: 40−103) seconds. Technical and procedural success was achieved in 77 (94%) and 74 (90%) cases, respectively. Two (2.4%) Ellis Class 2 perforations occurred after IVL use and were managed conservatively. Conclusion: IVL is increasingly being used in CTO PCI with encouraging outcomes.",

keywords = "calcified lesions, chronic total occlusion, coronary artery disease, coronary calcification, intravascular lithotripsy, percutaneous coronary intervention, stents, undilatable lesions",

author = "Spyridon Kostantinis and Bahadir Simsek and Judit Karacsonyi and Davies, {Rhian E.} and Stewart Benton and William Nicholson and Stephane Rinfret and Jaber, {Wissam A.} and Leah Raj and Sandesara, {Pratik B.} and Khaldoon Alaswad and Basir, {Mir Babar} and Michael Megaly and Khatri, {Jaikirshan J.} and Young, {Laura D.} and Jaffer, {Farouc A.} and {Abi Rafeh}, Nidal and Patel, {Mitul P.} and Kerrigan, {Jimmy L.} and Haddad, {Elias V.} and Phil Dattilo and Yader Sandoval and Schimmel, {Daniel R.} and Sheikh, {Abdul M.} and ElGuindy, {Ahmed M.} and Omer Goktekin and Mastrodemos, {Olga C.} and Rangan, {Bavana V.} and Burke, {M. Nicholas} and Brilakis, {Emmanouil S.}",

note = "Funding Information: The authors are grateful for the philanthropic support of our generous anonymous donors, and the philanthropic support of Drs. Mary Ann and Donald A. Sens, Mrs. Diane and Dr. Cline Hickok, Mrs. Wilma and Mr. Dale Johnson, Mrs. Charlotte and Mr. Jerry Golinvaux Family Fund, the Roehl Family Foundation, and the Joseph Durda Foundation. The generous gifts of these donors to the Minneapolis Heart Institute Foundation's Science Center for Coronary Artery Disease (CCAD) helped support this research project. Publisher Copyright: {\textcopyright} 2022 Wiley Periodicals LLC.",

year = "2022",

month = oct,

day = "1",

doi = "10.1002/ccd.30354",

language = "English (US)",

volume = "100",

pages = "512--519",

journal = "Catheterization and Cardiovascular Interventions",

issn = "1522-1946",

publisher = "Wiley-Liss Inc.",

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Kostantinis, S, Simsek, B, Karacsonyi, J, Davies, RE, Benton, S, Nicholson, W, Rinfret, S, Jaber, WA, Raj, L, Sandesara, PB, Alaswad, K, Basir, MB, Megaly, M, Khatri, JJ, Young, LD, Jaffer, FA, Abi Rafeh, N, Patel, MP, Kerrigan, JL, Haddad, EV, Dattilo, P, Sandoval, Y, Schimmel, DR, Sheikh, AM, ElGuindy, AM, Goktekin, O, Mastrodemos, OC, Rangan, BV, Burke, MN & Brilakis, ES 2022, 'Intravascular lithotripsy in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry', Catheterization and Cardiovascular Interventions, vol. 100, no. 4, pp. 512-519. https://doi.org/10.1002/ccd.30354

TY - JOUR

T1 - Intravascular lithotripsy in chronic total occlusion percutaneous coronary intervention

T2 - Insights from the PROGRESS-CTO registry

AU - Kostantinis, Spyridon

AU - Simsek, Bahadir

AU - Karacsonyi, Judit

AU - Davies, Rhian E.

AU - Benton, Stewart

AU - Nicholson, William

AU - Rinfret, Stephane

AU - Jaber, Wissam A.

AU - Raj, Leah

AU - Sandesara, Pratik B.

AU - Alaswad, Khaldoon

AU - Basir, Mir Babar

AU - Megaly, Michael

AU - Khatri, Jaikirshan J.

AU - Young, Laura D.

AU - Jaffer, Farouc A.

AU - Abi Rafeh, Nidal

AU - Patel, Mitul P.

AU - Kerrigan, Jimmy L.

AU - Haddad, Elias V.

AU - Dattilo, Phil

AU - Sandoval, Yader

AU - Schimmel, Daniel R.

AU - Sheikh, Abdul M.

AU - ElGuindy, Ahmed M.

AU - Goktekin, Omer

AU - Mastrodemos, Olga C.

AU - Rangan, Bavana V.

AU - Burke, M. Nicholas

AU - Brilakis, Emmanouil S.

N1 - Funding Information: The authors are grateful for the philanthropic support of our generous anonymous donors, and the philanthropic support of Drs. Mary Ann and Donald A. Sens, Mrs. Diane and Dr. Cline Hickok, Mrs. Wilma and Mr. Dale Johnson, Mrs. Charlotte and Mr. Jerry Golinvaux Family Fund, the Roehl Family Foundation, and the Joseph Durda Foundation. The generous gifts of these donors to the Minneapolis Heart Institute Foundation's Science Center for Coronary Artery Disease (CCAD) helped support this research project. Publisher Copyright: © 2022 Wiley Periodicals LLC.

PY - 2022/10/1

Y1 - 2022/10/1

N2 - Background: The use of intravascular lithotripsy (IVL) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 82 CTO PCIs that required IVL at 14 centers between 2020 and 2022. Results: During the study period, IVL was used in 82 of 3301 (2.5%) CTO PCI procedures (0.4% in 2020 and 7% in 2022; p for trend < 0.001). Mean patient age was 69 ± 11 years and 79% were men. The prevalence of hypertension (95%), diabetes mellitus (62%), and prior PCI (61%) was high. The most common target vessel was the right coronary artery (54%), followed by the left circumflex (23%). The mean J-CTO and PROGRESS-CTO scores were 2.8 ± 1.1 and 1.3 ± 1.0, respectively. Antegrade wiring was the final successful crossing strategy in 65% and the retrograde approach was used in 22%. IVL was used in 10% of all heavily calcified lesions and 11% of all balloon undilatable lesions. The 3.5 mm lithotripsy balloon was the most commonly used balloon (28%). The mean number of pulses per lithotripsy run was 33 ± 32 and the median duration of lithotripsy was 80 (interquartile range: 40−103) seconds. Technical and procedural success was achieved in 77 (94%) and 74 (90%) cases, respectively. Two (2.4%) Ellis Class 2 perforations occurred after IVL use and were managed conservatively. Conclusion: IVL is increasingly being used in CTO PCI with encouraging outcomes.

AB - Background: The use of intravascular lithotripsy (IVL) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 82 CTO PCIs that required IVL at 14 centers between 2020 and 2022. Results: During the study period, IVL was used in 82 of 3301 (2.5%) CTO PCI procedures (0.4% in 2020 and 7% in 2022; p for trend < 0.001). Mean patient age was 69 ± 11 years and 79% were men. The prevalence of hypertension (95%), diabetes mellitus (62%), and prior PCI (61%) was high. The most common target vessel was the right coronary artery (54%), followed by the left circumflex (23%). The mean J-CTO and PROGRESS-CTO scores were 2.8 ± 1.1 and 1.3 ± 1.0, respectively. Antegrade wiring was the final successful crossing strategy in 65% and the retrograde approach was used in 22%. IVL was used in 10% of all heavily calcified lesions and 11% of all balloon undilatable lesions. The 3.5 mm lithotripsy balloon was the most commonly used balloon (28%). The mean number of pulses per lithotripsy run was 33 ± 32 and the median duration of lithotripsy was 80 (interquartile range: 40−103) seconds. Technical and procedural success was achieved in 77 (94%) and 74 (90%) cases, respectively. Two (2.4%) Ellis Class 2 perforations occurred after IVL use and were managed conservatively. Conclusion: IVL is increasingly being used in CTO PCI with encouraging outcomes.

KW - calcified lesions

KW - chronic total occlusion

KW - coronary artery disease

KW - coronary calcification

KW - intravascular lithotripsy

KW - percutaneous coronary intervention

KW - stents

KW - undilatable lesions

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U2 - 10.1002/ccd.30354

DO - 10.1002/ccd.30354

M3 - Article

C2 - 35916076

AN - SCOPUS:85135205195

SN - 1522-1946

VL - 100

SP - 512

EP - 519

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

IS - 4

ER -

Intravascular lithotripsy in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry

Abstract

Keywords

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UN SDGs

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